Tabaddor Ramin R, Banffy Michael B, Andersen Jason S, McFeely Eric, Ogunwole Olabode, Micheli Lyle J, Kocher Mininder S
Division of Sports Medicine, Department of Orthopaedic Surgery, Children's Hospital, Harvard Medical School, Boston, MA, USA.
J Pediatr Orthop. 2010 Jan-Feb;30(1):14-20. doi: 10.1097/BPO.0b013e3181c6318c.
The fixation of juvenile osteochondritis dissecans (OCD) lesions has been described using metal implants, staples, bone pegs, and bioabsorbable implants. Bioabsorbable fixation has potential benefits including not requiring a second surgery for implant removal, no interference on postoperative magnetic resonance imaging (MRI) scans, and a potentially lower incidence of prominent hardware. The possible complications of bioabsorbable fixation include synovitis, loss of fixation owing to noncompressive properties, and sterile abscess formation. The results of bioabsorbable fixation of juvenile OCD lesions of the knee have not been well studied. The purpose of this study was to evaluate the efficacy and safety of a bioabsorbable copolymer fixation in the management of unstable OCD lesions of the knee in adolescents.
This is a retrospective case series of patients with unstable OCD lesions of the knee that were treated with poly 96L/4D-lactide copolymer bioabsorable implants. Information was gathered through 3 standardized and validated knee-function questionnaires, participants' medical records, plain films, MRIs, and pain level and satisfaction scale questionnaires.
Twenty-four knees in 24 patients were evaluated. The mean age at the time of surgery was 14.4 years. The mean follow-up was 39.6 months. The mean International Knee Documentation Committee score at follow-up was 84.9, the mean Lysholm score was 88.0, and the mean Tegner score was 7.9. Plain films at an average of 19.2 months postoperatively revealed interval healing in 9 patients, no significant change in 1 patient, complete healing in 13 patients, and loose bodies with no interval healing in 1 patient. MRIs were obtained postoperatively in 17 knees, with a mean follow-up of 22.4 months. Interval healing was present in 16 of 17 MRIs, consistent with the plain film findings. Twenty-two of 24 patients had good-to-excellent outcomes.
Poly 96L/4D-lactide copolymer bioabsorable implants seem to be safe and effective for the management of unstable juvenile OCD lesions of the knee. They offer stability for the healing OCD lesions, with minimal reaction from degradation products.
青少年剥脱性骨软骨炎（OCD）病变的固定方法有使用金属植入物、钉书钉、骨栓和生物可吸收植入物等。生物可吸收固定具有潜在的优势，包括无需二次手术取出植入物、不干扰术后磁共振成像（MRI）扫描以及植入物突出的发生率可能较低。生物可吸收固定的可能并发症包括滑膜炎、因非压缩性导致固定失败以及无菌性脓肿形成。青少年膝关节OCD病变的生物可吸收固定效果尚未得到充分研究。本研究的目的是评估一种生物可吸收共聚物固定在青少年不稳定膝关节OCD病变治疗中的疗效和安全性。
这是一项回顾性病例系列研究，纳入了使用聚96L/4D-丙交酯共聚物生物可吸收植入物治疗的膝关节不稳定OCD病变患者。通过3份标准化且经过验证的膝关节功能问卷、参与者的病历、X线平片、MRI以及疼痛程度和满意度量表问卷收集信息。
对24例患者的24个膝关节进行了评估。手术时的平均年龄为14.4岁。平均随访时间为39.6个月。随访时国际膝关节文献委员会平均评分为84.9分，Lysholm平均评分为88.0分，Tegner平均评分为7.9分。术后平均19.2个月的X线平片显示，9例患者出现间隙愈合，1例无明显变化，13例完全愈合，1例有游离体且无间隙愈合。17个膝关节术后进行了MRI检查，平均随访时间为22.4个月。17例MRI中有16例出现间隙愈合，与X线平片结果一致。24例患者中有22例获得了良好至优秀的结果。
聚96L/4D-丙交酯共聚物生物可吸收植入物在治疗青少年不稳定膝关节OCD病变方面似乎是安全有效的。它们为愈合中的OCD病变提供稳定性，降解产物的反应最小。
