微骨折术治疗距骨骨软骨缺损时，孔几何形状无影响。
No effect of hole geometry in microfracture for talar osteochondral defects.
机构信息
Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, G4-262 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands,
出版信息
Clin Orthop Relat Res. 2013 Nov;471(11):3653-62. doi: 10.1007/s11999-013-3189-y. Epub 2013 Jul 27.
BACKGROUND
Débridement and bone marrow stimulation is an effective treatment option for patients with talar osteochondral defects. However, whether surgical factors affect the success of microfracture treatment of talar osteochondral defects is not well characterized.
QUESTIONS/PURPOSES: We hypothesized (1) holes that reach deeper into the bone marrow-filled trabecular bone allow for more hyaline-like repair; and (2) a larger number of holes with a smaller diameter result in more solid integration of the repair tissue, less need for new bone formation, and higher fill of the defect.
METHODS
Talar osteochondral defects that were 6 mm in diameter were drilled bilaterally in 16 goats (32 samples). In eight goats, one defect was treated by drilling six 0.45-mm diameter holes in the defect 2 mm deep; in the remaining eight goats, six 0.45-mm diameter holes were punctured to a depth of 4 mm. All contralateral defects were treated with three 1.1-mm diameter holes 3 mm deep, mimicking the clinical situation, as internal controls. After 24 weeks, histologic analyses were performed using Masson-Goldner/Safranin-O sections scored using a modified O'Driscoll histologic score (scale, 0-22) and analyzed for osteoid deposition. Before histology, repair tissue quality and defect fill were assessed by calculating the mean attenuation repair/healthy cartilage ratio on Equilibrium Partitioning of an Ionic Contrast agent (EPIC) micro-CT (μCT) scans. Differences were analyzed by paired comparison and Mann-Whitney U tests.
RESULTS
Significant differences were not present between the 2-mm and 4-mm deep hole groups for the median O'Driscoll score (p = 0.31) and the median of the μCT attenuation repair/healthy cartilage ratios (p = 0.61), nor between the 0.45-mm diameter and the 1.1-mm diameter holes in defect fill (p = 0.33), osteoid (p = 0.89), or structural integrity (p = 0.80).
CONCLUSIONS
The results indicate that the geometry of microfracture holes does not influence cartilage healing in the caprine talus.
CLINICAL RELEVANCE
Bone marrow stimulation technique does not appear to be improved by changing the depth or diameter of the holes.
背景
清创和骨髓刺激是治疗距骨骨软骨缺损患者的有效治疗选择。然而，手术因素是否会影响微骨折治疗距骨骨软骨缺损的效果尚不清楚。
问题/目的：我们假设（1）深入骨髓填充的小梁骨的孔允许更类似透明软骨的修复；（2）更多数量的小孔且直径较小会导致修复组织更牢固地整合，减少新骨形成的需求，并更高地填充缺损。
方法
在 16 只山羊（32 个样本）的距骨上钻取直径为 6mm 的骨软骨缺损。在 8 只山羊中，一侧的缺损用 6 个直径为 0.45mm 的孔在 2mm 深处进行处理；在其余 8 只山羊中，用 6 个直径为 0.45mm 的孔以 4mm 的深度进行穿刺。所有对侧的缺损均用 3 个直径为 1.1mm、深 3mm 的孔进行处理，模仿临床情况，作为内部对照。24 周后，通过改良 O'Driscoll 组织学评分（评分范围 0-22）对 Masson-Goldner/Safranin-O 切片进行组织学分析，并对类骨质沉积进行分析。在组织学分析之前，通过计算 EPIC 微 CT（μCT）扫描中平衡离子对比剂的平均衰减修复/健康软骨比值，评估修复组织质量和缺损填充。通过配对比较和 Mann-Whitney U 检验分析差异。
结果
2mm 和 4mm 深孔组的中位数 O'Driscoll 评分（p = 0.31）和 μCT 衰减修复/健康软骨比值中位数（p = 0.61）差异无统计学意义，0.45mm 直径孔和 1.1mm 直径孔之间的缺损填充（p = 0.33）、类骨质（p = 0.89）或结构完整性（p = 0.80）差异也无统计学意义。
结论
结果表明，微骨折孔的几何形状不会影响山羊距骨的软骨愈合。
临床相关性
骨髓刺激技术似乎不会因改变孔的深度或直径而得到改善。
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