膝关节骨软骨损伤评估及治疗方法  

Evaluation and treatment of osteochondral injury of knee joint

作　　者：王辉[1] 李箭[2] 邹宏[1] 沈建平[1] 张妍[1] 李剑峰[1] 龚双全 WANG Hui;LI Jian;ZOU Hong;SHEN Jianping;ZHANG Yan;LI Jianfeng;GONG Shuangquan(Department of Knee Joint,Mianyang Orthopaedic Hospital,Mianyang Sichuan,621000,P.R.China;Sports Medicine Center of Orthopaedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)

机构地区：[1]绵阳市骨科医院膝关节科,四川绵阳621000 [2]四川大学华西医院骨科运动医学中心,成都610041

出　　处：《中国修复重建外科杂志》2019年第11期1384-1388,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨膝关节骨软骨损伤评估、治疗方法以及疗效。方法2010年1月—2016年1月,收治17例膝关节骨软骨损伤患者。男2例,女15例;年龄15~33岁,平均19.3岁。致伤原因:扭伤14例,膝关节过伸、内翻暴力致伤3例。骨软骨骨折部位:髌骨8例,股骨外髁4例,股骨内髁1例,胫骨平台4例。新鲜骨折15例,陈旧性骨折2例。术前膝关节Lysholm评分为(31.6±2.3)分。14例骨软骨骨折切开复位后,根据骨质情况分别选择可吸收棒(9例)、可吸收软骨钉(3例)或可吸收缝线(2例)固定;3例骨块位于胫骨内侧平台边缘非负重区直接取出。结果术后1例发生切口脂肪液化,再次清创后愈合;其余患者切口均Ⅰ期愈合。患者均获随访,随访时间6个月~2年,平均13个月。14例行内固定患者中,13例骨折愈合良好,1例髌骨骨软骨骨折未愈合;3例非负重区骨软骨取出患者,随访期间未见膝关节内侧关节间隙变窄及创伤性关节炎发生。术后1年,膝关节Lysholm评分为(91.3±1.1)分,较术前明显改善(t=7.136,P=0.001)。结论对于膝关节骨软骨损伤,骨软骨骨块带有全层松质骨时可选择切开复位内固定,带点状松质骨时可直接取出。Objective To investigate evaluation and treatment of osteochondral injury of knee joint and its effectiveness. Methods Between January 2010 and January 2016, 17 patients with osteochondral injury of knee joint were admitted. There were 2 males and 15 females, with an average age of 19.3 years(range, 15-33 years). The causes of injury included the sprain in 14 cases and knee hyper-extension and varus due to violence in 3 cases. The osteochondral injury located at patella in 8 cases, lateral femoral condyle in 4 cases, medial femoral condyle in 1 case, and tibial plateau in4 cases. There were 15 cases of fresh fractures and 2 cases of old fractures. The Lysholm score of the knee joint was31.6±2.3. After open reduction of osteochondral fractures of 14 cases, the absorbable rods(9 cases), absorbable cartilage nail(3 cases), or absorbable sutures(2 cases) were selected for fixation. The osteochondral fractures at the medial tibial plateau margin(non-weight-bearing area) in 3 cases were removed. Results The incision fat liquefaction occurred in1 case after operation and healed after debridement. The other incisions had primary healing. All 17 patients were followed up 6 months to 2 years(mean, 13 months). Thirteen of 14 patients with internal fixation had good fractures healing without traumatic arthritis;1 case of patella osteochondral fracture did not heal. Three patients with non-weightbearing osteochondral removal had no narrowing of the medial joint space and traumatic arthritis during the follow-up.The Lysholm score of knee joint at 1 year after operation was 91.3±1.1, which significantly improved when compared with preoperative score(t=7.136, P=0.001). Conclusion For the osteochondral injury of the knee joint, the osteochondral block with full-layer cancellous bone can be treated with open reduction and internal fixation;while osteochondral block with punctate cancellous bone can be directly remove.

关 键 词：膝关节 骨软骨损伤 内固定 

分 类 号：R68[医药卫生—骨科学]