股骨髁骨软骨破坏性病变联合修复术在青少年中的应用：临床观察与文献综述

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详细

论证。儿童和青少年股骨髁病变的主要原因之一是营养不良过程，该过程伴有骨下骨破坏，并进一步累及覆盖软骨。主要病理状态包括离断性骨软骨炎和因糖皮质激素治疗导致的药物性骨坏死。 目前文献中缺乏关于股骨髁骨软骨缺损患者最佳手术治疗方法的数据。

临床观察。报道2例青少年广泛性股骨髁骨软骨缺损患者的临床病例。

讨论。进行了文献综述，介绍了相关分类，并探讨了股骨髁深层骨软骨缺损患者的手术治疗方法。 现有方法可获得良好至优异的临床结果，但由于缺乏涵盖所有治疗方法的随机或比较性研究，尚无法明确确定最佳手术方法。在大多数现代研究中，治疗效果主要通过间接影像学评估，而该评估方式与临床结局呈负相关，这可能会扭曲对治疗效果的正确解读。

结论。股骨髁骨软骨缺损问题在创伤与矫形外科领域具有重要意义，包括青少年和儿童患者。在众多现有治疗方法（从再血管化骨钻孔术到关节置换术）中，联合应用自体骨与胶原膜的修复术可能提供稳定的临床和功能改善效果。

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作者简介

Sergey Y. Semenov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

编辑信件的主要联系方式.
Email: sergey2810@yandex.ru
ORCID iD: 0000-0002-7743-2050
SPIN 代码: 8093-3924

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Vyacheslav I. Zorin

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov

Email: zoringlu@yandex.ru
ORCID iD: 0000-0002-9712-5509
SPIN 代码: 4651-8232

MD, PhD, Cand. Sci. (Medicine), Assistant Professor

俄罗斯联邦, Saint Petersburg; Saint Petersburg

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2. Fig. 1. Diagnostic imaging of patient B (age: 17 years at admission): a, X-ray of the right knee joint in anteroposterior and axial views; b, computed tomography scans exhibiting frontal, sagittal, and axial slices through the lesion; c, magnetic resonance imaging scans, frontal and sagittal views through the lesion. The area of destruction is indicated by an arrow.

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3. Fig. 2. Intraoperative images of patient B. a, arthrotomy, lesion is marked by an arrow; b, view of the defect after sequestrectomy, site is indicated by an arrow; the removed sequestrum is shown; c, autologous bone grafting of the defect; d, collagen membrane placed over the defect.

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4. Fig. 3. Patient B. Arthroscopic view 8 months after reconstruction.

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5. Fig. 4. Follow-up clinical and imaging evaluation of patient B at 2.5 years after reconstruction: a, range of motion in the right knee joint; b, magnetic resonance images in the frontal and sagittal planes.

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6. Fig. 5. Imaging of patient M.: a, magnetic resonance imaging, sagittal slice; b, spiral computed tomography, sagittal slice through the osteochondral defect of the lateral femoral condyle; c, spiral computed tomography, 3D reconstruction illustrating the size of the defect and the presence of a loose osteochondral fragment in the lateral femoral condyle. Arrows indicate the osteochondral defect region and the loose osteochondral fragment.

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7. Fig. 6. Intraoperative images of patient M.: a, osteochondral defect of the lateral femoral condyle, with the removed osteochondral body; b, post-resection defect filled with an autologous bone graft; c, the area of bone grafting was covered with a collagen membrane secured with interrupted sutures.

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8. Fig. 7. Patient M. Computed tomography of the left knee joint with three standard projections. The bone graft zone is indicated by an arrow.

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