Xin Long, Zhang Chun, Xu Wei-Xing, Zhong Fu-Hua, Fan Shun-Wu, Wang Zhen-Bin
Department of Orthopaedics, the Forth Affiliated Hospital to Xinjiang Medical Univesity, Urummqi 830002, Xinjiang, China;
Zhongguo Gu Shang. 2018 Mar 25;31(3):281-285. doi: 10.3969/j.issn.1003-0034.2018.03.019.
Chondral injuries are short of self-healing ability and need to surgical repair after articular cartilage injury. Conventional treatment includes debridement and drainage under arthroscope, micro-fracture, osteochondral autograft transplantation (OATS), mosaiplasty and osteochondral allografts (OCA), autologous chondrocyte implantation (ACI). Debridement and drainage could remove pain factor, and has advantages of simple operation, wide clinical application and early clinical effect. Micro-fracture and osteochondral autograft transplantation is suitable for small area of cartilage repair, while the further effect showed that fibrous cartilage permeated by drill could decrease postoperative clinical effect. Osteochondral autograft transplantation has better advantages for reconstruction complete of wear-bearing joint. Autologous chondrocyte implantation and allogeneic cartilage transplantation are suitable for large area of cartilage defect, postoperative survival of allogeneic cartilage transplantation is effected by local rejection reaction and decrease further clinical effect. Cartilage tissue engineering technology could improve repair quality of autologous chondrocyte implantation, and make repair tissue close to transparent cartilage, but has limit to combined subchondral bone plate, reactive bone edema, bone loss and bad axis of lower limb. New technology is applied to cartilage injury, and has advantages of less trauma, simple operation, rapid recover, good clinical effect and less cost;and could be main method for treat cartilage injury with surgical repair technology. How to improve repair quality with compression resistance and abrasive resistance are expected to be solved.
软骨损伤缺乏自我修复能力,关节软骨损伤后需要手术修复。传统治疗方法包括关节镜下清创引流、微骨折、自体骨软骨移植(OATS)、马赛克成形术和异体骨软骨移植(OCA)、自体软骨细胞植入(ACI)。清创引流可去除疼痛因素,具有操作简单、临床应用广泛、临床效果出现早等优点。微骨折和自体骨软骨移植适用于小面积软骨修复,而进一步的研究结果表明,钻孔形成的纤维软骨会降低术后临床效果。自体骨软骨移植在重建负重关节完整性方面具有更好的优势。自体软骨细胞植入和异体软骨移植适用于大面积软骨缺损,异体软骨移植术后的存活受局部排斥反应影响,会降低进一步的临床效果。软骨组织工程技术可提高自体软骨细胞植入的修复质量,使修复组织接近透明软骨,但在合并软骨下骨板、反应性骨水肿、骨质流失和下肢力线不良方面存在局限性。新技术应用于软骨损伤,具有创伤小、操作简单、恢复快、临床效果好、成本低等优点;并可能成为手术修复技术治疗软骨损伤的主要方法。如何提高修复质量的抗压性和耐磨性仍有待解决。