半月板同种异体移植术后中期结果：有无挤压病例的比较。
Midterm outcomes after meniscal allograft transplantation: comparison of cases with extrusion versus without extrusion.
机构信息
Department of Orthopaedic Surgery, Korea University School of Medicine, Anam Hospital, Seoul, Korea.
出版信息
Am J Sports Med. 2010 Feb;38(2):247-54. doi: 10.1177/0363546509346399. Epub 2009 Dec 4.
BACKGROUND
Although graft extrusion is of concern after meniscal allograft transplantation (MAT), the correlation between extrusion and clinicoradiological outcomes remains unclear. Hypothesis Patients with graft extrusion after MAT have worse clinical outcomes and greater arthritic change than those without graft extrusion.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
Forty-three patients underwent MAT between 1999 and 2004. Grafts were classified as either nonextruded (<3 mm) or extruded (>or=3 mm) according to 1-year postoperative magnetic resonance imaging (MRI) findings. The mean patient age at the time of surgery was 33.5 years (range, 17-43 years), and the mean follow-up period was 5.1 years (range, 3.5-8.3 years). The Lysholm score was used to evaluate knee function. In addition, preoperative and postoperative (final follow-up) measurements were taken to determine the absolute and relative (affected side/normal side) joint space width (JSW) on a standing 45 degrees flexion posteroanterior view.
RESULTS
Magnetic resonance imaging at 1 year showed the mean graft subluxation was 3.03 +/- 0.872 mm across all patients. Twenty-six knees (60%) were classified as nonextruded and 17 (40%) as extruded. No statistical difference was found between these 2 groups regarding Lysholm score improvement after MAT. Overall, absolute and relative JSWs were slightly narrower postoperatively compared with preoperatively across all patients (mean absolute difference, 0.283 mm; mean relative difference; 4.79%; P <.001). However, extruded and nonextruded knees were similar in terms of absolute (P = .764) and relative (P = .482) JSW after MAT. The amount of extrusion did not correlate with Lysholm score or the relative difference between preoperative and postoperative JSW across all patients or in either group.
CONCLUSION
Joint space width was slightly narrower after MAT. Extrusion had no effect on 5-year clinical or radiological outcomes.
背景
尽管半月板同种异体移植（MAT）后移植物挤出是令人关注的问题，但挤出与临床和影像学结果之间的相关性尚不清楚。
假设
MAT 后移植物挤出的患者比没有挤出的患者临床结果更差，关节炎改变更大。
研究设计
队列研究；证据水平，3 级。
方法
1999 年至 2004 年期间，43 例患者接受 MAT。根据术后 1 年 MRI 结果，将移植物分为未挤出（<3mm）或挤出（≥3mm）。手术时患者平均年龄为 33.5 岁（范围，17-43 岁），平均随访时间为 5.1 年（范围，3.5-8.3 年）。Lysholm 评分用于评估膝关节功能。此外，在术前和术后（最终随访）测量站立 45 度屈膝前后位片上的绝对和相对（患侧/健侧）关节间隙宽度（JSW）。
结果
所有患者 1 年的 MRI 显示平均移植物半脱位为 3.03±0.872mm。26 膝（60%）未挤出，17 膝（40%）挤出。这两组患者在 MAT 后 Lysholm 评分改善方面无统计学差异。总体而言，与术前相比，所有患者术后 JSW 均稍窄（平均绝对差值为 0.283mm；平均相对差值为 4.79%；P<.001）。然而，MAT 后挤出和未挤出的膝关节在绝对（P=.764）和相对（P=.482）JSW 方面相似。挤出量与所有患者或任何组的 Lysholm 评分或术前和术后 JSW 之间的相对差值均无相关性。
结论
MAT 后 JSW 稍窄。挤出对 5 年临床和影像学结果无影响。
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