Arthroplasty, Subchondral

关节成形术,软骨下
  • 文章类型: Journal Article
    目的:骨髓刺激是髋关节全层软骨缺损的常用治疗方法。然而,常见的手术可能会导致不良的纤维修复组织和软骨下解剖结构的变化。这项研究调查了与接受简单清创/软骨成形术的人相比,接受骨髓刺激治疗的国际软骨修复协会(ICRS)3级和4级软骨缺损队列的临床结果。
    方法:在这项回顾性注册研究中,包括236例髋臼软骨单灶性病变至400mm²(平均177.4±113.4mm²),ICRS等级≥3,随访至少12个月(平均33.2±15.3个月)的患者。81例患者除了接受基础病理治疗外,还接受了骨髓刺激(微骨折:n=44,磨损:n=37)。155例患者接受了缺损清创/软骨成形术。使用国际髋关节结果工具33(iHOT33)评分和疼痛视觉模拟量表(VAS)测量患者报告的结果。
    结果:清创组术后6、12、24、36和60个月与术前评分相比,iHOT33和VAS均有显著的统计学改善(p<0.001)。而微骨折或磨损后的iHOT33和VAS没有显示出统计学上显著的变化。术后24个月和60个月,清创组发现iHOT33评分明显高于骨髓刺激组。
    结论:与骨髓刺激治疗的患者相比,在保留软骨下骨板的情况下,髋部软骨病变≤400mm2的患者在功能结局和疼痛方面可持续受益于关节镜清理。这些发现阻碍了目前推荐的髋关节微骨折的使用。
    方法:三级。
    OBJECTIVE: Bone marrow stimulation is a common treatment for full-thickness cartilage defects in the hip joint. However, common procedures may result in poor fibrous repair tissue and changes to the subchondral anatomy. This study investigated the clinical outcome of a cohort of International Cartilage Repair Society (ICRS) grades 3 and 4 cartilage defects treated with bone marrow stimulation compared to those who received simple debridement/chondroplasty.
    METHODS: In this retrospective registry study, 236 patients with uni-focal acetabular chondral lesions of the hip up to 400 mm² (mean 177.4 ± 113.4 mm²) and of ICRS grade ≥3 with follow-up of at least 12 months (mean 33.2 ± 15.3 months) were included. Eighty-one patients underwent bone marrow stimulation (microfracture: n = 44, abrasion: n = 37) besides treatment of the underlying pathology, 155 patients underwent defect debridement/chondroplasty. The patient-reported outcome was measured using the International Hip Outcome Tool 33 (iHOT33) score and the Visual Analogue Scale (VAS) for pain.
    RESULTS: iHOT33 and VAS both improved highly statistically significantly (p < 0.001) in the debridement group after 6, 12, 24, 36 and 60 months compared to the preoperative scores, whereas iHOT33 and VAS after microfracture or abrasion did not show statistically significant changes over time. Twenty-four and sixty months postsurgery the debridement group revealed significant higher scores in the iHOT33 compared to the bone marrow stimulation groups.
    CONCLUSIONS: Patients with chondral lesions of the hip ≤400 mm2 sustainably benefit from arthroscopic debridement under preservation of the subchondral bone plate in terms of functional outcome and pain in contrast to patients treated with bone marrow stimulation. These findings discourage the currently recommended use of microfracture in the hip joint.
    METHODS: Level III.
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  • 文章类型: Journal Article
    运动员髋部的软骨缺损是比较常见的,常表现为衰弱的疼痛和活动受限。术前识别软骨缺损具有挑战性,并且有许多不同的治疗方式。非手术干预,包括活动修改,物理治疗,和注射,发挥至关重要的作用,特别是在不太严重的病例中,作为手术干预的辅助手段。治疗外科医生必须熟悉可用的软骨修复程序,包括清创,微骨折,以及各种植入和移植选择。安全有效地管理软骨缺损是运动员回归体育运动的必要条件。外科医生也必须了解所有这些不同的治疗方案,以确定哪种方式最适合患者。这篇评论概述了这些选择,涵盖已出版的文献,并为外科医生在办公室和手术室中遇到软骨缺损时提供一般指导。
    Chondral defects in the athlete\'s hip are a relatively common occurrence, often presenting with debilitating pain and activity limitation. Preoperative identification of cartilage defects is challenging and there are many different modalities for treatment. Nonsurgical interventions, including activity modification, physical therapy, and injections, play a vital role, especially in less severe cases and as adjuncts to surgical intervention. Treating surgeons must be familiar with the cartilage restoration procedures available, including debridement, microfracture, and various implantation and transplantation options. Safe and effective management of cartilage defects is imperative to an athlete\'s return to sport. It is also imperative that surgeons are aware of all these various treatment options to determine what modality is best for their patients. This review serves to outline these options, cover the published literature, and provide general guidelines for surgeons when they encounter chondral defects in the office and the operating room.
