自体骨软骨移植治疗距骨骨软骨损伤疗效分析

目的评价同侧股骨髁内侧髌股关节面自体骨软骨移植治疗距骨骨软骨损伤的临床疗效。方法选择从2010年3月至2012年12月在我院就诊的20例距骨骨软骨损伤患者,主要损伤病因包括创伤后软骨缺损13例,距骨剥脱性骨软骨炎3例,局灶性骨关节炎1例,其他3例;StephenⅢ型6例,Ⅳ型11例,Ⅴ型3例。所有患者均采用同侧股骨髁内侧髌股关节面自体骨软骨移植治疗距骨骨软骨损伤。随访患者12个月,观察患者治疗前后踝关节的疼痛情况,踝关节活动范围的改善情况,踝关节的评分比较及同侧膝关节的功能评分情况。踝关节的疼痛情况采用视觉模拟评分进行评价,膝关节功能评分参照Harris的关节功能评分标准,踝关节功能的评分采用美国足踝外科医师协会评分细则。结果所有患者术后均获得随访,术后患者踝关节的VAS疼痛评分明显下降,差异有统计学意义(t=25.662 9,P=0.000 0),而同侧膝关节的功能评分改变与治疗前比较差异无统计学意义(χ2=0.305 3,P=0.761 8),术后踝关节的活动范围及踝关节功能均有明显改善,差异均有统计学意义(P0.05)。结论利用同侧股骨髁内侧髌股关节面自体骨软骨移植治疗距骨骨软骨损伤临床疗效显著,可以很好的改善踝关节功能。     

关节镜下自体软骨镶嵌移植修复股骨髁软骨损伤

目的探讨关节镜下自体软骨镶嵌移植修复股骨髁软骨损伤的效果。方法12例股骨髁软骨损伤患者,术前Brittberg-peterson功能评定标准评定,膝关节功能45~98分,平均(67±7.36)分。在关节镜下采用自体软骨镶嵌移植修复股骨髁软骨损伤。结果术后随访10~12个月,平均11个月。术后11例为2分,1例3分。结论关节镜下自体软骨镶嵌移植修复股骨髁软骨损伤有确切的疗效。     

基质诱导自体软骨细胞移植修复膝关节软骨损伤的早期疗效

目的探讨基质诱导自体软骨细胞移植修复膝关节软骨损伤的早期疗效。方法基质诱导自体软骨细胞移植修复50例膝关节软骨损伤患者,全程关注治疗情况。结果患者均获12个月随访。术后6个月36例疾病症状显著改善。术后12个月,膝关节功能主观评分表(IKDC) 2000分值、关节活动度均较术前明显提高(P 0. 01),MRI、关节镜检查显示关节软骨以及软骨下骨修复明显。结论对膝关节软骨损伤患者实施基质诱导自体软骨细胞移植,操作简便,安全且创伤轻。     

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。     

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。     

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。     

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。     

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...     

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。     

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。     

Arthroscopic osteochondral transplantation: Histologic results

Purpose: Localized, full-thickness articular cartilage defects of the femoral condyle are challenging. This report presents the histology of clinical cases obtained at intervals from 2 to 12 months after arthroscopic osteochondral transplantation. Type of Study: Longitudinal cohort study. Methods: Patients found at arthroscopy to have full-thickness femoral condyle defects between 1 and 3.5 cm in diameter underwent arthroscopic osteochondral transplantation. Exclusion criteria were associated tibial defects, patellar defects, or generalized arthritic change. The grafts taken from the superior and lateral intercondylar femoral notch were press-fit into holes drilled into the defect starting adjacent to the articular cartilage margin. Cancellous bone bridges were maintained between grafts. At various time intervals from 2 to 12 months after the osteochondral transplantation, arthroscopic biopsy specimens of the recipient sites were obtained. Results: Ten patients (5 male, 5 female) enrolled at 2 centers were evaluated arthroscopically at various intervals up to 13 months after osteochondral transplantation. The average patient age was 40 years (range, 17 to 65 years). One to 3 plugs had been harvested and inserted. Seven patients underwent biopsy at intervals ranging up to 12 months postoperatively. All showed maintenance of the integrity of the grafts with living chondrocytes and osteocytes. Donor sites filled without grafting and were covered with fibrocartilagenous scar. No complications occurred in this group. Conclusions: These histologic results suggest that arthroscopic osteochondral transplantation is a viable alternative for treating full-thickness chondral defects, with the grafts retaining their integrity and living chondrocytes and osteocytes observed in the grafts for up to 12 months after implantation.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 8 (October), 2001: pp 832–835     

