网状微钻孔同种异体骨软骨移植治疗膝大面积骨软骨缺损

Nanofracture osteochondral allografting for large osteochondral defect of the knee

摘要:

［目的］介绍网状微钻孔同种异体骨软骨移植治疗膝大面积骨软骨缺损的手术技术和初步临床效果。［方法］镜下检查膝关节大面积骨软骨缺损，行切口显露病灶，清理坏死软骨。将同种异体骨软骨修整成与受区大小形态相同的移植物，嵌压入受区，用埋头钉固定。使用 1 mm 克氏针对移植物及受区行网状微钻孔处理，孔深至软骨下骨下 9 mm 左右。［结果］患者顺利完成手术，无严重并发症。随访 19 个月，末次随访时膝关节 HSS 评分和关节活动度（ROM）均较术前明显增加，患者对治疗效果满意。术后复查 DR 及 MRI 显示骨软骨移植物无降解，膝关节平面软骨平整。［结论］采用此技术可修复膝大面积骨软骨缺损，无不良反应，初步结果良好。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcome of nanofracture allogenic osteochondral transplantation in the treatment of large osteochondral defect of the knee. [Methods] After arthroscopic location of the large osteochondral defect of the knee, a small incision was made to expose the lesion, followed by a thorough debridement. An allogeneic osteochondral graft was trimmed to meet the recipient area in size and shape, then pressed into the recipient area and fixed with a countersunk screw. Subse- quently, a Kirschner wire 1mm in diameter was used to conduct nanofracture on the graft and recipient area, with the hole was about 9 mm deep the subchondral bone. [Results] The patient completed the operation successfully without serious complications. At 19 months of fol- low-up postoperatively, the HSS score and ROM of the knee significantly improved, and the patients were satisfied with the treatment out- come. The postoperative DR and MRI showed no degradation of the osteochondral graft, whereas with smooth articular surface. [Conclusion] The technique can be used to repair large osteochondral defect of the knee without adverse reaction, whereas good preliminary results.