Buckwalter J A
Department of Orthopaedic Surgery, University of Iowa College of Medicine, Iowa City 52242, USA.
J Orthop Sports Phys Ther. 1998 Oct;28(4):192-202. doi: 10.2519/jospt.1998.28.4.192.
Impact and torsional joint loading can injure articular cartilage, causing pain, joint dysfunction and effusions, and, in some instances, progressive joint degeneration. Differences in the type of injury and the repair response distinguish three classes of articular surface injuries: 1) damage to the joint surface that leaves the articular surface intact but causes internal chondral damage and may cause subchondral bone injury, 2) mechanical disruption of the articular surface limited to articular cartilage, and 3) mechanical disruption of articular cartilage and subchondral bone. A variety of treatments has the potential to improve healing of articular surfaces, including perforation of subchondral bone, altered joint loading, periosteal and perichondrial grafts, cell transplantation, growth factors, and artificial matrices. Selection of treatment for a patient with an articular cartilage injury should be guided by an understanding of the type of injury, the potential for healing, and the effects of treatment on joint surface restoration.
冲击和扭转关节负荷会损伤关节软骨，导致疼痛、关节功能障碍和积液，在某些情况下还会导致关节进行性退变。损伤类型和修复反应的差异区分了三类关节面损伤：1）关节表面损伤，关节表面保持完整，但导致软骨内部损伤，并可能导致软骨下骨损伤；2）仅限于关节软骨的关节表面机械性破坏；3）关节软骨和软骨下骨的机械性破坏。多种治疗方法有可能改善关节面愈合，包括软骨下骨穿孔、改变关节负荷、骨膜和软骨膜移植、细胞移植、生长因子和人工基质。对于关节软骨损伤患者的治疗选择，应以对损伤类型、愈合潜力以及治疗对关节面修复的影响的了解为指导。