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  • 文章类型: Case Reports
    背景:涉及距下关节的距骨外侧突骨软骨损伤很少见;由于报道很少,因此最佳的手术治疗仍有待澄清。此外,双边病例极为罕见。因此,涉及距下关节的距骨外侧突双侧骨软骨损伤的手术治疗的临床结果尚未完全阐明。
    方法:一名踢足球的16岁男孩因双侧后足疼痛就诊。即使经过3个月的保守治疗,症状仍然存在。患者和家属要求手术治疗以缓解症状。
    方法:患者诊断为距骨外侧突双侧骨软骨损伤,根据计算机断层扫描和磁共振成像结果,涉及距下关节。
    方法:双侧进行关节镜下清理和微骨折。
    结果:双足的术后计算机断层扫描和磁共振成像显示软骨下骨重塑。患者恢复到受伤前的水平,没有疼痛。
    结论:本报告描述了距骨外侧突的双侧骨软骨损伤,涉及距下关节。关节镜下清理和微骨折可有效缓解症状和软骨下骨重建。据我们所知,这是关节镜治疗距骨外侧突骨软骨损伤累及距下关节的首次报道。
    BACKGROUND: Osteochondral lesions on the lateral process of the talus involving the subtalar joint are rare; the optimal surgical treatment remains to be clarified as there are few reports. Additionally, bilateral cases are extremely rare. Therefore, the clinical outcomes of the surgical treatment for bilateral osteochondral lesions on the lateral process of the talus involving the subtalar joint have not been fully elucidated.
    METHODS: A 16-year-old boy who played soccer presented to our hospital with bilateral hindfoot pain. The symptoms persisted even after 3 months of conservative treatment. The patient and family requested surgical treatment to relieve the symptoms.
    METHODS: The patient was diagnosed with bilateral osteochondral lesions on the lateral process of the talus, involving the subtalar joint based on computed tomography and magnetic resonance imaging findings.
    METHODS: Arthroscopic debridement and microfracture were performed bilaterally.
    RESULTS: Postoperative computed tomography and magnetic resonance imaging of both feet revealed remodeling of the subchondral bone. The patient returned to play at the pre-injury level with no pain.
    CONCLUSIONS: This report describes a case of bilateral osteochondral lesions on the lateral process of the talus, involving the subtalar joint. Arthroscopic debridement and microfracture were effective in relieving symptoms and the subchondral bone remodeling. To the best of our knowledge, this is the first report of arthroscopic treatment of osteochondral lesions of the lateral process of the talus involving the subtalar joint.
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  • 文章类型: Journal Article
    目的:本研究旨在比较放射学,生物力学,以及使用包含明胶-透明质酸-藻酸盐的三维(3D)生物打印方法生产的新型支架产品进行微骨折治疗和骨软骨损伤修复治疗的组织病理学结果。
    方法:一种由明胶组成的新型3D生物打印支架,透明质酸,我们设计的藻酸盐被植入10只兔子的股骨滑车中产生的骨软骨缺损中。通过随机化,确定了用3D生物打印的支架修复10只兔子的哪一侧,对兔子的其他膝盖进行微骨折治疗。经过六个月的随访,兔子被处死了。两个治疗组的结果进行了放射学比较,生物力学,和组织病理学。
    结果:没有兔子出现任何并发症。磁共振成像评估显示,两组中所有骨软骨缺损区域均与健康软骨整合。在生物力学载荷测试中,各组之间没有显着差异(p=0.579)。在使用改良的Wakitani评分的组织学检查中未检测到统计学上的显着差异(p=0.731)。
    结论:我们的研究结果表明,3D生物打印的支架具有相当的放射学,生物力学,以及常规微骨折技术治疗骨软骨缺损的组织学特性。
    OBJECTIVE: This study aims to compare the radiological, biomechanical, and histopathological results of microfracture treatment and osteochondral damage repair treatment with a new scaffold product produced by the three-dimensional (3D) bioprinting method containing gelatin-hyaluronic acid-alginate in rabbits with osteochondral damage.
