关节镜下自体骨软骨移植修复股骨关节面软骨缺损

目的探讨关节镜下自体骨软骨镶嵌式移植术治疗股骨负重面关节软骨缺损的可行性。方法2001年6月起,共17例股骨关节面软骨缺损患者,男12例,女5例;年龄18～45岁,平均29岁;左膝10例,右膝7例。按照Brittberg-Peterson功能评定标准,膝关节的功能为65～105分,平均(80.65±9.69)分。3例无明显外伤史,但有风湿病史;14例有外伤史,均有膝关节疼痛,大腿肌肉萎缩。3例伴绞锁,2例伴弹响。14例外伤患者为股骨外髁负重面局灶性软骨损伤,均为单个创面,损伤范围2.5～3.0cm2;3例无外伤患者为股骨内髁负重面局灶性软骨软化或软骨剥脱,损伤范围2.0～2.5cm2。采用镶嵌式骨软骨移植器,在关节镜下取膝关节非负重关节面骨软骨条,将之移植修复膝关节负重面的局灶性软骨缺损。结果术后随访10～20个月,平均15个月,患者临床症状消失,关节活动度正常。术后Brit-tberg-Peterson评分,14例为0分,3例因活动时轻微疼痛分别评为3分和2分。MRI显示软骨缺损区软骨表面平整,移植的骨软骨柱位置良好。结论自体骨软骨镶嵌式移植术对关节负重面局灶性软骨缺损有较好、确切的治疗效果。     

关节镜下自体骨软骨移植修复软骨缺损

目的探讨在关节镜监视下,非负重区自体骨软骨移植修复负重区软骨缺损的可行性、效果及并发症。方法2000年8月～2003年8月,对25例软骨缺损患者采用镶嵌式骨软骨移植技术,在关节镜下行相同关节内非负重区自体骨软骨移植修复软骨缺损,作为移植组,定期随访,观察患者症状缓解及软骨愈合情况。同时回顾性分析25例剥脱性骨软骨炎患者,行局部刨削、钻孔减压后症状缓解情况及软骨缺损自行修复情况,作为对照组。两组患者术前Brittberg-Peterson功能评分分别为98.65±9.87、96.98±8.94分。术后1年行膝关节MRI检查评价疗效。结果术后获随访3～24个月。移植组患者膝关节活动良好,疼痛基本消失,术后1年复查MRI示原软骨缺损区软骨表面光滑,移植物位置良好;术后2周Brittberg-Peterson功能评分,其中22例评分为0分,3例因活动后轻微疼痛评分为4分;术后3个月,24例评分为0分,1例评分为3分。对照组术后2周Brittberg-Peterson功能评分为24.63±10.51分,同时诉感觉良好;术后3个月,评分为58.48±6.98分。各组手术前后及组间Brittberg-Peterson功能评分差异均有统计学意义(P<0.01)。结论关节镜下自体骨软骨移植术后效果良好,创伤小,且能避免异体移植产生的排斥反应及疾病传播,是修复软骨缺损的较好方式。但长期疗效仍需进一步探讨。传统的关节内刨削、钻孔减压,对缓解症状也有一定效果。     

关节镜下自体骨软骨移植治疗膝关节软骨缺损

目的探讨关节镜下自体骨软骨移植术修复治疗膝关节软骨缺损的疗效。方法关节镜下采用自体骨软骨镶嵌式移植技术治疗22例股骨髁负重区软骨缺损,从非负重区取出骨软骨柱移植到负重区缺损处,术后膝关节支具保护、功能锻炼。结果本组22例均获得随访12-30个月,平均21个月。术后2例活动后关节轻微疼痛,2例关节积血,1例关节活动剧烈后肿胀,经对症处理后症状缓解。术后复查膝关节MRI提示受区软骨移植物位置良好,无脱落,软骨表面光滑平整。末次随访时膝关节功能Lysholm评分（86.46±10.31）分,较术前（53.62±9.58）分明显提高,差异有统计学意义（t=19.72,P〈0.001）。结论关节镜下自体骨软骨移植术后效果良好,并发症少,是修复软骨缺损的一种可靠方式。     

