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。

Effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation for large area cartilage injury of femoral condyle of knee

Objective To explore the effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation(OAT)in treatment of large area(4-6 cm^2)cartilage injury of the femoral condyle of knee.Methods Between March 2016 and June 2017,22 patients of large area cartilage injury of the femoral condyle of knee were treated with arthroscopic microfracture combined with OAT.There were 16 males and 6 females with an average age of 22-60 years(mean,38.6 years).The cause of injury was traffic accident in 8 cases and sports injuries in 14 cases.The disease duration was 1-6 months(mean,3.4 months).There were 15 cases of medial femoral condyle injuries and 7 cases of lateral condyle injuries.The area of cartilage defect was 4-6 cm^2(mean,4.98 cm^2).According to the International Cartilage Repair Society(ICRS)classification,9 cases were rated as grade Ⅲ and 13 cases as grade Ⅳ.Eighteen cases were combined with meniscus injuries.Preoperative visual analogue scale(VAS)score was 6.36±1.25 and Lysholm score was36.00±7.77.Results All incisions healed by first intention.All patients were followed up 2-3 years with an average of 2.3 years.At 2 years after operation,the VAS score was 1.27±0.94 and the Lysholm score was 77.82±6.21,which were significantly improved when compared with those before operation(t=16.595,P=0.000;t=21.895,P=0.000).At 2 years after operation,MRI showed that the cartilage defect was repaired well.Conclusion Arthroscopic microfracture combined with OAT can be used to treat large area cartilage injury of the femoral condyle of knee,and the good early effectiveness can be obtained.