成年人股骨髁剥脱性骨软骨炎的外科治疗

目的 探讨成年人不同类型股骨髁剥脱性骨软骨炎（OCD）治疗方法.方法 采用回顾性研究方法.纳入标准：18岁以上成年人,股骨髁OCD,采用外科治疗,术后随访24个月以上.排除标准：青少年OCD,非手术治疗患者,术后失随访患者.回顾2007年1月～2011年7月治疗股骨髁OCD 32例,男23例,女9例,男∶女为2.6：1,平均年龄23.6岁（18～52岁）.关节镜下病灶清理、微骨折10例,关节镜下用可吸收软骨钉（SmartNail; ConMed Linvatec,Largo,FL）固定骨软骨片12例,切开复位、AO钛合金空心钉固定骨软骨片8例,外侧单髁置换2例.术前、术后用Lysholm评分和主观IKDC评分评定膝关节功能.结果 本组32例患者平均随访时间35.8个月（24～52个月）.术前Lysholm评分平均（53.77±4.48）分,术后平均（90.89±4.42）分（t=-266.01,P〈0.01）;主观IKDC评分术前平均（58.50±5.99）分,术后平均（92.15±4.16）分（t=-87.62,P〈0.01）.结论 不同类型、不同时期股骨髁OCD有不同治疗选择,选择适当的治疗方法可获得良好的临床疗效,晚期治疗医疗成本增加.

Surgical management for adult osteochondritis dissecans of femoral condyle

Objective To discuss the different treatments of adult osteochondritis dissecans of the femoral condyle. Methods A retrospective study was carried out. The inclusion criteria were as follows ： the adults above 18 years old, who were diagnosed osteochondritis dissecans of the femoral condyle, and underwent surgical treatment, the follow-up time was more than 24 months. The exclusion criteria were as follows： the juvenile osteochondritis dissecans, nonoperative management, no follow-up after surgery. 32 cases of osteochondritis dissecans of the femoral condyle treated from January 2007 to July 2011 were reviewed. There were 23 male and 9 female cases, and the sex ratio was 2. 6： 1. Among the samples there were 10 cases of arthroscopic microfractures, 12 cases of arthroscopic osteochondral piece fixed with a bioabsorbable nail composed of SR-PLLA （SmartNail; ConMed Linvatec, Largo, FL）, eight cases of osteochondral piece fixed with cannulated screws and two cases of unicondylar replacements. Lysholm scores and IKDC subjective evaluation were used to assess the function of the knee joint before and after the surgery. Results The 32 patients were followed up for 35.8 months in average （range： 24 ± 52 months）. The average Lysholm score was （53.77 ± 4.48 ） before the operation and （90. 89 ± 4.42 ） after the operation （ t = - 266. 01, P 〈 0. 01 ）. The average IKDC objective evaluation was （ 58. 50 ± 5.99 ） preoperation and （92. 15 ±4. 16） postoperation （t = -87. 62, P 〈 0. 01 ）. Conclusion Various treating options are available for osteochondritis dissecans of the femoral condyle of different types and stages. Appropriate treating methods will achieve good clinical efficacy, while the late-stage treatment will result in medical costs increase.