Ramsey General de Santé, Clinique du Sport Paris V, 36 Boulevard Saint-Marcel, 75005, Paris, France.
Lyon-Ortho-Clinic, 29B Avenue des sources, 69009, Lyon, France.
Knee Surg Sports Traumatol Arthrosc. 2020 Mar;28(3):767-776. doi: 10.1007/s00167-019-05442-1. Epub 2019 Feb 28.
Recent studies demonstrated promising results of mosaicplasty for femoral head osteochondral lesions using posterior and lateral approaches. This study aimed to evaluate outcomes of mosaicplasty using ipsilateral femoral head autografts by minimally invasive anterior approach. The hypothesis was that this surgical technique would grant satisfactory clinical outcomes with considerable improvement of clinical scores.
A consecutive series of 27 mosaicplasties, to treat osteochondral lesions of the femoral head measuring 1.6 ± 0.7 cm (range 0.8-4.0) in patients aged 28.7 ± 7.4 years (range 19-44), was evaluated using the mHHS and WOMAC scores at minimum follow-up of 12 months. All patients were operated by minimally invasive anterior (Hueter) approach and osteochondral plugs were harvested from the non-weight-bearing portion of the femoral head. Adjuvant osteoplasty was necessary for some patients at the acetabulum (n = 3), femur (n = 14) or both (n = 2).
Three patients were excluded due to concomitant periacetabular osteotomies or shelf procedures, one patient could not be reached, and another was revised to THA. This left 22 patients for clinical assessment at 39.4 ± 23.2 months (12.0-90.2). Their mHHS improved from 56.3 ± 12.6 to 88.4 ± 9.9, and WOMAC improved from 45.1 ± 16.9 to 80.6 ± 13.0. Two patients (8.4%) underwent arthroscopy at 13 and 30 months to remove painful residual cam-type deformities. Regression analyses revealed that net improvement in WOMAC decreased with lesion size (p = 0.002) and increased with follow-up (p = 0.004).
Hip mosaicplasty using autografts from the ipsilateral femoral head, performed by minimally invasive anterior approach, granted satisfactory outcomes and functional improvements. Caution is, however, advised for lesions > 2 cm (diameter > 16 mm) which may be a threshold limit for this procedure.
Level IV, Case series.
最近的研究表明，采用后路和外侧入路的马赛克成形术治疗股骨头骨软骨病变效果较好。本研究旨在评估微创前侧入路采用同侧股骨头自体移植物进行马赛克成形术的疗效。假设该手术技术将获得满意的临床结果，并显著改善临床评分。
对 27 例采用微创前侧（Hueter）入路治疗股骨头骨软骨病变的患者进行了连续系列研究，这些患者的年龄为 28.7±7.4 岁（19-44 岁），病变直径为 1.6±0.7cm（0.8-4.0cm）。使用 mHHS 和 WOMAC 评分在至少 12 个月的随访时进行评估。所有患者均采用微创前侧（Hueter）入路手术，从股骨头非负重区取骨软骨栓。对于一些髋臼（n=3）、股骨（n=14）或两者（n=2）需要辅助行骨成形术。
由于同时行髋臼周围截骨术或货架成形术有 3 例患者被排除，1 例患者无法联系到，另 1 例患者改行全髋关节置换术。最终有 22 例患者纳入临床评估，随访时间为 39.4±23.2 个月（12.0-90.2 个月）。他们的 mHHS 从 56.3±12.6 提高到 88.4±9.9，WOMAC 从 45.1±16.9 提高到 80.6±13.0。2 例（8.4%）患者分别在术后 13 个月和 30 个月行关节镜检查，以切除疼痛性残余凸轮畸形。回归分析显示，WOMAC 的净改善与病变大小呈负相关（p=0.002），与随访时间呈正相关（p=0.004）。
采用微创前侧入路同侧股骨头自体移植物的髋关节马赛克成形术可获得满意的疗效和功能改善。然而，对于直径大于 2cm（直径大于 16mm）的病变，需要谨慎考虑，因为这可能是该手术的一个阈值限制。
IV 级，病例系列研究。
