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[踝关节软骨修复:治疗选择、结果及技术要点]

[Ankle cartilage repair : Therapeutic options, results and technical aspects].

作者信息

Anders S, Götz J, Grifka J, Baier C

机构信息

Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.

出版信息

Orthopade. 2017 Nov;46(11):938-946. doi: 10.1007/s00132-017-3470-y.

Abstract

BACKGROUND

Therapeutic strategies for cartilage repair of the talus are varied. With the use of biologic scaffolds and biologic agents new cell-based therapies have become the focus of attention.

OBJECTIVES

Ankle cartilage repair techniques are presented and assessed by current data. In addition, technical notes for each technique are given.

MATERIAL AND METHODS

Currently, the following established ankle cartilage repair procedures exist: microfracturing, AMIC (autologous matrix-induced chondrogenesis), OCT (osteochondral transplantation, mosaicplasty), allograft transplantation.

DISCUSSION

The success of each repair technique is dependent on the proper indication, addressing of co-morbidities like axis deviation or ligament instabilities, the experience of the surgeon and the appropriate rehabilitation. Mid- and long-term results are often good or excellent. Best results are seen in isolated cartilage defects without co-morbidities in patients younger than 40 years of age and non-smokers with normal BMI and early intervention. New cell-based therapies utilize scaffolds and biologic agents. They offer promising perspectives, although current data is inconsistent.

摘要

背景

距骨软骨修复的治疗策略多种多样。随着生物支架和生物制剂的应用,新的基于细胞的疗法已成为关注焦点。

目的

通过当前数据介绍并评估踝关节软骨修复技术。此外,还给出了每种技术的技术要点。

材料与方法

目前,存在以下已确立的踝关节软骨修复手术:微骨折术、自体基质诱导软骨生成术(AMIC)、骨软骨移植术(OCT,镶嵌成形术)、同种异体移植术。

讨论

每种修复技术的成功取决于正确的适应证、对诸如轴线偏差或韧带不稳定等合并症的处理、外科医生的经验以及适当的康复治疗。中长期结果通常良好或优秀。在40岁以下、BMI正常且不吸烟的无合并症孤立软骨缺损患者中,早期干预可取得最佳效果。新的基于细胞的疗法利用支架和生物制剂。尽管目前的数据并不一致,但它们提供了有前景的前景。

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