Department of Orthopaedic Surgery, Schulthess Clinic, Lengghalde 2, 8008, Zürich, Switzerland,
Clin Orthop Relat Res. 2012 Dec;470(12):3421-31. doi: 10.1007/s11999-012-2466-5.
Compared to knees, hips have more bony constraint and soft tissue coverage. Thus, repair of focal cartilage defects in hips requires more invasive and technically complex surgeries than simple arthroscopy or arthrotomy. Autologous matrix-induced chondrogenesis (AMIC) is a second-generation bone marrow stimulation technique. Improvement in Tegner, Lysholm, International Cartilage Repair Society (ICRS), and Cincinnati scores has been reported at 1 and 2 years after AMIC in knees. AMIC is potentially useful to repair defects in hips, but it is unknown whether it relieves symptoms or results in a durable construct.
A surgical hip dislocation is used to access the defect. This is débrided to stable cartilage shoulders, necrotic bone is removed, and the lesion base is drilled. Autogenous bone graft is used for lesions with bony defects to create a level surface. Fibrin gel and a collagen membrane are placed to stabilize the superclot for fibrocartilage formation.
We treated six patients with AMIC in the hip between 2009 and 2010. We obtained Oxford Hip and UCLA Activity Scores. Repair quality was assessed on 6-month postoperative MRI using the modified magnetic resonance observation of cartilage repair tissue (MOCART) system. Minimum 1-year followup data were available for four patients (range, 1-2.5 years).
Postoperative Oxford Hip Scores ranged from 13 to 17, UCLA Activity Scores ranged from 5 to 10, and MOCART scores ranged from 55 to 75. No complications occurred.
We describe AMIC in the hip. Although these patients had pain relief and improved function, long-term followup is necessary to assess the duration of improvement, durability of repair, and potential for arthrosis.
Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
与膝关节相比，髋关节的骨性约束和软组织覆盖更多。因此，髋关节局灶性软骨缺损的修复需要比单纯关节镜或关节切开术更具侵入性和技术复杂性的手术。自体基质诱导软骨生成术（AMIC）是第二代骨髓刺激技术。在膝关节中，使用 AMIC 治疗后 1 年和 2 年，Tegner、Lysholm、国际软骨修复协会（ICRS）和辛辛那提评分均有改善。AMIC 可能对髋关节缺损的修复有用，但尚不清楚其是否能缓解症状或产生持久的结构。
使用外科髋关节脱位来访问缺陷。将其清创至稳定的软骨肩，去除坏死骨，并在病变基底钻孔。使用自体骨移植物治疗有骨缺损的病变，以创建一个水平表面。纤维蛋白凝胶和胶原膜用于稳定超凝块以形成纤维软骨。
我们在 2009 年至 2010 年间对 6 例髋关节 AMIC 患者进行了治疗。我们获得了牛津髋关节和 UCLA 活动评分。使用改良的磁共振观察软骨修复组织（MOCART）系统，在术后 6 个月的 MRI 上评估修复质量。有 4 例患者（1-2.5 年）获得至少 1 年的随访数据。
术后牛津髋关节评分为 13-17 分，UCLA 活动评分为 5-10 分，MOCART 评分为 55-75 分。无并发症发生。
我们描述了髋关节中的 AMIC。尽管这些患者的疼痛减轻且功能改善，但需要长期随访以评估改善的持续时间、修复的耐久性和关节炎的潜在风险。
IV 级，治疗研究。有关证据水平的完整描述，请参见作者说明。
