关节镜下微骨折或自体软骨移植术治疗肘关节剥脱性骨软骨炎早期临床疗效  

Short-term results of arthroscopic micro-fracture and autologous osteochondralplasty for osteochondritis dissecans of elbow

作　　者：鲁谊[1] 张海龙[1] 李屹钧 

机构地区：[1]北京积水潭医院运动医学科,100035

出　　处：《中华骨科杂志》2018年第1期1-7,共7页Chinese Journal of Orthopaedics

基　　金：2016国家自然科学基金面上项目（81672137）

摘　　要：目的探讨关节镜下微骨折或自体软骨移植术治疗肘关节剥脱性骨软骨炎的早期临床疗效。方法回顾性分析2012年1月至2014年12月，治疗肘关节剥脱性骨软骨炎患者30例，其中22例获得超过1年随访，男20例，女2例；年龄12-19岁，平均15岁；均为单侧发病，且均为主力侧肢体。患者术前均存在不同程度的肘关节疼痛与活动受限。针对肘关节骨软骨不同损伤范围采用不同的治疗方法，即损伤直径〈1cm行微骨折处理，损伤直径i〉1cm行自体软骨移植处理。22例患者中，专业运动员6例，均采用微骨折处理；普通患者16例，其中10例采用微骨折处理，6例采用自体软骨移植处理。采用视觉模拟评分（visual analogue scale, VAS ）评价疼痛，采用Mayo肘关节功能评分（Mayo elbow performance score,MEPS）评价肘关节功能。比较术前及术后末次随访的VAS评分、MEPS评分及肘关节活动度。结果22例患者随访时间12~18个月，平均13个月，无一例出现并发症。术后22例患者临床症状均明显改善。16例行微骨折治疗患者术前肘关节伸屈范围101．880±14．820，VAS评分为（5．13±1．09）分，MEPS评分为（64．38±4．79）分；术后肘关节伸屈范围114．38°±11．53°，VAS评分为（0．88±1．02）分，MEPS评分为（88．75±8．06）分，其中优13例，良3例，优良率为100％；各临床指标术前与术后分别比较，差异均有统计学意义。6例采用自体软骨移植治疗患者术前肘关节伸屈范围105．00°±11．83°，VAS评分为（5．67±1．37）分，MEPS评分为（60．83±6．11）分；术后肘关节伸屈范围120．83°±6．11°，VAS评分为（1．17±0．56）分，MEPS评分为（87．50±5．24）分，其中优4例，良2例，优良率为100％；各临床指标术前与术后分别比较，差异均有统计学意义。结论对于肘关节剥脱性骨软骨炎患者，关节镜下采用微骨折或自体软骨移Objective To evaluate the short-term results of arthroscopic treatment including micro-fractures and autolo- gous osteochondralplasty for osteochondritis dissecans （OCD） of elbow. Methods Data of 30 OCD patients who were treated by arthroseopic micro-fracture or autologous osteochondralplasty from January 2012 to December 2014 were retrospectively analyzed. 22 of them were followed-up for more than one year. Among them, there were 20 males and 2 females. All had OCD lesion on dominated side. The average age was 15 years old （range, 12-19 years old）. All patients suffered from pain and limitation on the range of motion at different level. Arthroscopic micro-fracture was performed if the diameter of the lesion was less than 1 cm, otherwise, autologous osteochondralplasty was performed. 16 cases received arthroscopic micro-fracture and 6 cased received autologous os- teochondralplasty. 6 patients were athletes who received micro-fracture. 16 patients were non-athletes and 10 of them received mi- cro-fractures. The flexion-extension range of motion（ROM）, Mayo elbow performance score （MEPS）, visual analog scale for pain （VAS） were recorded preoperatively and at the final follow-up for comparison. Results Patients were followed up for 13 month on average （range, 12-18 months） without any complications. All patients got improvement significantly with 100% good or excellent rate. For patients receiving arthroscopic micro-fracture, the preoperative ROM, MEPS and VAS was 101.88°±14.82°, 64.38±4.79 and 5.13±1.09, which was improved to 114.38°±11.53°, 88.75±8.06 and 0.88±1.02 respectively. There were significant differences between preoperative and postoperative ROM, MEPS and VAS. Among these 16 patients, 13 were excellent and 3 were good. For 6 patients who received arthroscopic autologous osteochondralplasty, the preoperative ROM, MEPS and VAS was 105.00°±11.83°, 60.83±6.11 and 5.67±1.37, which was improved to 120.83°±6.11°, 87.50±5.24 and 1.17±0.56 at the final follow up re- spe

关 键 词：关节镜检查 肘关节 移植 自体 

分 类 号：R687.4[医药卫生—骨科学]