Brittberg Mats
Cartilage Research Unit, University of Gothenburg, Region Halland Orthopaedics, Varberg Hospital, S-43237, Varberg, Sweden.
J Orthop. 2022 Aug 11;34:104-110. doi: 10.1016/j.jor.2022.08.005. eCollection 2022 Nov-Dec.
Current treatments of different stages of knee osteochondritis Dissecans (OCD) are depending on the age of the patients and the stability of the diseased osteochondral area. The purpose of this paper was to summarize the treatment alternatives in order to simplify the choice for the treating surgeon.
Osteochondritis dissecans (OCD) of the knee is an idiopathic and local osteochondral abnormality that affects mainly children and adolescents with risk of loosening of osteochondral fragments. A good clinical result can be expected when the physes are still open, when the osteochondritis is small and when the osteochondritis can be assessed as stable by MRI. Unstable OCD lesions most often need to be treated operatively by different fixation methods and when the osteochondral cannot be refixated, different local chondral and osteochondral repairs are available to fill up the defect area to congruity.
The final choice of which treatment to use is depending on fragment viability and forms. Viable fragments are refixated while poor quality fragments are removed followed by a local biological osteochondral repair. Such osteochondral resurfacing may be single bone marrow stimulation with or without scaffold augmentation or different cell seeded grafts.
目前针对不同阶段的膝关节剥脱性骨软骨炎（OCD）的治疗方法取决于患者的年龄以及病变骨软骨区域的稳定性。本文的目的是总结治疗方案，以便为治疗外科医生简化选择。
膝关节剥脱性骨软骨炎（OCD）是一种特发性局部骨软骨异常，主要影响儿童和青少年，存在骨软骨碎片松动的风险。当骨骺仍开放、骨软骨炎较小且通过MRI评估骨软骨炎为稳定时，有望获得良好的临床效果。不稳定的OCD病变通常需要通过不同的固定方法进行手术治疗，当骨软骨无法重新固定时，可以采用不同的局部软骨和骨软骨修复方法来填充缺损区域使其达到平整。
最终选择何种治疗方法取决于碎片的活力和形态。有活力的碎片进行重新固定，而质量较差的碎片则予以切除，随后进行局部生物性骨软骨修复。这种骨软骨表面修复可以是单纯的骨髓刺激，有或没有支架增强，也可以是不同的细胞种植移植物。