自体骨软骨镶嵌移植术修复关节软骨缺损

目的：回顾性分析关节镜下自体骨软骨镶嵌式移植术治疗负重面关节软骨损伤的可行性。方法：采用Smith Nephew镶嵌式骨软骨移植器，在关节镜下挖取膝关节非负重关节面骨软骨条，并将之移检修复膝关节负重面的局灶性软骨缺损。结果：手术15例，术后随访7—12个月，平均9个月，均达到优良效果。结论：自体关节骨软骨镶嵌移植术对关节负重面局灶性软骨缺损有较好、确实的治疗效果。     

自体骨软骨移植联合富血小板血浆技术治疗膝关节软骨缺损初步随访结果

目的探讨自体骨软骨移植联合富血小板血浆技术治疗膝关节内软骨缺损的安全性及临床效果。方法回顾性分析自2016-01—2016-12采用自体骨软骨移植联合富血小板血浆技术治疗的12例股骨髁软骨缺损,10例软骨缺损位于内侧髁负重区,2例软骨缺损位于外侧髁负重区,软骨缺损面积为1.0~3.5 cm2。比较术前及术后3、6个月时膝关节功能Lysholm评分。结果 12例均获得随访,随访时间平均9(6~13)个月。术后6个月时所有患者MRI显示骨软骨条与周围骨愈合,缺损区表面有符合关节面曲度的软骨样组织覆盖。术前膝关节功能Lysholm评分(55.1±9.2)分,术后3个月为(89.8±7.1)分,术后6个月为(95.2±8.7)分;术后3个月、6个月Lysholm评分明显高于术前,差异有统计学意义(P0.05);但术后3个月与6个月Lysholm评分差异无统计学意义(P0.05)。结论对于膝关节负重区小面积的软骨缺损,自体骨软骨移植联合富血小板血浆技术是安全有效的治疗方法之一。     

慢速梯度降温冷冻保存同种异体骨软骨移植治疗膝关节全层软骨缺损(附三例报告)

目的总结冷冻保存同种异体骨软骨移植物治疗3例膝关节全层骨软骨缺损的手术方法及疗效。方法应用梯度降温冷冻保存的6枚同种异体骨软骨移植物治疗3例膝关节全层骨软骨缺损,2例在关节镜下同种异体骨软骨移植,1例行关节切开移植。膝关节股骨髁关节软骨全层缺损平均面积2.16 cm2。所有患者在手术后第1个月、第3个月时进行膝关节MRI检查,了解移植物与周围骨软骨组织的愈合情况。并于门诊复查时进行Brittberg-Peterson膝关节功能评分,了解功能恢复情况。结果随访4～6个月,平均4.7个月。所有患者术后疼痛消失;无排异反应发生。术后3个月时,MRI检查示术后移植物与宿主软骨下骨整合良好,移植软骨组织结构与内部信号良好。Brittberg-Peterson评分术后6个月比手术前明显降低。结论经梯度降温冷冻保存的同种异体骨软骨移植治疗膝关节软骨缺损早期效果满意。     

自体软骨细胞移植治疗膝关节软骨缺损患者的护理

目的总结纤维蛋白凝胶型自体软骨细胞移植(G-ACI)修复膝关节软骨缺损患者的护理方法。方法 2例膝关节软骨损伤患者,分2次接受手术:第1次均在硬膜外麻醉下行膝关节镜软骨组织取出术,送实验室进行分离培养;1个月后接受第2次手术,分别为纤维蛋白凝胶型自体软骨细胞移植(G-ACI)手术和全镜下G-ACI手术。2例患者术前完善各项评估和检查,做好软骨取出术后护理及自体软骨细胞移植后护理,配合正确而有效的康复训练,并做好并发症预防及护理。结果 2例顺利完成手术,移植术后6周均能扶拐下地,负重1/2体质量,术后10周例1能够完全负重、例2可以3/4负重,术后9个月2例患者均能跑步和骑自行车;移植术后1年可上下楼梯、长途行走,生活质量明显改善。结论术后康复训练是保证自体软骨细胞移植治疗效果的关键因素,给予软骨取出部位及移植后患肢护理,规范的康复训练指导,有利于促进患者康复。自体软骨细胞移植术康复周期长,个体化的、精确的、规范的康复训练计划的实施可有效提高患者治疗效果。     

