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。     

同体骨软骨镶嵌移植术修复关节软骨病损

目的：探讨同体同关节内骨软骨镶嵌式移植，治疗关节软骨病损的可行性。方法：采用美国镶嵌式骨软骨移植器，通过开放或关节镜下进行同关节非负重关节面提供骨软骨移植条块修复关节负重面的软骨病损。结果：手术6例，术后随访5-9个月，平均6个月，均达到优良效果。结论：同体关节骨软骨镶嵌移植对治疗关节应力性局灶性软骨病、创伤性软骨缺损的45岁以下病人是一个效果确实、值得推广的方法。     

同体骨软骨镶嵌移植术修复关节软骨病损

目的　探讨同体同关节内骨软骨镶嵌式移植 ,治疗关节软骨病损的可行性。方法　采用美国镶嵌式骨软骨移植器 ,通过开放或关节镜下进行同关节非负重关节面提供骨软骨移植条块修复关节负重面的软骨病损。结果　手术 6例 ,术后随访 5～ 9个月 ,平均 6个月 ,均达到优良效果。结论　同体关节骨软骨镶嵌移植对治疗关节应力性局灶性软骨病、创伤性软骨缺损的45岁以下病人是一个效果确实、值得推广的方法     

关节镜下带骨软骨镶嵌移植修复软骨病损

目的：探讨关节镜下同体同关节内带骨软骨镶嵌式移植,治疗关节软骨病损的可行性。方法：采用美国戴安娜镶嵌式骨软骨移植器,关节镜下进行同关节非负重关节面提供骨软骨移植条块修复关节负重面的软骨病损。结果：手术15例,术后随访12－21个月,平均15个月,优良率达89．6％。结论：关节镜下同体同关节带骨软骨镶嵌移植对治疗关节应力性局限性软骨病及创伤性软骨缺损的45岁以下患者是一个效果确实、值得推广的方法。     

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。     

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。     

自体镶嵌式骨软骨移植治疗伴局灶性软骨缺损的膝骨性关节炎

目的探讨自体镶嵌式骨软骨移植修复膝骨性关节炎负重区局灶性软骨缺损的可行性和疗效。方法2004年1月～2006年11月,对19例伴局灶性软骨缺损的膝骨性关节炎采用自体镶嵌式骨软骨移植技术治疗,在关节镜下行非负重区自体骨软骨移植修复软骨缺损,术后给予中药口服、玻璃酸钠关节腔注射,6周下地部分负重。定期随访,根据改良Lysholm评分标准、关节液蛋白多糖(PG)、膝关节MRI评价疗效。结果术后获随访12～34(平均24个月)个月,患者疼痛基本消失,功能良好。术前改良Lysholm评分15～63(39.7±4.6)分,术后54～100(93.1±5.9)分,有显著性差异(P<0.01)。术前关节液蛋白多糖215.5～897.3(508.8±203.6)μg/L,术后80.4～571.6(263.5±141.2)μg/L,治疗前后相比,差异有统计学意义(P<0.05)。术后复查MRI示原缺损区软骨表面光滑,移植的软骨下骨愈合良好,总有效率94.8。结论关节镜下自体骨软骨移植创伤小,结合中药口服、玻璃酸钠关节腔注射是治疗伴软骨缺损的膝骨性关节炎的有效方法。     

关节镜下自体骨软骨移植治疗伴局灶性软骨缺损的膝骨关节炎

目的探讨关节镜下自体骨软骨移植技术治疗伴局灶性软骨缺损的膝骨关节炎的临床疗效。方法对72例伴局灶性软骨缺损的膝骨关节炎采用关节镜下自体骨软骨移植技术治疗。结果术后随访12～56个月,患者疼痛基本消失,膝关节活动良好。Brittberg-Peterson评分及关节液蛋白多糖,治疗前后比较有统计学差异(P<0.05)。术后1年复查膝关节MRI提示原缺损区软骨表面光滑,移植的软骨下骨愈合良好。结论关节镜下自体骨软骨移植创伤小、疗效确切,是治疗伴局灶性软骨缺损的膝骨关节炎的有效方法。     

自体骨软骨移植修复距骨软骨或骨软骨缺损

目的探讨从同侧膝关节非负重面获取骨软骨柱,行自体移植修复距骨穹窿部局限性软骨或骨软骨缺损的临床效果。方法23例距骨穹窿部软骨病损的患者,包括创伤后软骨缺损11例,剥脱性骨软骨炎9例和局灶性骨关节炎3例。踝关节镜下明确缺损的部位、大小,行关节镜下或加用关节切开移植术,缺损区清创后钻孔,自同侧膝关节非负重区钻取骨软骨小柱,利用骨软骨自体移植系统(osteochondralautografttransfersystem,OATS)的专用器械,采取压配固定技术将移植物植入受区的孔中,行单柱或多柱镶嵌式移植修复距骨软骨缺损。结果术后随访15～30个月,平均22个月。利用标准VAS(visualanaloguescale)尺子评估踝关节疼痛程度,评分从术前平均4.9±1.2降至术后0.8±0.1(P<0.001)。测量踝关节跖屈和背伸角度,关节活动范围由术前平均44.3°±5.8°增加到术后65.6°±11.2°(P<0.001)。按Mazur等方法综合评定踝关节的状况,评分从术前平均(51.7±8.6)分提高到(92.4±6.3)分(P<0.001)。术后MR检查提示修复的关节面平滑,移植物与周围组织结合良好。结论以同侧膝关节非负重区的骨软骨移植修复距骨局限性软骨或骨软骨缺损是一种疗效明显的外科手术方法。     

