Fresh Osteochondral Allografting for Steroid-associated Osteonecrosis of the Femoral Condyles
Fresh Osteochondral Allografting for Steroid-associated Osteonecrosis of the Femoral Condyles
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DOI：
10.1007/s11999-010-1250-7
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发表时间：
2010-05-01
影响因子：
4.2
通讯作者：
Bugbee, William D.
中科院分区：
文献类型：
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作者：
Goertz, Simon;De Young, Allison J.;Bugbee, William D.
骨坏死是皮质类固醇治疗的一种并发症，对于年轻、活跃的患者来说，治疗选择有限。这些选择包括清创、核心减压、截骨术、同种异体移植以及部分或全膝关节置换术。关于使用骨软骨同种异体移植物治疗类固醇相关性骨坏死的研究很少。我们询问新鲜的同种异体骨软骨移植物是否会（1）在存在骨坏死的情况下愈合至宿主骨，（2）提供临床上有意义的疼痛减轻和功能改善，以及（3）预防或推迟假体关节置换术的需要。22名患者（28个膝盖） 对因高级别皮质类固醇相关性骨坏死而接受同种异体骨软骨移植的患者进行了评估。他们的平均年龄为 24.3 岁（范围为 16-44 岁）。平均接枝表面积为 10.8 cm(2)（范围：5.0-19.0 cm(2)）。评估包括修正的（针对膝盖）D'Aubign 和 Postel（18 分）评分、国际膝关节文献委员会 (IKDC) 和膝关节协会功能评分。最短随访时间为 25 个月（平均 67 个月；范围 25-235 个月）。五个膝关节失败。移植物成活率为 89%（28 例中有 25 例）。 D'Aubign 和 Postel 的平均得分从 11.3 提高到 15.8； 25 人中有 19 人 (76%) 的得分大于 15。平均 IKDC 疼痛评分从 7.1 提高到 2.0，平均 IKDC 功能评分从 3.5 提高到 8.3，平均膝关节协会功能评分从 60.0 提高到 85.7。我们的数据表明同种异体骨软骨移植是股骨髁坏死的合理抢救选择。末次随访时，28 个膝关节中有 27 个膝关节避免了 TKA。IV 级，病例系列。有关证据级别的完整描述，请参阅作者指南。
Osteonecrosis is a complication of corticosteroid therapy with limited treatment options in young, active patients. These options include debridement, core decompression, osteotomy, allografting, and partial or total knee replacement. Few studies exist regarding the use of osteochondral allografts for treatment of steroid-associated osteonecrosis.We asked if fresh osteochondral allografts would (1) heal to host bone in the presence of osteonecrosis, (2) provide a clinically meaningful decrease in pain and improvement in function, and (3) prevent or postpone the need for prosthetic arthroplasty.Twenty-two patients (28 knees) who underwent osteochondral allografting for high-grade, corticosteroid-associated osteonecrosis were evaluated. Their average age was 24.3 years (range, 16-44 years). The mean graft surface area was 10.8 cm(2) (range, 5.0-19.0 cm(2)). Evaluation included a modified (for the knee) D'Aubign, and Postel (18-point) score, International Knee Documentation Committee (IKDC), and Knee Society function scores. The minimum followup was 25 months (mean, 67 months; range, 25-235 months).Five knees failed. The graft survival rate was 89% (25 of 28). The mean D'Aubign, and Postel score improved from 11.3 to 15.8; 19 of 25 (76%) had a score greater than 15. The mean IKDC pain score improved from 7.1 to 2.0, mean IKDC function score from 3.5 to 8.3, and mean Knee Society function score from 60.0 to 85.7.Our data suggest osteochondral allografting is a reasonable salvage option for osteonecrosis of the femoral condyles. TKA was avoided in 27 of the 28 of knees at last followup.Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.