新鲜同种异体骨软骨移植能否恢复青少年膝关节剥脱性骨软骨炎的功能？
Can fresh osteochondral allografts restore function in juveniles with osteochondritis dissecans of the knee?
机构信息
Department of Orthopaedic Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, 9000 W Wisconsin Avenue, Pediatric Orthopaedics, Suite C360, P.O. Box 1997, Milwaukee, WI 53201, USA.
出版信息
Clin Orthop Relat Res. 2013 Apr;471(4):1166-73. doi: 10.1007/s11999-012-2523-0.
BACKGROUND
Failure of initial treatment for juvenile osteochondritis dissecans (OCD) may require further surgical intervention, including microfracture, autograft chondrocyte implantation, osteochondral autografting, and fresh osteochondral allografting. Although allografts and autografts will restore function in most adults, it is unclear whether fresh osteochondral allograft transplantations similarly restore function in skeletally immature patients who failed conventional treatment.
QUESTIONS/PURPOSES: Therefore, we determined function in (1) daily activity; (2) sports participation; and (3) healing (by imaging) in children with juvenile OCD who failed conventional therapy and underwent fresh osteochondral allograft transplantation.
METHODS
We retrospectively reviewed 11 children with OCD of the knee treated with a fresh stored osteochondral allograft between 2004 and 2009 (six males and five females). The average age of the children at the time of their allograft surgery was 15.2 years (range, 13-20 years). The clinical assessments included physical examination, radiography, MRI, and a modified Merle D'Aubigné-Postel score. The size of the allograft was an average of 5.11 cm(2). The minimum followup was 12 months (average, 24 months; range, 12-41 months).
RESULTS
All patients had returned to activities of daily living without difficulties at 6 months and returned to full sports activities between 9 and 12 months after surgery. The modified Merle D'Aubigné-Postel score improved from an average of 12.7 preoperatively to 16.3 at 24 months postoperatively. Followup radiographs at 2 years showed full graft incorporation and no demarcation between the host and graft bone.
CONCLUSIONS
Our observations suggested fresh osteochondral allografts restored short-term function in patients with juvenile OCD who failed standard treatments.
LEVEL OF EVIDENCE
Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
背景
青少年骺软骨骨软骨病（OCD）初次治疗失败可能需要进一步的手术干预，包括微骨折、自体软骨细胞移植、骨软骨自体移植和新鲜骨软骨同种异体移植。尽管同种异体移植物和自体移植物在大多数成年人中恢复功能，但尚不清楚在常规治疗失败的骨骼未成熟患者中，新鲜骨软骨同种异体移植是否同样可以恢复功能。
问题/目的：因此，我们确定了（1）日常活动；（2）运动参与；以及（3）在接受常规治疗失败后接受新鲜骨软骨同种异体移植的青少年 OCD 患者中的功能（通过影像学检查）。
方法
我们回顾性分析了 2004 年至 2009 年间接受新鲜保存骨软骨同种异体移植治疗的 11 例膝关节 OCD 患儿（6 名男性，5 名女性）。患儿在同种异体移植手术时的平均年龄为 15.2 岁（范围，13-20 岁）。临床评估包括体格检查、影像学检查、MRI 和改良的 Merle D'Aubigné-Postel 评分。同种异体移植物的大小平均为 5.11cm²。随访时间至少为 12 个月（平均 24 个月；范围，12-41 个月）。
结果
所有患者在术后 6 个月即可恢复日常生活活动且无困难，9-12 个月后可恢复完全体育活动。改良的 Merle D'Aubigné-Postel 评分从术前的平均 12.7 分提高到术后 24 个月的 16.3 分。术后 2 年的随访 X 线片显示移植物完全融合，宿主骨与移植物骨之间无分界。
结论
我们的观察结果表明，在接受标准治疗失败的青少年 OCD 患者中，新鲜骨软骨同种异体移植可恢复短期功能。
证据水平
IV 级，病例系列。
注
有关证据水平的完整描述，请参见《作者指南》。
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