Wintges Kristofer, Körner Merle, Henkies Danny, Rüther Hauke
Klinik und Poliklinik für Kinderchirurgie, Universitätsklinikum Hamburg Eppendorf, Martinistraße 52, 20251, Hamburg, Deutschland.
Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
Orthopadie (Heidelb). 2024 Sep;53(9):646-650. doi: 10.1007/s00132-024-04527-1. Epub 2024 Jul 20.
Osteochondral fractures (OCF) are traumatic shearing injuries to portions of cartilage and bone. The most common cause is patellar dislocation, with the main localisation being the medial patellar facet and the lateral femoral condyle. They can occur in all age groups.
Clinically, there is a painful knee joint effusion (haemarthrosis) with a "dancing patella". This is usually accompanied by restricted movement and/or a locking phenomenon. In addition to the standard X‑ray of the knee in three planes (lateral, anterior-posterior and tangential patella), an MRI should be performed promptly in the case of haemarthrosis and suspicious symptoms, as concomitant injuries are present in up to 70% of cases.
The aim of treatment is to restore joint congruence in order to prevent the risk of secondary osteoarthritis. Small chondral and stable osteochondral fractures can be treated conservatively. Surgery is indicated for all other OCFs. In addition to refixation with various materials (bioresorbable screws, bone plugs, suture material and Kirschner wires), cartilage regeneration procedures (AMIC, MACI, OAT, etc.) are available for late diagnosed or non-refixable fragments. However, the number of cases is small.
Osteochondral fractures are rare injuries in children and adolescents. Prompt MRI is recommended for diagnosis in cases of suspected OCF. Refixation is the preferred treatment method, with bioresorbable implants showing promising results in reducing the need for additional surgery. The risk of secondary osteoarthritis can be reduced with regular treatment.
骨软骨骨折（OCF）是软骨和骨部分的创伤性剪切损伤。最常见的原因是髌骨脱位，主要发生部位是髌骨内侧关节面和股骨外侧髁。各年龄组均可发生。
临床上，膝关节有疼痛性积液（关节积血），伴有“跳跃髌骨”。通常伴有活动受限和/或绞锁现象。除了膝关节的标准三平面X线检查（侧位、前后位和髌骨切线位）外，对于关节积血和可疑症状，应立即进行MRI检查，因为高达70%的病例存在合并损伤。
治疗目的是恢复关节一致性，以预防继发性骨关节炎的风险。小的软骨骨折和稳定的骨软骨骨折可保守治疗。所有其他骨软骨骨折均需手术治疗。除了用各种材料（可生物吸收螺钉、骨栓、缝合材料和克氏针）进行重新固定外，对于晚期诊断或无法重新固定的碎片，还可采用软骨再生手术（AMIC、MACI、OAT等）。然而，病例数量较少。
骨软骨骨折在儿童和青少年中是罕见的损伤。疑似骨软骨骨折时，建议立即进行MRI检查以明确诊断。重新固定是首选的治疗方法，可生物吸收植入物在减少额外手术需求方面显示出有前景的结果。定期治疗可降低继发性骨关节炎的风险。
