Autologous osteochondral grafting-technique and long-term results
Autologous osteochondral grafting-technique and long-term results
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DOI：
10.1016/j.injury.2008.01.041
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发表时间：
2008-04-01
影响因子：
2.5
通讯作者：
Bodo, Gabor
中科院分区：
文献类型：
--
作者：
Hangody, Laszlo;Vasarhelyi, Gabor;Bodo, Gabor
背景资料：有效治疗负重关节面的软骨和骨软骨缺损是肌肉骨骼护理中的日常挑战。自体骨软骨移植是一种可能的解决方案，用于在非炎性病变来源的受累区域建立透明或透明样修复。本文讨论了实验背景和超过15年的临床经验与自体骨软骨mosaicplasty.Methods：几个系列的动物研究和随后的临床实践超过1,000 mosaicplasty患者进行了评估，以确认移植的透明软骨和纤维软骨填充位于相对较轻的负重表面的供体部位的生存，以及供体部位的干扰和发病率。本文总结了犬和马移植的组织学评价以及在人体材料中的几个系列的临床评价。临床评分、不同类型的成像技术、第二次关节镜检查、活检样本的组织学检查和软骨硬度测量用于评估移植软骨的临床结果和质量。临床评分分析显示，92%的股骨髁脱位患者、87%的胫骨表面置换患者的结果为良好至极好，74%的髌骨和/或踝关节镶嵌成形术和93%的距骨手术。通过Bandi评分测量的长期供体部位投诉是轻微的，仅存在于3%的患者中。在98例对照关节镜检查中，有81例表现出一致和良好的滑动表面，组织学证明移植的透明软骨存活以及供区纤维软骨覆盖。整个患者组的并发症为4例深部感染和4例深部静脉血栓形成。在近8%的病例中，在术后早期观察到关节内出血过多，这是手术的轻微并发症。对413例关节镜下表面置换术（均质亚组中的镶嵌成形术、Pridie钻孔术、磨损关节成形术和微骨折病例）进行的多中心、比较、前瞻性评价表明，与其他三种技术相比，镶嵌成形术在长期随访中获得了有利的临床结局。早期结果的持久性在股骨髁延长术和距骨镶嵌术的长期评估中得到了证实。根据我们在这个越来越大的系列中令人鼓舞的结果，并得到其他中心类似结果的支持，自体骨软骨镶嵌成形术似乎是一种替代中小型，膝关节和其他承重滑膜关节承重面的大面积局灶性软骨和骨软骨缺损。
Background: Efficacious treatment of chondral and osteochondral defects of weightbearing articular surfaces is a daily challenge in musculoskelatal care. Autogenous osteochondral transplantation represents a possible solution for creating hyaline or hyaline-like repair in the affected area that has a noninflammatory pathoorigin. This paper discusses the experimental background and over 15 years of clinical experience with autologous osteochondral mosaicplasty.Methods: Several series of animal studies and subsequent clinical practice of over 1,000 mosaicplasty patients were assessed to confirm the survival of transplanted hyaline cartilage and fibrocartilage filling of donor sites located on relatively less weightbearing surfaces, as well as donor-site disturbances and morbidity. Histological evaluations of dog and horse implantations as well as several series of clinical evaluations in the human material are summarized in this paper. Clinical scores, different types of imaging techniques, second-took arthroscopies, histological examination of biopsy samples, and cartilage stiffness measurements were used to evaluate the clinical outcomes and quality of the transplanted cartilage.Results: Analysis of clinical scores has shown good to excellent results in 92% of patients with femoral condylar implantations, 87% of tibial resurfacements, 74% of patellar and/or trochlear mosaicplasties and 93% of talar procedures. Longterm donor-site complaints measured by the Bandi score were minor and present only in 3% of patients. 81 out of the 98 control arthroscopies represented congruent and good gliding surfaces and histologically proven survival of the transplanted hyaline cartilage as well as fibrocartilage covering of the donor sites. Complications in the entire patient group were four deep infections and four deep venous thromboses. In nearly 8% of the cases excessive intraarticular bleeding was observed in the early postoperative period, as a minor complication of the procedure. Multicentric, comparative, prospective evaluation of 413 arthroscopic resurfacing procedures (mosaicplasty, Pridie drilling, abrasion arthroplasty and microfracture cases in homogenised subgroups) demonstrated that mosaicplasty resulted in favourable clinical outcome in the long-term follow-up compared to other three techniques. Durability of the early results was confirmed in long-term evaluations both of the femoral condylar implantations and talar mosaicplasties.Conclusions: According to our encouraging results in this increasingly large series, supported by similar findings from other centres, it seems that autologous osteochondral mosaicplasty may be an alternative for small and medium-sized focal chondral and osteochondral defects of weightbearing surfaces of the knee and other weightbearing synovial joints.