Green Chadwick John, Beck Aswin, Wood David, Zheng Ming H
Department of Orthopaedic Surgery, Royal Perth Hospital, Perth 6000, Australia and.
Centre for Orthopaedic Research, School of Surgery, University of Western Australia, Nedlands 6009, Australia.
J Hip Preserv Surg. 2016 Feb 26;3(2):108-23. doi: 10.1093/jhps/hnw007. eCollection 2016 Jul.
The use of microfracture in hip arthroscopy is increasing dramatically. However, recent reports raise concerns not only about the lack of evidence to support the clinical use of microfracture, but also about the potential harm caused by violation of the subchondral bone plate. The biology and pathology of the microfracture technique were described based on observations in translational models and the clinical evidence for hip microfracture was reviewed systematically. The clinical outcomes in patients undergoing microfracture were the same as those not undergoing microfracture. However, the overall clinical evidence quality is poor in hips. This review identified only one study with Level III evidence, while most studies were Level IV. There were no randomized trials available for review. Repair tissue is primarily of fibrocartilaginous nature. Reconstitution of the subchondral bone is often incomplete and associated with poor quality repair tissue and faster degeneration. Subchondral bone cyst formation is associated with microfracture, likely secondary to subchondral bone plate disruption and a combination of pressurized synovial fluid and inflammatory mediators moving from the joint into the bone. There is a lack of clinical efficacy evidence for patients undergoing microfracture. There is evidence of bone cyst formation following microfracture in animal studies, which may accelerate joint degeneration. Bone cyst formation following microfracture has not been studied adequately in humans.
髋关节镜下微骨折技术的应用正在急剧增加。然而，最近的报告不仅引发了对缺乏支持微骨折临床应用证据的担忧，还引发了对因破坏软骨下骨板而可能造成的危害的担忧。基于转化模型中的观察结果描述了微骨折技术的生物学和病理学，并系统回顾了髋关节微骨折的临床证据。接受微骨折治疗的患者的临床结果与未接受微骨折治疗的患者相同。然而，髋关节的总体临床证据质量较差。本综述仅确定了一项具有III级证据的研究，而大多数研究为IV级。没有可供综述的随机试验。修复组织主要为纤维软骨性质。软骨下骨的重建通常不完整，且与修复组织质量差和退变加快有关。软骨下骨囊肿的形成与微骨折有关，可能继发于软骨下骨板破坏以及加压的滑液和炎症介质从关节进入骨内。对于接受微骨折治疗的患者，缺乏临床疗效证据。动物研究中有证据表明微骨折后会形成骨囊肿，这可能会加速关节退变。微骨折后骨囊肿的形成在人类中尚未得到充分研究。
