Department of Orthopedic Surgery, Andre Mignot Hospital of Versailles, 177 rue de Versailles, 78157, Le Chesnay Cedex, France.
Knee Surg Sports Traumatol Arthrosc. 2011 Apr;19(4):568-71. doi: 10.1007/s00167-010-1259-1. Epub 2010 Sep 18.
Treatment of osteochondritis dissecans of the adult knee requires bone and cartilage integration of the loose fragment. Screw fixation provides primary stability but does not guarantee bony consolidation. Additional biological fixation using osteochondral grafts-hybrid fixation-could improve fragment integration.
The study included seven patients [median age 21 years (15-29)] who underwent surgery for Bedouelle IIB or III osteochondritis dissecans of the medial femoral condyle. The technique involved metal screw fixation of the fragment. Mosaicplasty grafts were then press-fitted through the fragment. Cancellous autograft was utilized in the cases of subchondral bone loss. Patients were followed up clinically and radiologically (Hughston score). Screws were removed arthroscopically at 3 months and the cartilage graded using the International Cartilage Repair Society score. Fragment integration was evaluated by MRI Arthrogram (4 patients).
Median follow-up was 27 months (7-35). Median clinical Hughston score was 2 (0-3) preoperatively and 4 (2-4) postoperatively. Median radiological Hughston score was 3 (2-4) and 4 (3-4). During arthroscopic removal of metalwork, osteochondritis fragments were well integrated in all cases. The International Cartilage Repair Society score was I in one patients, II in five, and III in one. Postoperative MRI arthrograms confirmed that cartilage and bone integration was complete.
Isolated screw fixation of osteochondritis dissecans in adults provides poor bony integration. Mosaicplasty is an alternative but does not retain normal condylar anatomy. The hybrid fixation technique adds a biological "booster" to osteochondritis fixation, with excellent short-term outcome. Further studies are required to investigate the long-term results.
成人膝关节剥脱性骨软骨炎的治疗需要游离体的骨软骨整合。螺钉固定提供了初始稳定性，但不能保证骨融合。使用骨软骨移植物进行额外的生物固定——杂交固定——可以改善碎片的整合。
该研究纳入了 7 名患者（平均年龄 21 岁[15-29 岁]），他们因内侧股骨髁的 Bedouelle IIB 或 III 型剥脱性骨软骨炎而行手术治疗。该技术涉及游离体的金属螺钉固定。然后将马赛克移植物通过游离体压配。对于软骨下骨缺损，使用松质自体移植物。通过临床和影像学（Hughston 评分）进行随访。在 3 个月时通过关节镜取出螺钉，并使用国际软骨修复学会评分对软骨进行分级。4 名患者通过 MRI 关节造影术评估游离体的整合情况。
中位随访时间为 27 个月（7-35 个月）。术前和术后的中位临床 Hughston 评分为 2（0-3）和 4（2-4）。术前和术后的中位放射学 Hughston 评分为 3（2-4）和 4（3-4）。在关节镜下取出金属时，所有病例的骨软骨碎片均整合良好。国际软骨修复学会评分为 I 级 1 例，II 级 5 例，III 级 1 例。术后 MRI 关节造影证实软骨和骨的整合是完整的。
成人剥脱性骨软骨炎的单纯螺钉固定提供的骨整合效果不佳。马赛克移植物是一种替代方法，但不能保留正常的髁间解剖结构。杂交固定技术为骨软骨炎固定增加了生物“助推器”，具有良好的短期效果。需要进一步的研究来调查长期结果。
