在连续被动活动作用下自体骨膜游离移植修复髋、膝关节软骨大面积缺损的临床应用  

TheRepairofLargeAreaofArticularCartilageDefectsoftheHipandtheKneewithFreeAutogeneousPeriosteumundertheInfluenceofPostoperativeContinuousPassiveMotion

作　　者：卢世璧[1] 杨贵勇[1] 王继芳[1] 张伯勋[1] 宋良发 

机构地区：[1]解放军总医院骨科

出　　处：《中华骨科杂志》1996年第8期475-478,共4页Chinese Journal of Orthopaedics

摘　　要：关节软骨损伤修复是临床骨科难题之一。在动物实验研究基础上，从１９８７年１月起，采用自体游离骨膜移植修复４３例关节软骨大面积缺损的病人，在连续被动活动作用下，促进修复后的关节功能恢复。并对３５例病人进行随诊观察，包括先天性髋关节脱位１８例、创伤性髋关节炎７例、股骨头低毒性感染１例、类风湿性髋关节炎１例、膝关节内骨折６例和创伤感染后膝关节僵直２例。术中，切除病变的软骨组织达出血的骨组织，从胫骨前内侧切取稍大于软骨缺损的骨膜缝合固定在缺损表面，移植骨膜和关节间放置硅膜。术后立即进行ＣＰＭ练习，逐渐增加活动范围，活动时间为４～６周，术后６个月取出硅膜。随访的３５例病人中男１６例，女１９例，年龄１２～２９岁，平均随访时间为３５个月（６～６０个月）。评价结果：髋和膝关节功能优良率分别为７６．９％和８８．９％。Therepairofarticularcartilaginousdefectsremainsadificultproblemtotheor-thopaedicsurgeons.Basedontheresultsofexperimentalstudies,theauthorsusedfreeautogeneouspe-riosteumtransplantationandpostoperativecontinuouspassivemotion(CPM)fortherepairoflargear-ticularcartilaginousdefectsin43patients.Of35folowinguppatients,18hadcongenitaldislocationofthehip,7hadtraumaticarthritisofhip,onehadfemoralheaddestructionfolowingmildinfection,6hadintra-articularfractureoftheknee,onehadrheumatoidarthritisofthehipand2hadstifkneefolowingjointinfection.Atoperation,thedevitalizedcartilagetissuewasremoveddowntothebleedingosseoustissue.Theperiosteumwasprocuredfromthemedialsurfaceofthetibiawiththesizealittlebiggerthanthecartilagedefectarea.Suturefixationwasusedafterthedefectwascoveredwiththeperiosteum.Asiliconemembranewasplacedinthejointspaceandnegativepressuresuctionwasused.CPMofthejointbeganrightafterthesurgery,withtherangeofmotionincreasedgradualy,untilto4～6weeksaf-tertheoperation.Thesiliconemembranewasremoved6monthsaftertheoperation.Theageofthepa-tientsrangedfrom12to29years.Therewere16malesand19females.35patientswereavailableforthefolow-upof6to60monthswithanaverageperiodof35months.Theexcelentandgoodresultswereseenin76.9%,and88.9%ofthepatientswiththehipandthekneelesionsrespectively.

关 键 词：关节软骨缺损 修复 骨膜移植 活动治疗 

分 类 号：R684.05[医药卫生—骨科学]