骨软骨镶嵌移植术与微骨折术治疗膝关节软骨损伤的疗效比较
|
摘要
目的:对比评估微骨折术与自体骨软骨镶嵌移植术治疗膝关节软骨损伤的临床疗效差异。方法 :回顾性分析2011年2月至2016年2月采用微骨折术或自体骨软骨镶嵌移植术治疗且随访时间≥2年的71例膝关节股骨远端关节面软骨损伤患者资料,按手术方式不同分为两组:微骨折组33例,男20例,女13例,年龄(28.1±4.2)岁;移植组38例,男26例,女12例,年龄(27.8±3.5)岁。采用Lysholm评分,美国特种外科医院膝关节评分(Hospital for Special Surgery Knee Score,HSS),Ahlb覿ck骨关节炎分级系统进行评估,并记录术后并发症。结果 :微骨折组与移植组的Lysholm评分,分别由术前62.9±6.8、60.3±7.5提高到术后的77.0±5.4、85.8±5.6 (P<0.05);HSS评分分别由术前81.5±7.6、79.6±8.6改善为88.0±4.7、91.9±4.7(P<0.05)。移植组术后Lysholm评分与HSS评分,均高于微骨折组(P<0.05)。移植组发生切口浅表感染1例。随访未发现患者出现膝关节骨关节炎。结论:自体骨软骨镶嵌移植术与微骨折术治疗膝关节软骨损伤均安全、有效,但自体骨软骨镶嵌移植术比微骨折术临床疗效更佳。
Objective:To compare the clinical outcomes of microfracture and autogenous osteochondral mosaic transplantation in the treatment of knee joint cartilage injury. Methods:A retrospective analysis of 71 patients with articular cartilage defects on the femoral condyles who were by autogenous osteochondral mosaic transplantation or microfracture from February2011 to February 2016,and these patients were followed up for at least 2 years. According to the sugical procedures,the patients were divided into two groups. In the microfracture group,there were 33 patients,20 males and 13 females,with a mean age of(28.1±4.2) years old;in the mosaicplasty group,there were 38 patients,26 males and 12 females,with a mean age of(27.8±3.5) years old. The Lysholm knee score,Hospital for Special Surgery(HSS) knee score and the Ahlb?ck classification grade were recorded to evaluate the clinical efficacy. Complications were also recorded. Results:The mean Lysholm scores of the microfracture group and the mosaicplasty group improved from 62.9 ±6.8 and 60.3 ±7.5 preoperatively to 77.0 ±5.4 and85.8±5.6 post operatively,respectively(P<0.05). Mean HSS scores of the microfracture group and the mosaicplasty group improved from 81.5±7.6 and 79.6±8.6 preoperatively to 88.0±4.7 and 91.9±4.7 post operatively,respectively(P<0.05). The mean Lysholm score and HSS score were significantly higher in the mosaicplasty group than those in the microfracture group at the latest follow up. One patient in the mosaicplasty group suffered superficial wound infection. During the follow up,no knee osteoarthritis was observed in two groups. Conclusion:Autogenous osteochondral mosaicplasty and microfracture are proved to be safe and effective procedures for knee articular cartilage defects. However,the mosaicplasty has better clinical outcome than the microfracture.
Objective:To compare the clinical outcomes of microfracture and autogenous osteochondral mosaic transplantation in the treatment of knee joint cartilage injury. Methods:A retrospective analysis of 71 patients with articular cartilage defects on the femoral condyles who were by autogenous osteochondral mosaic transplantation or microfracture from February2011 to February 2016,and these patients were followed up for at least 2 years. According to the sugical procedures,the patients were divided into two groups. In the microfracture group,there were 33 patients,20 males and 13 females,with a mean age of(28.1±4.2) years old;in the mosaicplasty group,there were 38 patients,26 males and 12 females,with a mean age of(27.8±3.5) years old. The Lysholm knee score,Hospital for Special Surgery(HSS) knee score and the Ahlb?ck classification grade were recorded to evaluate the clinical efficacy. Complications were also recorded. Results:The mean Lysholm scores of the microfracture group and the mosaicplasty group improved from 62.9 ±6.8 and 60.3 ±7.5 preoperatively to 77.0 ±5.4 and85.8±5.6 post operatively,respectively(P<0.05). Mean HSS scores of the microfracture group and the mosaicplasty group improved from 81.5±7.6 and 79.6±8.6 preoperatively to 88.0±4.7 and 91.9±4.7 post operatively,respectively(P<0.05). The mean Lysholm score and HSS score were significantly higher in the mosaicplasty group than those in the microfracture group at the latest follow up. One patient in the mosaicplasty group suffered superficial wound infection. During the follow up,no knee osteoarthritis was observed in two groups. Conclusion:Autogenous osteochondral mosaicplasty and microfracture are proved to be safe and effective procedures for knee articular cartilage defects. However,the mosaicplasty has better clinical outcome than the microfracture.
