【摘要】 背景:采用骨软骨移植系统关节镜下行自体骨软骨移植术,利于骨软骨移植成活并成熟愈合,愈合时间较短,临床功能恢复好而快,是一种安全而短期即见效的临床治疗方法。目的:评价关节镜下自体骨软骨移植技术治疗股骨软骨损伤的远期临床疗效。设计、时间及地点:病例随访分析,于2002-04/2008-12在韩国首尔NOW医院膝关节外科中心和青岛市市立医院(中国海洋大学附属医院)完成。对象:股骨软骨Ⅳ级损伤患者34例,28例获得随访,随访时间12～48个月,男17例,女11例,其中双膝1例,平均年龄43岁。方法:采用骨软骨移植系统在关节镜下行股骨软骨Ⅳ级损伤自体骨软骨移植术。供区骨软骨移植块取自股骨髁间窝上、外侧骨软骨区,骨软骨取出器套筒要完全垂直软骨面和骨面,每个大小为7～9mm(直径)×13～15mm(深度),通过套筒把骨软骨移植块垂直骨洞植入受区-股骨软骨损伤区,使骨软骨移植块完整无间隙镶嵌于骨洞内,软骨面恰好平周围软骨面。主要观察指标:患者Lysholm评分、IKDC评价及MRI检查。结果:Lysholm评分由术前的47.6提高到术后的90.6(P<0.01),24例临床疗效为好与优。IKDS评价有26例患者术后平均5.8个月恢复到受伤前的正常生活或运动水平,1例失败由于术后早期运动所致。术后4个月ICRS评价显示受区软骨完全成熟成活,与周边正常软骨融为一体,供区表面见软骨覆盖,其中央区为正常软骨,周边区为未成熟软骨,再生的软骨与周边软骨发生愈合。12例术后1年复查了MRI,其中11例显示软骨修复良好,受区软骨厚度及MRI信号与周围软骨一样,骨质与周边骨质完全愈合,供区中央区有正常软骨生成,骨洞完全被新生成的骨质填充,其周边是厚度均一的皮质骨,中央区是密度均一的松质骨。结论:关节镜下自体骨软骨移植技术是治疗股骨髁及股骨滑车Ⅳ级软骨损伤一种安全有效的临床治疗方法,供区和受区是否能长期维持正常或接近正常的结构和功能,还需进一步长期的随访和研究。更多还原

【Abstract】 BACKGROUND: Arthroscopic osteochondral autologous transplantation by using an osteochondral autograft transfer system is benefit for survival and mature healing of osteochondral graft with short healing time and good clinic function, which is a safe and high effective therapy. OBJECTIVE: To evaluate the long-term efficacy of arthroscopic osteochondral autologous transplantation for treating femoral cartilage defect. DESIGN, TIME AND SETTING: A follow-up analysis on cases was performed in Knee Joint Surgery Center, Seoul NOW Hospital in Korea and Qingdao Municipal Hospital (Affiliated Hospital of China Ocean University) from April 2002 to December 2008. PARTICIPANTS: A total of 34 patients with femoral cartilage defect of Grade Ⅳ were involved in the experiment. 28 of them obtained 12-48 months follow-up. They were consisted of 7 male and 11 female, with an average age of 43 years. There was one patient with femoral cartilage defects on both knees. METHODS: Arthroscopic osteochondral autologous transplantation were performed by using an osteochondral autograft transfer system for treating femoral cartilage defect of Grade Ⅳ. Osteochondral autografts, 7-9 mm in diameter × 13-15 mm in depth, were harvested from the superior and lateral osteochondral areas of femoral intercondylar notch and inserted into the sockets drilled into the defects with an osteochondral autograf transfer system. MAIN OUTCOME MEASURES: The mean Lysholm score, International Knee Documentation Committee (IKDC) Standard Evaluation Form, and magnetic resonance imaging (MRI) were performed. RESULTS: The mean Lysholm score significantly improved from 47.6 preoperatively to 90.5 postoperatively (P < 0.01). Excellent or good outcome was accomplished in 24 (86%) patients. Using the IKDS assessment, 26 (94%) patients returned to normal live or sports activities as before injury at an average of 5.8 months. But one case was failure because of early exercise after operation. The ICRS Assessment for macroscopic evaluation during arthroscopy at 4 months showed that the cartilages of donor areas were complete mature survival, and fused with normal cartilages nearly. The donor areas were covered with cartilages. The normal cartilages were in the center and immature cartilages were in the peripheral area. Regenerative cartilages fused with peripheral cartilages. MRI evaluation from 12 (43%) patients after 1 year showed that 11 (92%) patients were excellent or good repair. The MRI signals and thickness of the cartilages of the recipient areas were similar with around cartilages. Formations of normal cartilages were in center, and defects were filled with new bones. Cancellous bones were in the center and cortical bones were around. CONCLUSION: Arthroscopic osteochondral autologous transplantation is an effective and safe method for treating femoral condyle defects and femoral trochlea cartilage defects of grade Ⅳ. However, further studies and long-term follow-up are needed to determine if the recipient area and donor area can maintain normal or nearly normal structure and function.更多还原