自体骨软骨移植治疗股骨髁关节软骨缺损

目的探讨关节镜下自体骨软骨移植治疗关节软骨缺损的可行性。方法16例膝关节软骨缺损患者，关节镜下在其非负重区的软骨面上用专用器械凿取圆柱状骨软骨，移植至软骨缺损部位以修复缺损。术后行系统功能锻炼和MRI检查。结果随访7～20个月，患者关节症状消失，关节活动度正常，MRI显示原关节软骨缺损区表面平整，移植骨软骨位置良好。Brittberg-Peterson评分：13例0分，2例2分，1例1分。结论关节镜下自体镶嵌式骨软骨移植术创伤小，操作简单，能保持关节面曲度，可用于修复关节软骨缺损。     

自体软骨细胞移植的临床应用与研究

 目的探讨和研究自体软骨细胞移植技术治疗膝关节软骨缺损的临床效果和临床应用 的可行性。方法 2007年 11月至 2009年 6月, 共 6例膝关节软骨损伤患者。男 2例, 女 4例;年龄 19~ 55岁, 平均 39.5岁;均为膝关节股骨髁关节面软骨缺损, 缺损面积为 3.8~11.6 cm2, 平均 7.3 cm2。利用自 体软骨细胞移植术进行治疗: 关节镜下在膝关节股骨髁间非负重区获取软骨组织 0.2g, 送临床细胞培 养室进行软骨细胞的培养和体外扩增 2~3周;第二次手术, 利用骨膜缝合覆盖, 生物蛋白胶封闭, 将扩 增的软骨细胞悬浮液移植至软骨缺损区;术后进行严格的康复训练。术后定期进行随访, 术前及术后 6、12个月进行 Lysholm主观评分、国际膝关节文献委员会(International Knee Documentation Committee, IKDC)客观等级评定和膝关节 MRI扫描。结果 6例患者均获得随访。术前 Lysholm评分(63.0±8.1)分, 术后 6和 12个月分别为(83.7±10.6)分和(86.3±10.3)分, 获得明显改善;术前 IKDC等级均为 C或 D 级, 术后等级逐步获得改善。术后 6个月和 12个月 MR检查显示所有病例软骨缺损区基本得到修复, 无一例出现术后感染等严重并发症。一例患者由于未能按指导完成康复锻炼, 术后患侧关节疼痛症状 虽有缓解, 但出现粘连, 活动度部分丢失。结论 自体软骨细胞移植治疗膝关节软骨缺损初步疗效基本 满意;术前需严格控制适应证, 术后需高度重视康复锻炼, 以保证手术疗效。     

关节镜下微骨折术修复膝关节软骨缺损

目的探讨关节镜下微骨折术修复膝关节软骨缺损的效果。方法关节镜下微骨折术治疗膝关节股骨髁软骨缺损62例,其中股骨内髁软骨缺损34例,外髁软骨缺损28例,均为病状孤立、全层软骨损伤、关节稳定且有相应症状的患者。结果随访6个月～7年,按HSS评分评级:优良42例,可16例,差4例,术前和术后HSS评分比较,有显著增加(t=52.43,P<0.01)。结论关节镜下微骨折术修复膝关节软骨缺损在低年龄(45岁以下),低体重(体重指数低)患者中疗放显著,而对高龄肥胖患者疗效不佳。     

自体骨软骨移植治疗膝关节软骨缺损的长期随访

目的:探讨自体骨软骨移植治疗膝关节局限性软骨缺损的临床疗效。方法:选取2007年1月至2008年1月行自体骨软骨移植治疗膝关节软骨缺损的患者15例,其中男7例,女8例;年龄23～45岁。比较术前与术后10年KSS评分。结果:本组15例患者获得随访,时间10.0～10.7(10.2±0.3)年。KSS评分临床总分由术前的38.86±4.09上升至术后10年的85.07±2.19,功能评分由术前的3.33±4.88上升至术后10年的82.67±4.58,KSS总分由术前的42.20±7.84提高至术后10年的167.73±6.29(P0.05);而膝关节稳定性比较差异无统计学意义(P0.05)。所有随访患者并未出现其他并发症。结论:通过对自体骨软骨移植治疗膝关节软骨缺损患者的长期随访后发现,该治疗方式能够有效改善膝关节功能,减轻膝关节疼痛,是一种有效的修复膝关节软骨缺损的方法。     