关节镜骨软骨镶嵌移植术治疗膝关节软骨损伤效果分析

目的 探讨关节镜骨软骨镶嵌移植术治疗膝关节软骨损伤的安全性和效果.方法 回顾性分析2017-06—2021-06社旗县人民医院骨外二科行关节镜手术的96例膝关节软骨损伤患者的临床资料.分为骨软骨镶嵌移植术组(镶嵌移植组)和微骨折术组,各48例.术后随访3个月,统计随访期间并发症发生率.末次随访评价患者的运动能力和膝关节...     

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

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 (P0.05);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(P0.05)。移植组术后Lysholm评分与HSS评分,均高于微骨折组(P0.05)。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。     

Mosaicplasty: long-term follow-up

The successful treatment of chondral and osteochondral defects of the weightbearing surfaces is a challenge for orthopaedic surgeons. Autologous osteochondral transplantation is one method that can be used to create a hyaline or hyaline-like repair in the defect area. Ten years of clinical experience with autologous osteochondral mosaicplasty are described. Clinical scores, imaging techniques, arthroscopy, histological examination of biopsy samples, and cartilage stiffness measurements were used to evaluate the clinical outcomes and quality of the transplanted cartilage in a total of 831 patients who underwent mosaicplasty. According to our investigations, good-to-excellent results were achieved in 92% of the patients treated with femoral condylar implantations, in 87% of those treated with tibial resurfacing, in 79% of those treated with patellar and/or trochlear mosaicplasties, and in 94% of those treated with talarprocedures. Long-term donor-site disturbances, which were assessed using the Bandi score, showed that patients had 3% morbidity after mosaicplasty. Sixty-nine of 83 patients who were followed arthroscopically showed congruent gliding surfaces, histological evidence of the survival of the transplanted hyaline cartilage, and fibrocartilage filling of the donor sites. Four deep infections and 36 painful postoperative hemarthroses were experienced as complications arising from the surgical procedures. On the basis of both these promising results and also those of other similar studies, autologous osteochondral mosaicplasty would appears to be an alternative for the treatment of small and medium-sized focal chondral and osteochondral defects of the weightbearing surfaces of the knee and other weightbearing synovial joints.     

Autologous osteochondral mosaicplasty grafting

Successful management of chondral and osteochondral defects of the weight-bearing joint surfaces has always been a challenge for orthopedic surgeons and rehabilitation specialists. Autologous osteochondral mosaic transplantation technique is one of the recently evolved methods to create hyaline or hyaline-like repair tissue in the pathologic area. Clinical evaluation, various imaging techniques, arthroscopy (second look), histological examination of biopsy samples, and measurements of cartilage mechanical properties are used to evaluate the merits of outcomes and quality of the transplanted cartilage. According to our investigations, good to excellent results were achieved in more than 92% of patients treated with femoral condylar implantations, 87% of those treated with tibial resurfacing, 79% of those treated with patellar and/or trochlear mosaicplasties, and 94% of those treated with talar procedures. Long-term donor-site discrepancies, assessed with use of the Bandi Score, showed that patients had 3% morbidity after mosaicplasty. Sixty-nine of 89 patients who were followed up with a second-look arthroscopy showed congruent gliding surfaces, histological evidence of the survival of the transplanted hyaline cartilage, and fibrocartilage filling of the donor sites. In a series of 831 consecutive patients, very few complications have been observed. These included 4 deep infections and 36 painful postoperative intra-articular bleedings. On the basis of these results and those of other similar studies, autologous osteochondral mosaicplasty appears to be a promising alternative for the treatment of small- and medium-sized focal chondral and osteochondral defects of the weight-bearing surfaces of the knee and other weight-bearing synovial joints.     

Technique of osteochondral autograft transplantation mosaicplasty for capitellar osteochondritis dissecans

Osteochondritis dissecans (OCD) is a localized condition affecting an articular surface that involves separation of a segment of cartilage and subchondral bone. It is found primarily in the knee, ankle, and elbow joints. Various theories about its etiology have been proposed, but the exact etiology of OCD still remains obscure. Osteochondritis dissecans of the elbow is characterized by pain, swelling, and limitation of motion, usually in adolescence through early adulthood. An uncommon clinical entity, it occurs as a result of overuse injuries, especially throwing activities. The treatment of OCD has evolved from the removal of loose bodies to the resurfacing of defects with an osteochondral autogenous graft (mosaicplasty). Mosaicplasty is a relatively new and viable option for the treatment of advanced OCD of the capitellum. In this article, we describe the technique of mosaicplasty for OCD of the capitellum.     

