一项关于使用骨软骨支架塞进行膝关节软骨修复的初步研究，以及如何应对早期临床失败。
A pilot study of the use of an osteochondral scaffold plug for cartilage repair in the knee and how to deal with early clinical failures.
机构信息
Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.
出版信息
Arthroscopy. 2012 Feb;28(2):225-33. doi: 10.1016/j.arthro.2011.07.017. Epub 2011 Oct 20.
PURPOSE
To present our short-term experience with an osteochondral scaffold plug (TruFit plug; Smith & Nephew, Andover, MA) for cartilage repair in the knee and, more importantly, to discuss our approach to treat early clinical failures.
METHODS
Twenty patients were consecutively treated for their cartilage lesions with the plug technique. These patients were prospectively clinically evaluated at 6 and 12 months of follow-up. Magnetic resonance imaging (MRI) was used for morphologic analysis of the cartilage repair. Biopsy samples were taken from 3 cases during revision surgery, allowing histologic assessment of the repair tissue.
RESULTS
The short-term clinical and MRI outcome of this pilot study are modest. No signs of deterioration of the repair tissue were observed. Of the 15 patients followed up during 1 year, 3 (20.0%) showed persistent clinical symptoms or even more clinical symptoms after insertion of the plug. These patients were considered as failures and therefore eligible for revision surgery. During revision surgery, the repair tissue was carefully removed. The remaining osteochondral defect was filled with autologous bone grafts. Immediate and persistent relief of symptoms was observed in all 3 patients. Histologic assessment of biopsy specimens taken during revision surgery showed fibrous vascularized repair tissue with the presence of foreign-body giant cells.
CONCLUSIONS
The overall short-term clinical and MRI outcome of the osteochondral scaffold plug for cartilage repair in the knee is modest. In this pilot study a modest clinical improvement became apparent at 12 months of follow-up. MRI data showed no deterioration of the repair tissue. Of the 15 patients, 3 (20%) had persistent clinical symptoms after surgery. These patients were successfully treated with removal of the osteochondral plug remnants and the application of autologous bone grafts.
LEVEL OF EVIDENCE
Level IV, therapeutic case series.
目的
介绍我们在膝关节软骨修复中使用骨软骨支架塞（TruFit 塞；Smith & Nephew，马萨诸塞州安多弗）的短期经验，更重要的是，讨论我们治疗早期临床失败的方法。
方法
连续 20 例患者采用塞技术治疗软骨病变。这些患者在随访 6 和 12 个月时进行前瞻性临床评估。磁共振成像（MRI）用于软骨修复的形态分析。在 3 例翻修手术中取活检样本，允许对修复组织进行组织学评估。
结果
这项初步研究的短期临床和 MRI 结果是适度的。未观察到修复组织恶化的迹象。在 15 例随访 1 年的患者中，3 例（20.0%）在插入塞后出现持续的临床症状甚至更多的临床症状。这些患者被认为是失败的，因此有资格接受翻修手术。在翻修手术中，仔细清除修复组织。用自体骨移植物填充剩余的骨软骨缺损。所有 3 例患者均立即和持续缓解症状。翻修手术中取活检标本的组织学评估显示纤维血管化的修复组织，存在异物巨细胞。
结论
膝关节软骨修复中使用骨软骨支架塞的总体短期临床和 MRI 结果是适度的。在这项初步研究中，在随访 12 个月时明显出现适度的临床改善。MRI 数据显示修复组织没有恶化。在 15 例患者中，3 例（20%）术后仍有持续的临床症状。这些患者通过清除骨软骨塞残余物和应用自体骨移植物成功治疗。
证据水平
IV 级，治疗性病例系列。
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