Osteochondral autologous transplantation in various joints

A chondral/osteochondral defect involving the articular surface of a joint is still a therapeutic problem. The goal of articular cartilage repair is restoration of cartilage congruity, accomplishing full painfree range of motion and elimination of cartilage detoriation. The use of autologous grafts was first reported by Wagner 1964. Now the use of cylindrical autograft plugs was described by Bobic 1996 and Hangody 1996. Operative management and early results of osteochondral cylindrical autograft plugs in the femoral condyle, patella, elbow and talar dome are presented. The arthroscopic/open use of autologous osteochondral grafts from the knee is indicated in osteochondral lesions in diameter from 1 to 3 cm, which can not be primarily refixed and in osteonecrosis at femoral condyle, patella, elbow, talar dome as well as shoulder.     

关节镜下微骨折术联合自体骨软骨移植治疗膝关节股骨髁大面积软骨损伤

目的探讨关节镜下微骨折术联合自体骨软骨移植(osteochondral autologous transplantation,OAT)治疗膝关节股骨髁大面积(4~6 cm^2)软骨损伤的疗效。方法2016年3月-2017年6月,采用关节镜下微骨折术联合OAT治疗22例膝关节股骨髁大面积软骨损伤患者。其中男16例,女6例;年龄22~60岁,平均38.6岁。致伤原因:交通事故伤8例,运动损伤14例。病程1~6个月,平均3.4个月。股骨内侧髁损伤15例,外侧髁损伤7例;软骨损伤面积4~6 cm^2,平均4.98 cm^2。软骨损伤国际软骨修复协会(ICRS)分级:Ⅲ级9例,Ⅳ级13例。伴半月板损伤18例。术前疼痛视觉模拟评分(VAS)为(6.36±1.25)分,Lysholm评分为(36.00±7.77)分。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间2~3年,平均2.3年。术后2年时VAS评分为(1.27±0.94)分,Lysholm评分为(77.82±6.21)分,均较术前明显改善(t=16.595,P=0.000;t=21.895,P=0.000)。术后2年,MRI显示软骨缺损区修复良好。结论关节镜下微骨折术联合OAT治疗膝关节股骨髁大面积软骨损伤早期疗效较好。     

Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective,comparative trial

BACKGROUND: Current methods used to restore the joint surface in patients with localized articular cartilage defects include transplantation of an autologous osteochondral cylinder and implantation of autologous chondrocytes. The purpose of this study was to evaluate the clinical and histological outcomes of these two techniques. METHODS: We performed a prospective clinical study to investigate the two-year outcomes in forty patients with an articular cartilage lesion of the femoral condyle who had been randomly treated with either transplantation of an autologous osteochondral cylinder or implantation of autologous chondrocytes. Biopsy specimens from representative patients of both groups were evaluated with histological staining, immunohistochemistry, and scanning electron microscopy. RESULTS: According to the postoperative Lysholm score, the recovery after autologous chondrocyte implantation was slower than that after osteochondral transplantation at six months (p < or = 0.015), twelve months (p < or = 0.001), and twenty-four months (p < or = 0.012). On the basis of the Meyers score and the Tegner activity score, the results were equally good with the two methods two years after treatment. Histomorphological evaluation of biopsy specimens within two years after autologous chondrocyte implantation demonstrated a complete, mechanically stable resurfacing of the defect in all patients. The tissue consisted mainly of fibrocartilage, while localized areas of hyaline-like regenerative cartilage could be detected close to the subchondral bone. Although a gap remained at the site of the transplantation in all five biopsy specimens examined as long as two years after osteochondral cylinder transplantation, histomorphological analysis and scanning electron microscopy revealed no differences between the osteochondral transplants and the surrounding original cartilage. CONCLUSIONS: Both treatments resulted in a decrease in symptoms. However, the improvement provided by the autologous chondrocyte implantation lagged behind that provided by the osteochondral cylinder transplantation. Histologically, the defects treated with autologous chondrocyte implantation were primarily filled with fibrocartilage, whereas the osteochondral cylinder transplants retained their hyaline character, although there was a persistent interface between the transplant and the surrounding original cartilage. Limitations of our study included the small number of patients, the relatively short (two-year) follow-up, and the absence of a control group.     