Treatment of focal osteochondral defects of the acetabulum with osteochondral allograft transplantation

To our knowledge, treatment of focal osteochondral defects of the acetabulum with osteochondral allograft transplantation has not been described. As with osteochondral lesions of other weight-bearing surfaces, these defects may lead to disabling pain and early degenerative changes. In older patients who fail nonoperative treatment, hip arthroplasty is a reliable option to obtain pain relief and restore function. However, in young and active patients, it may be advantageous to restore joint congruity biologically. The clinical success of osteochondral allograft transplantation in the femoral condyles has been well-documented, with over 25 years of experience. We propose similar treatment principles in the hip joint.This article presents the cases of a 24-year-old woman (patient 1) and a 32-year-old man (patient 2) with hip pain and dysfunction secondary to a focal osteochondral defect of the acetabulum. Both were treated with osteochondral allograft transplantation to the defect using a dowel technique. A magnetic resonance image at 18 months in both cases demonstrated incorporation of the allograft bone into the host acetabulum. At 24 months in patient 1 and 42 months in patient 2, radiographs showed no progressive osteoarthritis. Both patients' Hip Outcome Scores were 100 points each.Osteochondral allografts allow large areas to be resurfaced without donor site morbidity, and these grafts provide an immediate functional joint surface. Although it has not been proven in terms of long-term follow-up, we believe that osteochondral allograft transplantation for focal osteochondral defects of the acetabulum in young, active patients is a feasible option to restore joint congruity.     

Improved repair of chondral and osteochondral defects in the ovine trochlea compared with the medial condyle

Associations between topographic location and articular cartilage repair in preclinical animal models are unknown. Based on clinical investigations, we hypothesized that lesions in the ovine femoral condyle repair better than in the trochlea. Full‐thickness chondral and osteochondral defects were simultaneously established in the weightbearing area of the medial femoral condyle and the lateral trochlear facet in sheep, with chondral defects subjected to subchondral drilling. After 6 months in vivo, cartilage repair and osteoarthritis development was evaluated by macroscopic, histological, immunohistochemical, and biochemical analyses. Macroscopic and histological articular cartilage repair and type‐II collagen immunoreactivity were better in the femoral trochlea, regardless of the defect type. Location‐independently, osteochondral defects induced more osteoarthritic degeneration of the adjacent cartilage than drilled chondral lesions. DNA and proteoglycan contents of chondral defects were higher in the condyle, reflecting physiological topographical differences. The results indicate that topographic location dictates the structural patterns and biochemical composition of the repair tissue in sheep. These findings suggest that repair of cartilage defects at different anatomical sites of the ovine stifle joint needs to be assessed independently and that the sheep trochlea exhibits cartilage repair patterns reflective of the human medial femoral condyle. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1772–1779, 2013     

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.     

Experiences with arthroscopic therapy of chondral and osteochondral defects of the knee joint with OATS (Osteochondral Autograft Transfer System)

Between 1.6.1997 and 31.12.1998 an osteochondral transplantation with the OATS (Osteochondral Autograft Transfer System) was performed in 18 patients. Indication for OATS was in 9 cases a chondral defect in ACL deficient knees. 3 times we found a fresh chondral defect, in 6 cases we found cartilage damage on the medial femoral condyle at the main weight-bearing area (Outerbridge, type III-IV) in chronic ACL deficient knees. The defect-size in these 9 patients (7 male and 2 female) ranged between 12 mm and 23 mm in diameter and had an average-size of 15 mm. There have been 3 cases with osteochondrosis dissecans, 4 patients had a osteonecrosis at the medial femoral condyle. In the 18 cases an average of 1.8 grafts was needed; more than 3 grafts were used only in exceptional cases, because in such cases the stability between the grafts is reduced. The short outcome in the Lysholm-score showed mainly good results. The average score value during follow-up was 89.5 (range 78-92). This outcome makes hopeful for likewise middle-term-results. The OATS can be recommended for the treatment of chondral and osteochondral defects in the main-weight-bearing area of the knee as a safe procedure for transplantation of hyaline cartilage.     

