Akgun Isik, Kesmezacar Hayrettin, Ogut Tahir, Kebudi Alper, Kanberoglu Kaya
Department of Orthopaedics and Traumatology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Arthroscopy. 2005 Jul;21(7):834-43. doi: 10.1016/j.arthro.2005.04.106.
This study evaluated the results of arthroscopic subchondral microfracture performed on patients with spontaneous osteonecrosis (ON) (group 1) or secondary ON (group 2) of the knee joint.
Retrospective clinical study.
Group 1 included 26 patients (mean age, 48 years) who had spontaneous ON. Group 2 included 15 patients (mean age, 32 years) with ON secondary to inflammatory disease or steroid therapy. Seventy-six percent of the chondral defects were located in the medial femoral condyle. The average defect sizes in group 1 was 162 mm2 and in group 2 was 362 mm2. After debridement of the necrotic tissues, multiple perforations were placed into the subchondral bone to obtain revascularization.
There was an increase in the average Lysholm scores from 57 to 90 in group 1 after 27 months of mean follow-up (P < .05); 71% of patients could participate in strenuous sports with no or minimal limitation. The mean activity level in group 1 according to Cincinnati Knee Rating System was 6 preoperatively and 13.54 postoperatively. For group 2, the average scores showed significant improvement and patient satisfaction after surgery (preoperative and postoperative average Lysholm scores were 41 and 75, respectively, with mean follow-up of 37 months). Average activity level in group 2 increased from 2.67 to 11.73. Control magnetic resonance imaging scans of the cases revealed the continuity of normal cartilage with cartilage-like tissue in the treated areas. However, an increase of the size of ON in the subchondral bone was detected in 27% of the knees.
The microfracture technique is safe, simple, and cost-effective, and may be an alternative procedure for treatment of ON of the knee, especially in young patients, before possible subsequent replacement surgery.
Level IV.
本研究评估了关节镜下对膝关节自发性骨坏死（第1组）或继发性骨坏死（第2组）患者进行软骨下微骨折的结果。
回顾性临床研究。
第1组包括26例（平均年龄48岁）自发性骨坏死患者。第2组包括15例（平均年龄32岁）因炎症性疾病或类固醇治疗继发骨坏死的患者。76%的软骨缺损位于股骨内侧髁。第1组平均缺损面积为162平方毫米，第2组为362平方毫米。清除坏死组织后，在软骨下骨上进行多处钻孔以实现血管再生。
第1组平均随访27个月后，Lysholm评分平均从57分提高到90分（P <.05）；71%的患者能够参加剧烈运动，且无或仅有极小限制。根据辛辛那提膝关节评分系统，第1组术前平均活动水平为6分，术后为13.54分。对于第2组，术后平均评分显示有显著改善且患者满意度较高（术前和术后Lysholm平均评分分别为41分和75分，平均随访37个月）。第2组平均活动水平从2.67分提高到11.73分。病例的对照磁共振成像扫描显示治疗区域正常软骨与软骨样组织连续。然而，27%的膝关节检测到软骨下骨骨坏死面积增大。
微骨折技术安全、简单且具有成本效益，可能是治疗膝关节骨坏死的一种替代方法，尤其是在年轻患者中，可作为后续可能的置换手术前的选择。
IV级。
