Pediatric Traumatology, Orthopaedics and Reconstructive Surgery

Ортопедия, травматология и восстановительная хирургия детского возраста

Pediatric Traumatology, Orthopaedics and Reconstructive Surgery

2309-39942410-8731

Eco-Vector

649883

10.17816/PTORS649883

CLSGZJ

Clinical cases

Клинические случаи

Clinical cases

Research Article

Combined reconstruction of femoral condylar osteochondral defects in adolescents: clinical cases and a review

Комбинированная пластика дефектов мыщелков бедра при остеохондральных деструкциях у подростков. Клинические наблюдения и обзор литературы

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

https://orcid.org/0000-0002-7743-2050

8093-3924

Semenov

Sergey Y.

Семенов

Сергей Юрьевич

Semenov

Sergey Y.

Russian Federation

MD, PhD, Cand. Sci. (Medicine)

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канд. мед наук

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MD, PhD, Cand. Sci. (Medicine)

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sergey2810@yandex.ru

https://orcid.org/0000-0002-9712-5509

4651-8232

Zorin

Vyacheslav I.

Зорин

Вячеслав Иванович

Zorin

Vyacheslav I.

Russian Federation

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

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канд. мед. наук, доцент

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

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zoringlu@yandex.ru

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma SurgeryНациональный медицинский исследовательский центр детской травматологии и ортопедии имени Г.И. ТурнераH. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

North-Western State Medical University named after I.I. MechnikovСеверо-Западный государственный медицинский университет имени И.И. МечниковаNorth-Western State Medical University named after I.I. Mechnikov

15032025

18042025

131

86963101202524022025

2025

Eco-Vector

Эко-Вектор

Eco-Vector

https://creativecommons.org/licenses/by-nc-nd/4.0/

https://journals.eco-vector.com/turner/article/view/649883

BACKGROUND: A leading cause of femoral condylar lesions in children and adolescents is dystrophic processes resulting in subchondral bone destruction followed by overlying cartilage involvement. The most common pathological conditions include osteochondritis dissecans and corticosteroid-induced osteonecrosis. Currently, there is no consensus on the optimal surgical approach for treating osteochondral defects of the femoral condyles.

CASE DESCRIPTIONS: Two clinical cases of adolescents with extensive osteochondral defects of the femoral condyles are presented.

DISCUSSION: This article provides a review, existing classification systems, and an overview of surgical options for deep osteochondral defects of the femoral condyles. Existing methods induce good to excellent clinical outcomes. However, the absence of randomized and comparative studies of these treatment approaches does not allow for a clear determination of the optimal surgical strategy. In most contemporary studies, outcomes are assessed using indirect imaging methods, which negatively correlate with clinical results and may distort accuracy of treatment outcome interpretation.

CONCLUSION: Osteochondral defects of the femoral condyles remain a critical problem in pediatric and adolescent orthopedics and traumatology. Considering the variety of existing surgical techniques (from revascularization osteoperforation to joint replacement), combined reconstruction using autologous bone grafts and collagen membranes may offer stable and favorable clinical and functional outcomes.

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Обоснование. Одна из ведущих причин поражений мыщелков бедра у детей и подростков — дистрофические процессы, сопровождающиеся деструкцией субхондральной кости с последующим вовлечением покровного хряща. К основным патологическим состояниям относят рассекающий остеохондрит и лекарственный остеонекроз вследствие терапии глюкокортикоидами. В современной литературе нет данных об оптимальном методе хирургического лечения пациентов с костно-хрящевыми дефектами мыщелков бедра.

Клинические наблюдения. Представлены два клинических наблюдения пациентов подросткового возраста с обширными остеохондральными дефектами мыщелков бедра.

Обсуждение. Приведен обзор литературы, представлены классификации, рассмотрены варианты хирургического лечения пациентов с глубокими остеохондральными дефектами мыщелков бедра. Имеющиеся методы могут обеспечивать клинические результаты от хороших до отличных, но отсутствие рандомизированных или сравнительных исследований по всему спектру этих подходов лечения не позволяет четко определить оптимальный вариант хирургического лечения. В большей части современных исследований оценивают результаты за счет непрямой визуализации, которая отрицательно коррелирует с клиническим исходом, что может искажать правильную интерпретацию результата лечения.

Заключение. Проблема остеохондральных дефектов мыщелков бедра актуальна в травматологии и ортопедии, в том числе у пациентов молодого и детского возраста. На фоне множества существующих методик (от реваскуляризирующей остеоперфорации до эндопротезирования) комбинированная пластика аутокостью в сочетании с коллагеновыми мембранами может обеспечивать стойкий положительный клинический и функциональный результат.

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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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osteochondritis dissecansosteonecrosisadolescentschondroplastybone graftingarticular cartilageknee joint

рассекающий остеохондритостеонекрозподросткихондропластикакостная пластикасуставной хрящколенный сустав

离断性骨软骨炎骨坏死青少年软骨成形术骨成形术关节软骨膝关节

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