引文
[1]Widuchowski W,Widuchowski J,Trzaska T.Articular cartilage defects:study of 25,124 knee arthroscopies[J].Knee,2007,14(3):177-182.
[2]Pánics G,Hangody LR,BalóE,et al.Osteochondral autograft and mosaicplasty in the football(soccer)athlete[J].Cartilage,2012,3(1 Suppl):25S-30S.
[3]Ulstein S,魡r覬en A,R覬tterud JH,et al.Microfracture technique versus osteochondral autologous transplantation mosaicplasty in patients with articular chondral lesions of the knee:a prospective randomized trial with long term follow up[J].Knee Surg Sports Traumatol Arthrosc,2014,22(6):1207-1215.
[4]辛龙,张春,徐卫星,等.膝关节软骨损伤的外科治疗进展[J].中国骨伤,2018,31(3):281-285.XI L,ZHANG C,XU WX,et al.Current advances on surgical treatment for knee articular cartilage injuries[J].Zhongguo Gu Shang/China J Orthop Trauma,2018,31(3):281-285.Chinese with abstract in English.
[5]王连,侯鹏,蒋涛,等.不同来源间充质干细胞在膝关节软骨修复中的临床研究进展[J].中国骨伤,2017,30(6):581-586.WANG L,HOU P,JIANG T,et al.Different sources of mesenchymal stem cells for the treatment of cartilage repair in knee joint[J].Zhongguo Gu Shang/China J Orthop Trauma,2017,30(6):581-586.Chinese with abstract in English.
[6]石仕元,应小樟,胡德新,等.含自体富集骨髓干细胞松质骨移植与自体松质骨镶嵌移植修复关节软骨缺损的对比研究[J].中国骨伤,2011,24(4):332-335.SHI SY,YING XZ,HU DX,et al.Experiment on articular cartilage defect repaired with autologous cancellous bone or cancellous bone enriching bone marrow stem cell[J].Zhongguo Gu Shang/China JOrthop Trauma,2011,24(4):332-335.Chinese with abstract in English.
[7]Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of scoring scale[J].Am J Sports Med,1982,10(3):150-154.
[8]Insall JN,Dorr LD,Scott RD,et al.Rationale of the Knee Society clinical rating system[J].Clin Orhop Relat Res,1989,(248):13-14.
[9]Chalmers PN,Vigneswaran H,Harris JD,et al.Activity related outcomes of articular cartilage surgery:a systematic review[J].Cartilage,2013,4(3):193-203.
[10]Bowland P,Ingham E,Fisher J,et al.Simple geometry tribological study of osteochondral graft implantation in the knee[J].Proc Inst Mech Eng H,2018,232(3):249-256.
[11]Devitt BM,Bell SW,Webster KE,et al.Surgical treatments of cartilage defects of the knee:systematic review of randomised controlled trials[J].Knee,2017,24(3):508-517.
[12]Miller DJ,Smith MV,Matava MJ,et al.Microfracture and osteochondral autograft transplantation are cost effective treatments for articular cartilage lesions of the distal femur[J].Am J Sports Med,2015,43:2175-2181.
[13]Pareek A,Reardon PJ,Macalena JA,et al.Osteochondral autograft transfer versus microfracture in the knee:a meta analysis of16 prospective comparative studies at midterm[J].Arthroscopy,2016,32:2118-2130.
[14]Solheim E,Hegna J,Inderhaug E.Long term clinical follow up of microfracture versus mosaicplasty in articular cartilage defects of medial femoral condyle[J].Knee,2017,24(6):1402-1407.
[15]Solheim E,Hegna J,Strand T,et al.Randomized study of long term(15-17 years)outcome after microfracture versus mosaicplasty in knee articular cartilage defects[J].Am J Sports Med,2018,46(4):826-831.
[16]Mundi R,Bedi A,Chow L,et al.Cartilage restoration of the knee:a systematic review and meta analysis of level 1 studies[J].Am JSports Med,2016,44:1888-1895.
[17]Chawla A,Twycross Lewis R,Maffulli N.Microfracture produces inferior outcomes to other cartilage repair techniques in chondral injuries in the paediatric knee[J].Br Med Bull,2015,116:93-103.
[18]Chadli L,Steltzlen C,Toanen C,et al.Hybrid fixation in adult osteochondritis dissecans of the knee[J].Orthop Traumatol Surg Res,2018,104(2):223-225.
