Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA.
Clin Orthop Relat Res. 2010 May;468(5):1269-78. doi: 10.1007/s11999-010-1250-7. Epub 2010 Feb 9.
Osteonecrosis is a complication of corticosteroid therapy with limited treatment options in young, active patients. These options include debridement, core decompression, osteotomy, allografting, and partial or total knee replacement. Few studies exist regarding the use of osteochondral allografts for treatment of steroid-associated osteonecrosis.
QUESTIONS/PURPOSES: We asked if fresh osteochondral allografts would (1) heal to host bone in the presence of osteonecrosis, (2) provide a clinically meaningful decrease in pain and improvement in function, and (3) prevent or postpone the need for prosthetic arthroplasty.
Twenty-two patients (28 knees) who underwent osteochondral allografting for high-grade, corticosteroid-associated osteonecrosis were evaluated. Their average age was 24.3 years (range, 16-44 years). The mean graft surface area was 10.8 cm(2) (range, 5.0-19.0 cm(2)). Evaluation included a modified (for the knee) D'Aubigné and Postel (18-point) score, International Knee Documentation Committee (IKDC), and Knee Society function scores. The minimum followup was 25 months (mean, 67 months; range, 25-235 months).
Five knees failed. The graft survival rate was 89% (25 of 28). The mean D'Aubigné and Postel score improved from 11.3 to 15.8; 19 of 25 (76%) had a score greater than 15. The mean IKDC pain score improved from 7.1 to 2.0, mean IKDC function score from 3.5 to 8.3, and mean Knee Society function score from 60.0 to 85.7.
Our data suggest osteochondral allografting is a reasonable salvage option for osteonecrosis of the femoral condyles. TKA was avoided in 27 of the 28 of knees at last followup.
Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
骨坏死是皮质类固醇治疗的一种并发症，在年轻、活跃的患者中，治疗选择有限。这些选择包括清创术、核心减压术、截骨术、同种异体骨移植术以及部分或全膝关节置换术。关于使用软骨同种异体移植物治疗类固醇相关性骨坏死的研究很少。
问题/目的：我们想知道新鲜软骨同种异体移植物是否会（1）在骨坏死的情况下与宿主骨愈合，（2）提供有临床意义的疼痛减轻和功能改善，以及（3）预防或推迟对假体关节置换术的需求。
对 22 例（28 膝）因高级别、皮质类固醇相关性骨坏死而行软骨同种异体移植的患者进行了评估。他们的平均年龄为 24.3 岁（范围，16-44 岁）。平均移植物表面积为 10.8 cm²（范围，5.0-19.0 cm²）。评估包括改良（用于膝关节）的 D'Aubigné 和 Postel（18 分）评分、国际膝关节文献委员会（IKDC）和膝关节协会功能评分。最低随访时间为 25 个月（平均随访时间为 67 个月；范围，25-235 个月）。
有 5 个膝关节失败。移植物存活率为 89%（25/28）。D'Aubigné 和 Postel 评分从 11.3 分提高到 15.8 分；25 个膝关节中有 19 个（76%）评分大于 15。IKDC 疼痛评分从 7.1 分提高到 2.0 分，IKDC 功能评分从 3.5 分提高到 8.3 分，膝关节协会功能评分从 60.0 分提高到 85.7 分。
我们的数据表明，软骨同种异体移植是治疗股骨髁骨坏死的一种合理的挽救选择。在最后一次随访时，28 个膝关节中有 27 个避免了全膝关节置换术。
四级，病例系列。有关证据水平的完整描述，请参见作者指南。