微骨折+原位钻孔缝合法治疗股骨髁骨软骨骨折

目的探讨切开复位微骨折+原位钻孔缝合法治疗股骨髁负重区大面积骨软骨骨折的临床疗效。方法对15例股骨髁负重区大面积粉碎骨软骨骨折患者进行原位解剖复位、钻孔、可吸收缝线双隧道骨软骨块加强缝合,小的骨软骨块表面固定,骨折块间软骨缺损处予以微骨折术。术后3、6、12个月采用Lysholm评分评价膝关节功能。结果患者均获得随访,时间12~18个月。所有患者关节软骨面的平整结构恢复良好,骨软骨骨折均愈合。术后6个月膝关节Lysho Im评分为81~93(86.3±5.5)分,优良率86.7%,较术后3个月增加,差异有统计学意义(P0.05);术后12个月膝关节Lysholm评分为86~98(90.8±6.7)分,优良率93.3%,较术后6个月增加,差异有统计学意义(P0.05)。结论切开复位微骨折+原位钻孔缝合法治疗股骨髁负重区大面积骨软骨骨折操作简便,费用低廉,并发症少,功能恢复良好。     

Donor-site morbidity after osteochondral autograft transfer procedures

We report on 2 patients who had donor-site morbidity after an autogenous osteochondral grafting was performed. Both patients had fibrocartilage hypertrophy at the donor sites that contributed to knee pain and occasional locking; the second patient also had a lack of fibrocartilaginous regrowth with symptomatic residual osteocartilaginous defects. Additional arthroscopic surgery was required in both cases to trim the fibrocartilage. In addition, for the second case, a fresh osteoarticular allograft was used to transfer osteocartilaginous plugs back into the original knee donor sites due to continued knee pain. When performing an osteochondral autograft transfer, the benefits provided at the recipient site must be weighed against the possible donor-site morbidity that may result.     

Weight-bearing osteochondral lesions of the lateral femoral condyle following patellar dislocation in adolescent athletes

In patients with patellar dislocation, osteochondral injury is often an indication for early surgical intervention. However, no studies have identified a relationship between injury to the weight-bearing surface of the lateral femoral condyle following a patellar dislocation and the eventual need for surgical treatment. The authors hypothesized that a significant number of patients sustain injury to the weight-bearing surface of the lateral femoral condyle following an acute patellar dislocation.Radiographs and magnetic resonance images were retrospectively reviewed and the patterns of injury were evaluated for 80 patients with a diagnosis of acute patellar dislocation, including the presence of osteochondral damage, the location of the medial patellofemoral ligament injury, and concomitant meniscal pathology. Magnetic resonance imaging identified a 27.5% incidence of osteochondral injury involving the articular, weight-bearing region of the lateral femoral condyle following an acute lateral patellar dislocation. Surgical intervention was performed in more than 60% of these injuries, and most were not identified with plain radiographs. Injury to the weight-bearing surface of the lateral femoral condyle following patellar dislocation was 3.6 times more common in boys in the current study population.Osteochondral injury to the weight-bearing surface of the lateral femoral condyle may occur in a high percentage of patients following a lateral patellar dislocation and in a higher percentage of boys than girls. Patients with tenderness over the lateral femoral condyle following an acute lateral patellar dislocation should undergo magnetic resonance imaging.     

Large autogenous osteochondral graft for replacing knee cartilage defect

Summary Major cartilaginous defects of the femoral condyles of the knee joint, caused by chondropathy and chondral trauma can be a precursor to osteoarthritis.Particularly in cases with large defects the therapy often remains unsuccessful. Even the substitution of articular hyaline cartilage by autogenous osteochondral grafts, regarded as superior to other procedures like Pridies's drilling and abrasion arthroplasty, carries the risk of failure by necrosis of the craft and morbidity at the donor side.We present a 10-year follow-up case who had a large autogenous osteochondral graft from the non-weight bearing periphery of the patellofemoral joint that was implanted after necrosis of the medial femoral condyle following immunsuppressive chemotherapy.