| 膝关节软骨损伤的外科治疗进展 |
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投稿时间：2016-12-08
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| 作者 | Author | 单位 | Address | E-Mail |
| 辛龙 |
XIN Long |
浙江省立同德医院骨科, 浙江 杭州 310012 |
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| 张春 |
ZHANG Chun |
浙江省立同德医院骨科, 浙江 杭州 310012 |
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| 徐卫星 |
XU Wei-xing |
浙江省立同德医院骨科, 浙江 杭州 310012 |
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| 钟甫华 |
ZHONG Fu-hua |
浙江省立同德医院骨科, 浙江 杭州 310012 |
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| 范顺武 |
FAN Shun-wu |
浙江大学附属邵逸夫医院骨科, 浙江 杭州 310016 |
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| 王振斌 |
WANG Zhen-bin |
新疆医科大学第四附属医院骨科, 新疆 乌鲁木齐 830002 |
Department of Orthopaedics, the Forth Affiliated Hospital to Xinjiang Medical Univesity, Urummqi 830002, Xinjiang, China |
wangzb0202@163.com |
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| 期刊信息：《中国骨伤》2018年，第31卷，第3期，第281-285页 |
| DOI：10.3969/j.issn.1003-0034.2018.03.019 |
| 基金项目:浙江省卫计委基金（编号：2010KYB026） |
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| 中文摘要:关节软骨损伤后，软骨缺损通常缺乏自行修复能力，要求外科修复。传统外科治疗软骨损伤包括关节镜下冲洗清理术、微骨折术、自体骨软骨移植术、异体骨软骨移植术和自体软骨细胞移植等方法。关节冲洗清理术去除了关节内致痛因素，操作简单，应用广泛，早期疗效确切。微骨折术及自体骨软骨移植对小面积的软骨缺损修复较为理想，然而远期临床观察发现钻孔渗透修复的纤维软骨会降低微骨折术后疗效，相对于重建负重区关节面完整性自体骨软骨移植更具有优势。自体软骨细胞移植及异体骨软骨移植适用于更大面积的软骨缺损，异体骨软骨移植术后存活率受到局部排斥反应影响，从而降低了远期疗效。软骨组织工程技术可最大限度地提高自体软骨细胞移植的修复质量，实现修复组织接近透明软骨，但对于累及软骨下骨板、反应性骨水肿、严重骨量丢失或下肢轴线不良具有局限性。近年来许多新技术陆续应用于软骨损伤治疗领域，创伤小、操作简便、恢复快、疗效好、花费低、多技术联合应用的外科修复技术将会成为未来的治疗软骨损伤的重要手段。目前如何提高软骨修复质量，更具抗压、耐磨性，仍亟待解决。 |
| 【关键词】膝关节 软骨损伤 外科治疗 综述文献 |
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| Current advances on surgical treatment for knee articular cartilage injuries |
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| ABSTRACT Chondral injuries are short of self-healing ability and need to surgical repair after articular cartilage injury. Conventional treatment includes debridement and drainage under arthroscope,micro-fracture,osteochondral autograft transplantation (OATS),mosaiplasty and osteochondral allografts (OCA),autologous chondrocyte implantation (ACI). Debridement and drainage could remove pain factor,and has advantages of simple operation,wide clinical application and early clinical effect. Micro-fracture and osteochondral autograft transplantation is suitable for small area of cartilage repair,while the further effect showed that fibrous cartilage permeated by drill could decrease postoperative clinical effect. Osteochondral autograft transplantation has better advantages for reconstruction complete of wear-bearing joint. Autologous chondrocyte implantation and allogeneic cartilage transplantation are suitable for large area of cartilage defect,postoperative survival of allogeneic cartilage transplantation is effected by local rejection reaction and decrease further clinical effect. Cartilage tissue engineering technology could improve repair quality of autologous chondrocyte implantation,and make repair tissue close to transparent cartilage,but has limit to combined subchondral bone plate,reactive bone edema,bone loss and bad axis of lower limb. New technology is applied to cartilage injury,and has advantages of less trauma,simple operation,rapid recover,good clinical effect and less cost;and could be main method for treat cartilage injury with surgical repair technology. How to improve repair quality with compression resistance and abrasive resistance are expected to be solved. |
| KEY WORDS Knee joint Cartilage injury Surgical treatment Review literature |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 辛龙,张春,徐卫星,钟甫华,范顺武,王振斌.膝关节软骨损伤的外科治疗进展[J].中国骨伤,2018,31(3):281~285 |
| 英文格式: | XIN Long,ZHANG Chun,XU Wei-xing,ZHONG Fu-hua,FAN Shun-wu,WANG Zhen-bin.Current advances on surgical treatment for knee articular cartilage injuries[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(3):281~285 |
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