Slough J A, Noto A M, Schmidt T L
Department of Orthopaedic Surgery, University of Missouri, Kansas City Medical Center.
Clin Orthop Relat Res. 1991 Jun(267):122-7.
Ten knees in nine patients with large, symptomatic osteochondritis dissecans lesions of the knee were treated by cortical bone peg fixation. The follow-up time averaged 2.9 years (range, 0.9-6.6 years). The average age was 19.5 years (range, 15-33 years). The knees were evaluated and rated clinically and roentgenographically. Magnetic resonance (MR) imaging of nine knees was obtained at the follow-up examination to evaluate lesion and bone peg incorporation, evidence of lesion loosening, and the articular cartilage. Eight good to excellent, one fair, and one poor result were obtained clinically. MR imaging showed 33% of knees had poor lesion cartilage and 44% had partial or poor lesion incorporation possibly consistent with loosening. Complications included four partial defect healings, one tibial donor graft-site fracture, and one bone peg loosening. Four symptomatic knees had follow-up arthroscopy at an average of 1.8 years postsurgery and findings included four loose bodies, one loose peg, one meniscal tear, and one symptomatic hypertrophic synovium. MR imaging was a useful tool in evaluating lesion stability, articular cartilage quality, lesion and bone peg incorporation, the menisci, and cruciate ligaments. Bone peg fixation of large osteochondritis dissecans defects of the knee offers a physiologic approach to treatment of this lesion in nearly skeletally mature or skeletally mature patients.
对9例患有大型、有症状的膝关节剥脱性骨软骨炎病变的患者的10个膝关节采用皮质骨栓固定进行治疗。随访时间平均为2.9年（范围0.9 - 6.6年）。平均年龄为19.5岁（范围15 - 33岁）。对膝关节进行临床和影像学评估及评级。在随访检查时对9个膝关节进行磁共振（MR）成像，以评估病变和骨栓融合情况、病变松动的证据以及关节软骨情况。临床结果为8例良好至优秀，1例一般，1例差。MR成像显示33%的膝关节病变软骨情况差，44%的膝关节病变融合部分或情况差，可能与松动一致。并发症包括4例部分缺损愈合、1例胫骨供骨部位骨折和1例骨栓松动。4个有症状的膝关节在术后平均1.8年进行了关节镜检查，发现包括4个游离体、1个松动的骨栓、1例半月板撕裂和1例有症状的肥厚滑膜。MR成像在评估病变稳定性、关节软骨质量、病变和骨栓融合情况、半月板及交叉韧带方面是一种有用的工具。膝关节大型剥脱性骨软骨炎缺损的骨栓固定为近骨骼成熟或骨骼成熟患者的这种病变提供了一种生理性的治疗方法。
