膝骨关节炎的关节镜治疗进展

膝关节是骨关节炎的好发部位.目前,关节镜下治疗膝骨关节炎主要针对两个方面,清除引起症状的因素和恢复关节软骨的完整性.关节镜冲洗和清理术是以改善症状、延缓病变进展为目的的姑息性手术,应用于临床已有几十年历史,在部分病人中效果显著,但近年对于其作用产生了新的争论.间充质干细胞刺激技术,包括钻孔、微骨折和打磨成形术,可产生纤维软骨和透明样软骨的混合物,是一类创伤小、成本低廉、操作简单的术式,且对部分病例疗效满意.而新兴的关节镜下软骨或软骨细胞移植在技术上已逐渐成熟.这类手术采用更激进的外科手段以尽可能恢复受累区域软骨的完整性.尽管已有的资料显示出可喜的结果,其长期转归还有待未来的研究证实.

Arthroscopic management for osteoarthritis of the knee joint

Osteoarthritis is common in the knee joint. Currently, arthroscopic techniques and procedures are developed for osteoarthritis of the knee aiming to remove factors that causing symptoms as well as regain the integrity of the articular cartilage. Arthroscopic lavage and debridement which has been widely used for many years is palliative, other than curative, for the purpose of reducing pain, improving function and postponing total knee arthroplasty. Satisfactory results are shown in some patients. How- ever, challenge arose in recent years to the role of debridement in treating osteoarthritis of the knee. Mesenchymal stem cell stimulation techniques, including drilling, microfracture and abrasion arthroplas- ty, can produce a hybrid of fibrocartilage and hyaline-like cartilage. These procedures are minimally traumatic, relatively easy to operate and low in cost. Newly designed methods, such as arthroscopic osteochondral autologous transplantation and autologous chondrocyte implantation, have become technically feasible nowadays. These surgical interventions seeking to repair large localized chondral defects are more aggressive, and expensive. Although early reports have shown encouraging results, long-term tissue survival and clinical outcome remains to be evaluated in the future.