中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (3): 397-402.doi: 10.3969/j.issn.2095-4344.2988

• 骨科植入物Orthopedic implants • 上一篇    下一篇

Herbert螺钉内固定治疗成年人膝关节剥脱性骨软骨炎

王晓非1,滕学仁2,丛琳岩1,周  旭1,马振华2   

  1. 1大连医科大学,辽宁省大连市   116044;2青岛市市立医院骨关节与运动医学科,山东省青岛市  266071
  • 收稿日期:2020-02-26 修回日期:2020-03-05 接受日期:2020-04-21 出版日期:2021-01-28 发布日期:2020-11-17
  • 通讯作者: 马振华,硕士,副主任医师,青岛市市立医院骨关节与运动医学科,山东省青岛市 266071
  • 作者简介:王晓非,男,1992年生,山东省济宁市人,汉族,2020年大连医科大学毕业,硕士,医师,主要从事骨关节与运动医学方向研究。

Herbert screw internal fixation for treating adult osteochondritis dissecans of the knees

Wang Xiaofei1, Teng Xueren2, Cong Linyan1, Zhou Xu1, Ma Zhenhua2   

  1. 1Dalian Medical University, Dalian  116044, Liaoning Province, China; 2Department of Bone, Joint and Sports Meicine, Qingdao Municipal Hospital, Qingdao  266071, Shandong Province, China
  • Received:2020-02-26 Revised:2020-03-05 Accepted:2020-04-21 Online:2021-01-28 Published:2020-11-17
  • Contact: Ma Zhenhua, Master, Associate chief physician, Department of Bone, Joint and Sports Medicine, Qingdao Municipal Hospital, Qingdao 266071, Shandong Province, China
  • About author:Wang Xiaofei, Master, Physician, Dalian Medical University, Dalian 116044, Liaoning Province, China

摘要:

文题释义:
剥脱性骨软骨炎:是指各种致病因素导致的局限性关节软骨及软骨下骨病变,并逐渐与其周围正常骨分离、脱落的一种关节疾病,可发生于全身任何关节,以膝关节发病最为常见,即股骨内外侧髁最易受累,多见于运动量较大的青少年。
膝关节骨性关节炎:是骨科常见的慢性关节疾病,特点是膝关节软骨的退行性变和关节周围继发性骨质增生。在膝关节部位还常患有膝关节滑膜炎、韧带损伤、半月板损伤、膝关节游离体、腘窝囊肿、髌骨软化、鹅足滑囊炎、膝内/外翻等关节疾病。

背景:成年人膝关节剥脱性骨软骨炎会出现局部关节软骨与软骨下骨不稳定,如不及时治疗,将对关节软骨产生继发性影响,发生膝关节骨性关节炎的概率明显提高,目前尚缺乏明确的治疗方案。
目的:探讨膝关节镜联合Herbert双向加压螺钉内固定治疗膝关节剥脱性骨软骨炎的临床疗效。
方法:回顾性分析2014年6月至2018年9月接受治疗的符合膝关节剥脱性骨软骨炎诊断标准的成年人患者,并排除合并其他膝关节疾病者。接受治疗的患者有43例,其中男25例,女18例,所有患者均行膝关节镜联合Herbert双向加压螺钉内固定治疗;所有患者均为成年人,年龄18-53岁,平均为(29.00±4.62)岁;所有患者均为单侧膝关节发病,其中左侧19例,右侧24例。治疗前和末次随访时对比膝关节活动度,使用目测类比评分评估膝关节疼痛程度,膝关节Lysholm评分评价膝关节功能变化情况。
结果与结论:①43例患者中有35例完成1年以上随访,随访时间为12-20个月,平均(14.0±2.5)个月,无一例患者出现相关并发症;②治疗后所有患者膝关节疼痛与功能均显著改善,治疗前膝关节活动度为(109.57±12.45)°,末次随访时膝关节活动度为(126.39±13.73)°,差异有显著性意义(t=-56.72,P < 0.001);治疗前目测类比评分为(5.53±1.47)分,治疗后为(0.79±1.35)分,差异有显著性意义(t=-137.51,P < 0.001);治疗前Lysholm评分为(58.27±10.51)分,治疗后为(89.36±5.43)分,差异有显著性意义(t=-163.65,P < 0.001);③结果表明,应用膝关节镜联合Herbert双向加压螺钉治疗成年人膝关节剥脱性骨软骨炎固定可靠、手术创伤小,可以显著改善膝关节功能,临床疗效满意。
https://orcid.org/0000-0001-9051-7764 (王晓非) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 骨, 膝关节, 关节镜, 内固定, 螺钉, 剥脱性骨软骨炎, 疼痛, 活动度

Abstract: BACKGROUND: Osteochondritis dissecans of the knee in adults may lead to local instability of articular cartilage and subchondral bone. If it is not treated in time, it will have a secondary impact on articular cartilage, and the probability of osteoarthritis of knee joint is significantly increased. At present, there is no clear treatment plan. 
OBJECTIVE: To investigate the clinical effect of knee arthroscopy combined with Herbert bidirectional compression screw internal fixation for osteochondritis dissecans of the knee.  
METHODS: Adult patients who met the diagnostic criteria of osteochondritis dissecans of the knee from June 2014 to September 2018 were retrospectively analyzed, and those with other knee joint diseases were excluded. There were 43 patients treated, including 25 males and 18 females. All patients were treated with knee arthroscopy combined with Herbert two-way compression screw internal fixation. All patients were adults, aged 18-53 years, with an average age of (29.00±4.62) years. All patients had unilateral knee joint disease, including 19 cases of the left limb and 24 cases of the right limb. Before treatment and at final follow-up, knee motion range was compared. Visual analogue scale score was used to evaluate knee pain. Knee Lysholm score was used to evaluate knee function. 
RESULTS AND CONCLUSION: (1) Of the 43 patients, 35 completed the follow-up time of more than 1 year, and the follow-up time was 12-20 months, with an average of (14.0±2.5) months. None of the patients had related complications. (2) Knee joint pain and function improved significantly in all patients after surgery. The mean knee motion range before operation was (109.57±12.45)°, and (126.39±13.73)° at the final follow-up (t=-56.72, P < 0.001). Visual analogue scale score was (5.53±1.47) before surgery and (0.79±1.35) (t=-137.51, P < 0.001) after surgery. Mean Lysholm score was (58.27±10.51) before surgery, and (89.36±5.43) postoperatively (t=-163.65, P < 0.001). (3) Knee arthroscopy combined with Herbert’s two-way compression screw internal fixation for adult osteochondritis dissecans of knee has reliable fixation and small surgical trauma, which can significantly improve knee function, and the clinical effect is satisfactory.

Key words: bone, knee joint, arthroscopy, internal fixation, screw, exfoliative chondritis, pain, motion range

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