生物可吸收螺钉固定术对初期保守治疗未见好转的稳定型骨软骨炎脱位病变的中期随访结果良好，失败率低

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-02-12 DOI:10.1016/j.asmr.2023.100863

Ryan Quigley M.D., Sachin Allahabadi M.D., Allen A. Yazdi B.S., Landon P. Frazier B.S., Katie J. McMorrow B.S., Zachary D. Meeker B.S., Kyle R. Wagner M.D., Jimmy Chan M.D., Brian J. Cole M.D., M.B.A.

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引用次数: 0

摘要

目的评价对保守治疗至少 6 个月无效的完整、稳定的 I 级和 II 级骨软骨炎（OCD）病变进行生物可吸收螺钉固定的患者的临床和影像学疗效。方法对一家医疗机构前瞻性收集的数据进行回顾性审查，以确定 2010 年 1 月至 2020 年 1 月间对稳定的 I 级和 II 级 OCD 病变（根据 Guhl 分类）进行内固定的患者。无论是否同时接受手术，患者均被纳入研究范围。纳入标准包括：（1）初次手术；（2）至少 6 个月的保守治疗失败；（3）使用生物可吸收螺钉；（4）至少 2 年的临床随访。术后至少 1 年进行射线照相。结果对 23 名患者（96%随访）的 24 个膝关节进行了分析，随访时间为 6.36 ± 3.42 年（2.0-12.7 年）。患者术后在所有患者报告的结果（包括 Lysholm 评分、国际膝关节文献委员会评分以及膝关节损伤和骨关节炎结果评分子量表）方面均有统计学意义的改善（P <.05）。有 3 个膝关节（12%）在指数手术后平均 3.64 年因手术失败而需要再次手术。使用生物可吸收螺钉后没有出现特殊并发症。结论使用生物可吸收螺钉对稳定的I级和II级OCD病变进行内固定治疗效果可靠，但对于经过至少6个月的保守治疗无效的患者来说，失败率仅为12%。在中期随访期间，临床效果明显改善。

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Bioabsorbable Screw Fixation Provides Good Results With Low Failure Rates at Mid-term Follow-up of Stable Osteochondritis Dissecans Lesions That Do Not Improve With Initial Conservative Treatment

Purpose

To evaluate the clinical and radiographic outcomes of patients who have undergone bioabsorbable screw fixation for intact, stable grade I and II osteochondritis dissecans (OCD) lesions for which at least 6 months of conservative management has failed.

Methods

A retrospective review of prospectively collected data from a single institution was performed to identify patients who underwent internal fixation of stable grade I and II OCD lesions (according to the Guhl classification) between January 2010 and January 2020. Patients were included regardless of the presence of concomitant procedures. The inclusion criteria consisted of (1) primary surgery, (2) failure of at least 6 months of conservative management, (3) the use of a bioabsorbable screw (or screws), and (4) minimum 2-year clinical follow-up. Radiographs were obtained at a minimum of 1 year postoperatively. Patient demographic characteristics, clinical patient-reported outcomes, complications, and failure rates were noted.

Results

Twenty-four knees among 23 patients (96% follow-up) were analyzed and followed up for 6.36 ± 3.42 years (range, 2.0-12.7 years). Patients showed statistically significant postoperative improvements in all patient-reported outcomes including the Lysholm score, International Knee Documentation Committee score, and Knee Injury and Osteoarthritis Outcome Score subscales (P < .05). In 3 knees (12%), a reoperation was required due to failure at an average of 3.64 years after the index procedure. No specific complications were attributed to the use of bioabsorbable screws. Patients in whom primary surgical treatment failed did not differ in demographic characteristics, arthroscopic findings, or surgical treatment from those who had successful treatment.

Conclusions

Internal fixation of stable grade I and II OCD lesions with bioabsorbable screws produces reliable results with a 12% rate of failure in appropriately indicated patients in whom at least 6 months of conservative management has failed. Clinical outcomes improved significantly during the mid-term follow-up period.