Perelli Simone, Molina Romoli Agustín Rubén, Costa-Paz Matías, Erquicia Juan Ignacio, Gelber Pablo Eduardo, Monllau Juan Carlos
Institut Català de Traumatologia i Medicina de l'Esport (ICATME)-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, 08028 Barcelona, Spain.
Research Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires c1181ach, Argentina.
J Clin Med. 2019 Nov 10;8(11):1934. doi: 10.3390/jcm8111934.
The aim of the present study is to describe results at long-term follow-up of internal fixation of unstable Osteochondritis Dissecans (OCD) achieved with three different fixation devices in skeletally mature knees. A retrospective cohort study was performed at 5 to 19 years follow-up. Patient-reported questionnaires were collected at the final follow-up. Postoperative X-rays and MRIs were evaluated for healing of the lesion and articular degeneration. An arthroscopic second look was performed in 74.3% of the cases. Failures were reported as reintervention to address the osteochondral lesion or poor functional outcomes at the last follow-up. A total of 39 subjects with a median follow-up of 10.7 years were included. Herbert screws were used in 51.2% of the cases, bioabsorbable nails in 25.7% of the cases and cannulated screws in 23.1% of the cases. No differences were observed in terms of the clinical score (International Knee Documentation Committee (IKDC) = 0.211; Lysholm = 0.197), radiographic union ( = 0.102) or radiographic degeneration ( = 0.238) between the three different fixation devices. Arthroscopic second look found complete stability of the lesions in all 29 cases evaluated. The mean postoperative Lysholm score was 83 (range = 33-100) and IKDC score was 79 (range = 39-100). Radiographic union was seen in 74% of the cases. Lack of radiographic union was correlated with worst functional scores. A failure rate of 20.5% was found: four reinterventions were performed, and four patients had poor scores at last follow up. This study shows that internal fixation of condylar OCD in skeletally mature patients provides good long-term clinical results and a high degree of healing regardless of the dimensions of the lesion and type of fixation.
本研究的目的是描述在骨骼成熟的膝关节中，使用三种不同固定装置对不稳定剥脱性骨软骨炎（OCD）进行内固定的长期随访结果。进行了一项回顾性队列研究，随访时间为5至19年。在最终随访时收集患者报告的问卷。对术后X线片和MRI进行评估，以观察病变愈合情况和关节退变情况。74.3%的病例进行了关节镜二次探查。失败定义为因处理骨软骨病变而再次干预或在最后一次随访时功能结果不佳。共纳入39例受试者，中位随访时间为10.7年。51.2%的病例使用了Herbert螺钉，25.7%的病例使用了生物可吸收钉，23.1%的病例使用了空心螺钉。三种不同固定装置在临床评分（国际膝关节文献委员会（IKDC）=0.211；Lysholm=0.197）、影像学愈合（=0.102）或影像学退变（=0.238）方面未观察到差异。关节镜二次探查发现，在所有评估的29例病例中病变完全稳定。术后Lysholm评分平均为83分（范围=33-100），IKDC评分为79分（范围=39-100）。74%的病例出现影像学愈合。影像学未愈合与较差的功能评分相关。发现失败率为20.5%：进行了4次再次干预，4例患者在最后一次随访时评分不佳。本研究表明，在骨骼成熟的患者中，髁部OCD的内固定无论病变大小和固定类型如何，均可提供良好的长期临床结果和高度的愈合率。