兔自体松质骨颗粒修复关节软骨损伤

目的研究兔自体松质骨颗粒在膝关节软骨损伤处移植后能够诱导软骨组织生成、促进关节软骨损伤修复的现象。方法 12只新西兰大白兔麻醉后在兔的右侧膝关节股骨远端内、外侧髁负重区用电钻分别造成直径、深度均为3 mm的骨软骨缺损创面,取同侧髂骨松质骨,制成直径约为1 mm松质骨颗粒植入股骨内侧髁软骨缺损处,作为实验组,外侧髁软骨缺损不做处理作为对照组。术后12周进行膝关节大体观察、病理切片染色,评估关节软骨损伤的修复情况。结果兔膝关节实验组软骨缺损处被新生软骨填充,软骨面光滑,组织切片染色显示有关节软骨形成。对照组缺损创面仍然凹陷,仅在缺损边缘有少量软骨生长。结论兔自体松质骨颗粒在膝关节软骨损伤处能够诱导软骨生成,促进关节软骨的修复,是一种良好的关节软骨损伤修复方法。     

Osteochondral autografts transfer for post-traumatic osteochondral defect of the knee-2 to 5 years follow-up

The treatment of post-traumatic osteochondral defects of the weight-bearing surface of the knee in young active patients remains a significant challenge. We report the results of an osteochondral autograft transfer (OAT) in 18 patients (mean age 29 years) with post-traumatic focal osteochondral defects of the knee. Sixteen lesions were over the femoral condyle and two were over the tibial plateau. The average size of the lesion was 4.1 cm² (from 2.25 to 6 cm²), and the subchondral bone involved no more than 1 cm in depth. Osteochondral grafts were harvested from the non-weight-bearing area of the femoral condyle. Ten patients also had concomitant surgical procedures. The average follow-up was 42 months (from 24 to 64 months). All patients were evaluated by Lysholm and Tegner activity scores and plain radiographs. Nine patients had MRI, eight patients had second-look arthroscopy and two had a biopsy. Sixteen patients (89%) had good to excellent results, while two patients with lesion over the tibial surface had fair results. The biopsy revealed survival of hyaline cartilage. For small to medium osteochondral lesion over the femoral condyle of the knee in selected patients, osteochondral autografting yielded promising short to mid-term results.     

Arthroscopic osteochondral autograft transplantation for chondral lesion of the tibial plateau of the knee

Arthroscopic osteochondral autograft transplantation is often used to treat chondral/osteochondral lesions of the femoral condyle of the knee. However, arthroscopic autologous osteochondral grafting to the tibial plateau has not been reported. We report the surgical technique and the clinical course of a patient who underwent engraftment by this method. A 26-year-old man developed symptoms of pain and catching in his knee. Arthroscopy revealed a deep chondral lesion, 10 × 15 mm in size, down to the subchondral bone on the posterocentral area of the lateral tibial plateau. The injured cartilage was debrided using a curette and an abrader until normal healthy cartilage bordered the debrided defect. An osteochondral plug, 10 mm in diameter and 20 mm long, the chondral surface of which was orientated 25° obliquely, was harvested from the most peripheral and proximal part of the lateral patellar groove. A bony hole was created in the center of the defect through the tibia using a core reamer. The osteochondral plug was inserted from the tibial window through the bony hole. To enhance the stability of the osteochondral fragment, bioactive ceramic fillers were used to fill the space below the plug. A second-look arthroscopy 10 months after surgery showed that the grafted osteochondral plug was well adapted and integrated into the surrounding cartilage on the lateral tibial plateau.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 6 (July-August), 2001: pp 653–659