关节镜下微骨折技术联合关节内注射玻璃酸钠修复膝关节软骨缺损

摘要

Objective; To evaluate the treatment of knee chondral defect by microfracture (MF) technique in combination with intraarticular hyaluronic acid sodium injection. Methods; Twelve chondral defect patients on the femoral condyles were treated by MF under arthroscopy, with defect area 2.0-6.0 cm , average 3.2 cm . Postoperative 3 weeks all cases receive intraarticular injections of 20 mg hyaluronic acid sodium weekly. And the cases were followed up, the knee Lysholm scores, visual analog scores ( VAS) and complications were observed. Results; All the patients were followed up for 6 to 36 months (means 17.5 months). Two cases were rated as excellent, 6 as good, 3 as fair and 1 poor, the excellent-good rate was 66. 7% of the ultimate knee Lysholm scores. The ultimate knee Lysholm scores and VAS were significantly better than preoperative [ Lysholm scores ( 46. 2 ±3. 6) scores vs (78. 4 ± 4. 9 ) scores, P < 0. 01; and VAS (4. 26 ± 0. 56 ) scores vs (1. 82 ± 0. 14 ) scores, P <0. 05 ]. Nine patients had hematoma in knee joint capsule, two cases had slight joint pain and clicked occasionally. Conclusion: MF in combination with intraarticular hyaluronic acid sodium injection has good effect for chondral lesion on femoral condyles, which is one kind of uncomplicated and practical method for cartilage restoration.%目的:评价微骨折技术(microfracture,MF)联合关节内注射玻璃酸钠修复膝关节软骨缺损的修复效果.方法:对12例股骨髁软骨缺损患者采用关节镜下MF修复,缺损面积约2.0～6.0cm2,平均3.2cm2.术后第1、2、3周患膝关节腔注射玻璃酸钠20mg,1 次·周-1.术后随访,对比手术前后的膝关节Lysholm评分、痛觉视觉模拟评分(VAS),记录术后并发症.结果:术后随访6～36个月,平均17.5个月.最终随访Lysholm评分优2例、良6例、中3例、差1例,优良率为66.7%.术前Lysholm评分(46.2±3.6)分,随访终末时为(78.4±4.9)分,差异具有统计学意义(P<0.01).术前VAS为(4.26±0.56)分,终末随访时为(1.82±0.14)分,差异具有统计学意义(P<0.05).9例并发关节腔积血,2例有关节轻度疼痛和偶有交锁.结论:MF联合术后关节内注射玻璃酸钠对膝关节软骨损伤的修复效果较满意,是一种操作简单、实用的软骨修复技术.