Jannelli Eugenio, Fontana Andrea
Clinica Ortopedica e Traumatologica - IRCCS Policlinico San Matteo, Università degli Studi di Pavia, 27100 Pavia, Italy.
Ortopedia 1, COF Lanzo Hospital, 22024 Lanzo d'Intelvi (CO), Italy.
SICOT J. 2017;3:43. doi: 10.1051/sicotj/2017029. Epub 2017 Jun 7.
Chondral lesions are currently considered in the hip as a consequence of trauma, osteonecrosis, dysplasia, labral tears, loose bodies, dislocation, previous slipped capital femoral epiphysis and Femoro-Acetabular-Impingement (FAI). The management of chondral lesions is debated and several techniques are described. The physical examination must be carefully performed, followed by radiographs and magnetic resonance imaging (MRI). Differential diagnosis with other pathologies must be considered. Debridement is indicated in patients younger than 50 years with a chondropathy of 1st or 2nd degree. Microfractures are indicated in patients younger than 50 years with a chondropathy of 3rd or 4th degree less than 2 cm. Matrix-Induced Autologous Chondrocyte Implantation (MACI) and Autologous Matrix-Induced Chondrogenesis (AMIC) procedures are indicated in patients with full-thickness symptomatic 3rd-4th degree chondral defects, extended 2 cm or more. The AMIC procedure has the advantage of a one-step procedure and much less expense. Microfragmented adipose tissue transplantation (MATT) is indicated for the treatment of delamination and 1st and 2nd degree chondral lesions, regardless of the age of the patient. Chondral defects are effective when the joint space is not compromised. When the Tonnis classification is two or greater, treatment of chondral lesions should be considered ineffective.
目前认为，髋关节软骨损伤是由创伤、骨坏死、发育不良、盂唇撕裂、游离体、脱位、既往股骨头骨骺滑脱和股骨髋臼撞击症（FAI）引起的。软骨损伤的治疗存在争议，且有多种技术被描述。必须仔细进行体格检查，随后进行X线片和磁共振成像（MRI）检查。必须考虑与其他病症的鉴别诊断。对于50岁以下、患有1级或2级软骨病的患者，建议进行清创术。对于50岁以下、患有小于2厘米的3级或4级软骨病的患者，建议进行微骨折术。对于有全层症状性3-4级软骨缺损、缺损范围达2厘米或更大的患者，建议进行基质诱导自体软骨细胞植入术（MACI）和自体基质诱导软骨形成术（AMIC）。AMIC手术具有一步完成且费用低得多的优点。微碎脂肪组织移植（MATT）适用于治疗分层以及1级和2级软骨损伤，无论患者年龄如何。当关节间隙未受影响时，软骨缺损的治疗是有效的。当Tonnis分级为二级或更高时，软骨损伤的治疗应被视为无效。