自体骨软骨镶嵌移植修复猪膝关节骨软骨缺损

目的: 探讨猪自体骨软骨镶嵌移植治疗股骨负重区骨软骨复合缺损的优缺点。方法: 采用德国Arthrex公司OATS软骨移植器械, 进行长枫杂交仔猪同关节非负重区骨软骨移植修复负重区骨软骨缺损。结果: 12周后发现骨软骨柱移植后存活良好, 移植软骨中心区无明显凹陷及退变, 甚至稍有凸起, 质地同正常软骨; 与周围正常软骨界限仍清晰, 交界区软骨整合差, 有明显裂隙存在; 骨软骨供区有明显凹陷, 为白色组织充填, 质软, 周围可见正常软骨退变。结论: 自体骨软骨镶嵌移植具有移植软骨固定可靠、软骨细胞存活率高等优点, 但也有交界区整合差, 为纤维软骨修复等缺点。     

Autologous osteochondral grafting in the knee: indication,results, and reflections

The use of multiple autologous osteochondral plugs (mosaicplasty) for repair of articular cartilage defects is a well-accepted technique. Since 1995, the authors have used mosaicplasty to treat more than 110 patients with cartilage defects of the knee, hip, and ankle. The first 52 consecutive patients who had mosaicplasty of the knee and have an average followup of 37 months (range, 24-56 months) were examined. Indications for surgical treatment were osteochondritis dissecans, acute trauma, and posttraumatic lesions of the femorotibial joint, femoropatellar maltracking with recurrent episodes of patella dislocations, and distinct femoropatellar arthrosis. Preoperatively, cartilage defects were classified as International Cartilage Repair Society Grade III lesions in 23 patients and Grade IV lesions in 29 patients. Two years after surgery, an increased level of knee function was found in 86% of the patients. At the latest followup, improved knee function was observed in 92% of the patients. In four patients, reoperation was necessary because of graft failure. Complications and reoperation rate were related to large surface lesions. Autologous osteochondral transplantation is a valid option for the treatment of full-thickness osteochondral defects. However, the method is limited by the defect size and the number of plugs to be taken at the donor site.     

Traumatic Osteochondral Injury of the Femoral Head Treated by Mosaicplasty: A Report of Two Cases

The increased risk of symptomatic progression towards osteoarthritis after chondral damage has led to the development of multiple treatment options for cartilage repair. These procedures have evolved from arthroscopic lavage and debridement, to marrow stimulation techniques, and more recently, to osteochondral autograft and allograft transplants, and autogenous chondrocyte implantation. The success of mosaicplasty procedures in the knee has led to its application to other surfaces, including the talus, tibial plateau, patella, and humeral capitellum. In this report, we present two cases of a chondral defect to the femoral head after a traumatic hip dislocation, treated with an osteochondral autograft (OATS) from the ipsilateral knee, and the inferior femoral head, respectively, combined with a surgical dislocation of the hip. At greater than 1 year and greater than 5 years of follow-up, MRI studies have demonstrated good autograft incorporation with maintenance of articular surface conformity, and both patients clinically continue to have no pain and full active range of motion of their respective hips. In our opinion, treatment of osteochondral defects in the femoral head surface using a surgical dislocation combined with an OATS procedure is a promising approach, as full exposure of the femoral head can be obtained while preserving its vasculature, thus enabling adequate restoration of the articular cartilage surface.     

A prospective,randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee

Autologous chondrocyte implantation (ACI) and mosaicplasty are both claimed to be successful for the repair of defects of the articular cartilage of the knee but there has been no comparative study of the two methods. A total of 100 patients with a mean age of 31.3 years (16 to 49) and with a symptomatic lesion of the articular cartilage in the knee which was suitable for cartilage repair was randomised to undergo either ACI or mosaicplasty; 58 patients had ACI and 42 mosaicplasty. Most lesions were post-traumatic and the mean size of the defect was 4.66 cm2. The mean duration of symptoms was 7.2 years and the mean number of previous operations, excluding arthroscopy, was 1.5. The mean follow-up was 19 months (12 to 26). Functional assessment using the modified Cincinatti and Stanmore scores and objective clinical assessment showed that 88% had excellent or good results after ACI compared with 69% after mosaicplasty. Arthroscopy at one year demonstrated excellent or good repairs in 82% after ACI and in 34% after mosaicplasty. All five patellar mosaicplasties failed. Our prospective, randomised, clinical trial has shown significant superiority of ACI over mosaicplasty for the repair of articular defects in the knee. The results for ACI are comparable with those in other studies, but those for mosaicplasty suggest that its continued use is of dubious value.