[19]Gaweda K,Walawski J,Wegfowski R,et al.Treatment outcome after one stage reconstruction of the anterior cruciate ligament and mosaicplasty of the articular cartilage of the knee[J].Ortop Traumatol Rehabil,2005,7(1):66-71.
[2]Pánics G,Hangody LR,BalóE,et al.Osteochondral autograft and mosaicplasty in the football(soccer)athlete[J].Cartilage,2012,3(1 Suppl):25S-30S.
[3]Ulstein S,魡r覬en A,R覬tterud JH,et al.Microfracture technique versus osteochondral autologous transplantation mosaicplasty in patients with articular chondral lesions of the knee:a prospective randomized trial with long term follow up[J].Knee Surg Sports Traumatol Arthrosc,2014,22(6):1207-1215.
[4]辛龙,张春,徐卫星,等.膝关节软骨损伤的外科治疗进展[J].中国骨伤,2018,31(3):281-285.XI L,ZHANG C,XU WX,et al.Current advances on surgical treatment for knee articular cartilage injuries[J].Zhongguo Gu Shang/China J Orthop Trauma,2018,31(3):281-285.Chinese with abstract in English.
[5]王连,侯鹏,蒋涛,等.不同来源间充质干细胞在膝关节软骨修复中的临床研究进展[J].中国骨伤,2017,30(6):581-586.WANG L,HOU P,JIANG T,et al.Different sources of mesenchymal stem cells for the treatment of cartilage repair in knee joint[J].Zhongguo Gu Shang/China J Orthop Trauma,2017,30(6):581-586.Chinese with abstract in English.
[6]石仕元,应小樟,胡德新,等.含自体富集骨髓干细胞松质骨移植与自体松质骨镶嵌移植修复关节软骨缺损的对比研究[J].中国骨伤,2011,24(4):332-335.SHI SY,YING XZ,HU DX,et al.Experiment on articular cartilage defect repaired with autologous cancellous bone or cancellous bone enriching bone marrow stem cell[J].Zhongguo Gu Shang/China JOrthop Trauma,2011,24(4):332-335.Chinese with abstract in English.
[7]Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of scoring scale[J].Am J Sports Med,1982,10(3):150-154.
[8]Insall JN,Dorr LD,Scott RD,et al.Rationale of the Knee Society clinical rating system[J].Clin Orhop Relat Res,1989,(248):13-14.
[9]Chalmers PN,Vigneswaran H,Harris JD,et al.Activity related outcomes of articular cartilage surgery:a systematic review[J].Cartilage,2013,4(3):193-203.
[10]Bowland P,Ingham E,Fisher J,et al.Simple geometry tribological study of osteochondral graft implantation in the knee[J].Proc Inst Mech Eng H,2018,232(3):249-256.
[11]Devitt BM,Bell SW,Webster KE,et al.Surgical treatments of cartilage defects of the knee:systematic review of randomised controlled trials[J].Knee,2017,24(3):508-517.
[12]Miller DJ,Smith MV,Matava MJ,et al.Microfracture and osteochondral autograft transplantation are cost effective treatments for articular cartilage lesions of the distal femur[J].Am J Sports Med,2015,43:2175-2181.
[13]Pareek A,Reardon PJ,Macalena JA,et al.Osteochondral autograft transfer versus microfracture in the knee:a meta analysis of16 prospective comparative studies at midterm[J].Arthroscopy,2016,32:2118-2130.
[14]Solheim E,Hegna J,Inderhaug E.Long term clinical follow up of microfracture versus mosaicplasty in articular cartilage defects of medial femoral condyle[J].Knee,2017,24(6):1402-1407.
[15]Solheim E,Hegna J,Strand T,et al.Randomized study of long term(15-17 years)outcome after microfracture versus mosaicplasty in knee articular cartilage defects[J].Am J Sports Med,2018,46(4):826-831.
[16]Mundi R,Bedi A,Chow L,et al.Cartilage restoration of the knee:a systematic review and meta analysis of level 1 studies[J].Am JSports Med,2016,44:1888-1895.
[17]Chawla A,Twycross Lewis R,Maffulli N.Microfracture produces inferior outcomes to other cartilage repair techniques in chondral injuries in the paediatric knee[J].Br Med Bull,2015,116:93-103.
[18]Chadli L,Steltzlen C,Toanen C,et al.Hybrid fixation in adult osteochondritis dissecans of the knee[J].Orthop Traumatol Surg Res,2018,104(2):223-225.
[19]Gaweda K,Walawski J,Wegfowski R,et al.Treatment outcome after one stage reconstruction of the anterior cruciate ligament and mosaicplasty of the articular cartilage of the knee[J].Ortop Traumatol Rehabil,2005,7(1):66-71.