生物综合钉固定术改善膝关节软骨下功能不全患者的疼痛和功能

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-06-01 DOI:10.1016/j.asmr.2025.101105

Alexander C. Weissman M.S., Allen A. Yazdi B.S., Jared P. Sachs M.S., Sarah A. Muth B.A., Andrew S. Bi M.D., Ron Gilat M.D., Brian J. Cole M.D., M.B.A.

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引用次数: 0

摘要

目的探讨胫骨平台或股骨髁内植入生物一体化空心钉治疗膝关节软骨下功能不全的疗效。方法对软骨下功能不全患者采用生物一体化纤维增强固定钉进行手术干预后随访12个月。患者（年龄18-75岁）中度膝关节疼痛至少6个月，单室kelgren - lawrence分级2-3级，磁共振成像（MRI）证实骨髓病变。比较基线和术后膝关节损伤和骨关节炎结局评分（oos）是主要的结局指标。其他患者报告的结果测量包括国际膝关节文献委员会（IKDC）和患者报告的结果测量信息系统（PROMIS）。计算每个PRO的最小临床重要差异。从基线到术后12个月，通过MRI测量计算出的骨髓病变体积进行比较。结果9例患者入组，随访12±1个月。kos、IKDC、PROMIS和退伍军人RAND 12项健康调查（VR-12）均有显著改善。患者报告的12个月预后指标的平均变化为kos （19.68, P = 0.008）、IKDC （28.99, P = 0.004）、PROMIS疼痛干扰（10.35,P = 0.008）、PROMIS身体功能（11.06,P = 0.008）和VR-12 Physical （16.14, P = 0.008）。89%的kos患者、100%的IKDC患者、87.5%的PROMIS疼痛干扰和生理功能患者、62.5%的VR-12生理功能患者实现了最小的临床重要差异。MRI测量的软骨下病变大小平均减小，差异无统计学意义（P = 0.064）。所有患者均成功恢复运动，无再次手术或植入失败。结论：在早中度骨关节炎患者12个月的随访中，生物综合固定钉支架治疗膝关节软骨下功能不全可改善患者报告的疼痛和功能。证据水平：IV级，治疗性病例系列。

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Biointegrative Nail Raftering Improves Pain and Function in Patients With Subchondral Insufficiency of the Knee

Purpose

To evaluate the utility of implanting biointegrative cannulated nails in a rafter arrangement within the tibial plateau or femoral condyle for treatment of subchondral insufficiency of the knee.

Methods

Patients were followed for 12 months after surgical intervention for subchondral insufficiency using biointegrative, fiber-reinforced fixation nails. Patients (ages 18-75 years) had moderate knee pain for at least 6 months, unicompartmental Kellgren-Lawrence grade 2-3 and bone marrow lesions confirmed on magnetic resonance imaging (MRI). Comparison of baseline and postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) was the primary outcome measure. Other patient-reported outcome measures included International Knee Documentation Committee (IKDC) and Patient-reported Outcomes Measurement Information System (PROMIS). Minimal clinically important difference was calculated for each PRO. Calculated bone marrow lesion volumes measured on MRI were compared from baseline to 12 months postoperative.

Results

Nine patients were included, with follow-up of 12 ± 1 months. Significant improvements were seen in KOOS, IKDC, PROMIS, and Veterans RAND 12-Item Health Survey (VR-12). The average change in patient-reported outcome measures at 12 months were KOOS (19.68, P = .008), IKDC (28.99, P = .004), PROMIS Pain Interference (10.35, P = .008), PROMIS Physical Function (11.06, P = .008), and VR-12 Physical (16.14, P = .008). Minimal clinically important difference was achieved in 89% of patients for KOOS, 100% for IKDC, 87.5% for PROMIS Pain Interference and Physical Function, and 62.5% for VR-12 Physical. The average decrease in subchondral lesion size measured on MRI did not reach statistical significance (P = .064). All patients reported successful return to sport, with no reoperations or implant failures.

Conclusions

Biointegrative fixation nail raftering for treatment of subchondral insufficiency of the knee resulted in improved patient-reported pain and functionality at 12-month follow-up in the setting of early-to-moderate osteoarthritis.