中国修复重建外科杂志

中国修复重建外科杂志

关节镜下自体骨软骨移植术治疗青年与中年膝关节软骨损伤的疗效比较

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目的 比较关节镜下自体骨软骨移植术(osteochondral autologous transplantation,OAT)治疗青年及中年膝关节软骨损伤患者的疗效。 方法 回顾分析 2008 年 1 月—2016 年 8 月接受 OAT 治疗的 43 例(43 膝)膝关节软骨损伤患者临床资料,其中 20~40 岁 23 例(青年组)、40~60 岁 20 例(中年组)。两组患者年龄比较,差异有统计学意义(t=14.120,P=0.001);性别、体质量指数、合并症以及软骨损伤侧别、部位、面积、国际软骨修复协会(ICRS)分级比较,差异均无统计学意义(P>0.05)。随访期间采用 Lysholm 评分、国际膝关节文献委员会(IKDC)评分评价膝关节功能,MRI 检查观察术后供区及受区的修复情况。 结果 术后两组切口均Ⅰ期愈合。两组患者均获随访,随访时间 2~8 年,平均 3.6 年。 两组术后 2 年膝关节 Lysholm 评分、IKDC 评分均较术前显著提高(P<0.05)。术前及术后 2 年时,青年组 Lysholm 评分及 IKDC 评分明显优于中年组(P<0.05);但两组手术前后评分差值比较,差异无统计学意义(P>0.05)。术后 2 年,MRI 复查示两组受区、供区修复良好。 结论 根据患者软骨质地、厚度、弹性及损伤面积,关节镜下 OAT 可用于治疗中年膝关节软骨损伤,早期疗效较好。

Objective To compare the effectiveness of arthroscopic osteochondral autologous transplantation (OAT) in the treatment of young and middle-aged patients with the articular cartilage injury. Methods A clinical data of 43 patients (43 knees) with articular cartilage injury, who underwent OAT between January 2008 and August 2016, was retrospectively analyzed. There were 23 patients aged 20-40 years (young group) and 20 patients aged 40-60 years (middle-aged group). The difference in age between the two groups was significant (t=14.120, P=0.001). There was no significant difference in gender, body mass index, complications, affected side, lesion site, lesion area, and the International Cartilage Repair Society (ICRS) grade of cartilage injury between the two groups (P>0.05). The function of knee joint was evaluated by Lysholm score and International Knee Documentation Committee (IKDC) score during the follow-up. MRI examination was performed to observe the repair of both receiving and the donor sites. Results All the incisions in the two groups were healed by first intention. All patients in the two groups were followed up with an average of 3.6 years (range, 2-8 years). At 2 years after operation, the Lysholm and IKDC scores were significantly improved in the two groups when compared with the preoperative scores (P<0.05). The Lysholm and IKDC scores in the young group were significantly better than those in the middle-aged group before operation and at 2 years after operation (P<0.05). However, there was no significant difference in the differences of the Lysholm and IKDC scores between pre- and post-operation between the two groups (P>0.05). The MRI examination at 2 years after operation showed that both receiving and the donor sites healed well in the two groups. Conclusion According to the texture, thickness, elasticity, and lesion area of the cartilage, arthroscopic OAT might be the first choice for the articular cartilage injury in middle-aged patients and can obtain the satisfactory short-term effectiveness.

关键词: 软骨损伤; 自体骨软骨移植术; 关节镜; 软骨修复; 青年; 中年

Key words: cartilage injury; osteochondral autologous transplantation; arthroscopy; cartilage repair; youth; middle age

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