University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA.
University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA.
Knee. 2022 Aug;37:180-187. doi: 10.1016/j.knee.2022.06.009. Epub 2022 Jul 6.
Bioabsorbable fixation in managing osteochondral lesions is increasing in popularity. The purpose was to report on outcomes using bioabsorbable fixation nails for osteochondral lesions of the knee in a pediatric and adolescent population.
A retrospective review of pediatric patients undergoing surgery with bioabsorbable fixation for knee osteochondral lesions was performed. Demographic, clinical, and surgical data was collected including symptom duration, lesion location, size, use of bone grafting, and number of implants. Return to activities was documented. Patients recommended revision surgery were compared to those who were not.
47 patients with median age 13.9 years and 25.5% female were included with median clinical follow-up of 47.3 weeks. 87.2% of patients were cleared for full activities. Four male patients (8.5%) were recommended revision surgery, of whom three underwent surgery including removal of loose bioabsorbable fixation. Demographic data did not differ between the group with successful versus failed primary surgery (p > 0.05). Symptom duration was more acute (<1 month) in the four recommended revision surgery (75% versus 9.3%, p = 0.008). The group recommended revision also had larger lesion size (median 5.4 cm versus 2 cm, p = 0.04). Distal femoral physeal status, lesion location, necessity for bone grafting, and number of implants did not differ between groups.
Adolescents had a high return to activity following bioabsorbable fixation for knee osteochondral lesions with 87.2% cleared for full return. In the 8.5% of patients who were deemed to have failed primary fixation, symptoms were more likely to be acute in nature with larger lesion sizes.
可吸收固定在治疗骨软骨病变中的应用越来越普及。本研究旨在报告儿童和青少年膝关节骨软骨病变采用可吸收固定钉治疗的结果。
对接受可吸收固定治疗膝关节骨软骨病变的儿童患者进行回顾性研究。收集了人口统计学、临床和手术数据，包括症状持续时间、病变位置、大小、是否使用骨移植以及植入物数量。记录了患者重返活动的情况。比较了建议行翻修手术的患者和未建议行翻修手术的患者。
纳入 47 例患者，平均年龄为 13.9 岁，女性占 25.5%，平均临床随访时间为 47.3 周。87.2%的患者可完全活动。4 名男性患者（8.5%）建议行翻修手术，其中 3 名患者接受了手术，包括取出松动的可吸收固定物。两组患者的基本资料（p＞0.05）和初次手术的成功率无差异。建议行翻修手术的患者中，症状持续时间更短（＜1 个月）（75% vs 9.3%，p=0.008）。建议行翻修手术的患者病变面积更大（中位数 5.4cm vs 2cm，p=0.04）。股骨远端骨骺状态、病变位置、是否需要植骨以及植入物数量在两组间无差异。
儿童膝关节骨软骨病变采用可吸收固定治疗后，有 87.2%的患者可完全活动，8.5%的患者初次固定失败，症状更可能为急性，病变面积更大。
