Biodegradable Rods in Adult Osteochondritis Dissecans of the Knee
Biodegradable Rods in Adult Osteochondritis Dissecans of the Knee
复制标题
可生物降解的棒治疗成人膝关节剥脱性骨软骨炎
DOI：
10.1097/00003086-199811000-00029
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发表时间：
1998
影响因子：
4.2
通讯作者：
H. Chissell
中科院分区：
文献类型：
--
作者：
G. Dervin;G. Keene;H. Chissell
在骨成熟患者中，膝关节的症状性剥脱性骨软骨炎并不遵循可预测的自然病程，在可能的情况下，倾向于对不稳定骨折块进行内固定。可生物降解的植入物对于关节内用途：不需要取出植入物，并且其降解可能使载荷应力逐渐转移到骨折部位。9例患者平均年龄为18.6岁（范围：14-23岁），经X线平片检查认为已成熟，采用2 mm自增强聚乳酸棒对骨折块进行内固定。6例手术在关节镜下完成，3例需要关节切开术。所有碎片均来自股骨内侧髁。该手术耐受性良好，尽管3例患者术后早期出现浆液性渗出，但在一次抽吸后未复发。平均随访33个月（范围：24-54个月）时，8个骨折块在影像学上愈合，而1个骨折块在26个月时仍未愈合，这是该系列中1个结果较差的原因。根据Hughston的标准，7例患者获得了良好至极好的结果，并对手术感到满意。这7例患者中有1例在5个月时出现自发性积液，在抽吸和关节内类固醇注射后未复发。所有患者均未发生严重、持续性滑膜炎。用可生物降解聚乳酸棒内固定膝关节剥脱性骨软骨炎，在短期内提供了令人满意的症状控制，并在9例患者中的8例中产生了影像学稳定的病变。这些棒可能最适合于完整关节软骨的碎片病变作为钻孔的辅助工具。
Symptomatic osteochondritis dissecans of the knee in skeletally mature patients does not follow a predictable natural history and there has been a trend toward internal fixation of the unstable fragment(s) where possible. Biodegradable implants are enticing for intraarticular use: implant removal is unnecessary and its degradation potentially allows a gradual shift of loading stress to the fracture site. Nine patients with a mean age of 18.6 years (range, 14-23 years) deemed skeletally mature by plain film radiography underwent internal fixation of fragments by 2-mm self reinforced polylactic rods. Six procedures were completed arthroscopically and three required arthrotomy. All fragments were of the medial femoral condyle. The procedure was tolerated well although three patients had early postoperative serosanguinous effusions develop that did not recur after one aspiration. At a mean followup of 33 months (range, 24-54 months), eight fragments radiographically were united whereas one remained ununited at 26 months, accounting for the one poor result in this series. Seven patients had good to excellent results according to Hughston's criteria and were satisfied with the procedure. One of these seven patients had a spontaneous effusion develop at 5 months that did not recur after aspiration and intraarticular steroid injection. Severe, unremitting synovitis did not occur in any patient. Internal fixation of osteochondritis dissecans of the knee with biodegradable polylactic rods provided satisfactory control of symptoms in the short term and resulted in radiographically stable lesions in eight of nine patients. These rods may be suited best for fragmented lesions with intact articular cartilage as an adjunct to drilling.