    METHODS: A new 3D bioprinted scaffold consisting of gelatin, hyaluronic acid, and alginate designed by us was implanted into the osteochondral defect created in the femoral trochlea of 10 rabbits. By randomization, it was determined which side of 10 rabbits would be repaired with a 3D bioprinted scaffold, and microfracture treatment was applied to the other knees of the rabbits. After six months of follow-up, the rabbits were sacrificed. The results of both treatment groups were compared radiologically, biomechanically, and histopathologically.
    RESULTS: None of the rabbits experienced any complications. The magnetic resonance imaging evaluation showed that all osteochondral defect areas were integrated with healthy cartilage in both groups. There was no significant difference between the groups in the biomechanical load test (p=0.579). No statistically significant difference was detected in the histological examination using the modified Wakitani scores (p=0.731).
    CONCLUSIONS: Our study results showed that 3D bioprinted scaffolds exhibited comparable radiological, biomechanical, and histological properties to the conventional microfracture technique for osteochondral defect treatment.
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  • 文章类型: Review
    距骨软骨损伤(OLT)是距骨滑车的局部软骨和软骨下骨损伤。OLT是由外伤等原因引起的,包括距骨剥脱性骨软骨炎(OCD)和距骨软骨切向骨折。OLT可以从无症状发展为伴有深踝关节疼痛的软骨下骨囊肿。OLT往往发生在距骨穹窿的内侧和外侧。OLT严重影响患者的生活和工作,甚至可能导致残疾。在这里,我们回顾了OLT的治疗进展以及各种治疗方法的优缺点。不同的治疗方法,包括保守治疗和手术治疗,可根据OLT的不同亚型或临床症状采用。保守治疗大多在短期内缓解症状,只能减缓疾病。近年来,已经发现,富含血小板的血浆注射,微骨折,骨膜植骨,距骨软骨移植,同种异体骨移植,机器人导航下的反向钻孔,当应用这些治疗方法中的每一种时,和其他方法可以获得相当大的益处。此外,微骨折联合富血小板血浆注射,微骨折联合软骨移植,其他各种治疗方法联合前腓骨韧带修复均取得了良好的治疗效果。
    Osteochondral lesion of the talus (OLT) is a localized cartilage and subchondral bone injury of the talus trochlea. OLT is caused by trauma and other reasons, including osteochondritis dissecans of the talus (OCD) and talus osteochondral tangential fracture. OLT can develop from being asymptomatic to subchondral bone cysts accompanied by deep ankle pain. OLT tends to occur on the medial and lateral sides of the talar vault. OLT seriously affects the patients\' life and work and may even lead to disability. Herein, we reviewed advances in the treatment of OLT and the strengths and weaknesses of various treatments. Different treatment methods, including conservative treatments and surgical treatments, can be adopted according to the different subtypes or clinical symptoms of OLT. Conservative treatments mostly relieve symptoms in the short term and only slow down the disease. In recent years, it has been discovered that platelet-rich plasma injection, microfracture, periosteal bone grafting, talar cartilage transplantation, allograft bone transplantation, reverse drilling under robotic navigation, and other methods can achieve considerable benefits when each of these treatment methods is applied. Furthermore, microfracture combined with platelet-rich plasma injections, microfracture combined with cartilage transplantation, and various other treatment methods combined with anterior talofibular ligament repair have all led to good treatment outcomes.
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  • 文章类型: Journal Article
    目的:自体基质诱导的软骨形成(AMIC®)和微骨折是膝关节局灶性软骨缺损的既定治疗方法,但是从长远来看,关于这些手术的临床数据很少。本研究评估了经过10年随访的AMIC®与微骨折的比较结果。
    方法:对47例患者进行随机分组,用MFx(n=13)治疗,缝合AMIC®(n=17)或胶合AMIC®(n=17),随机化,对照多中心试验。改良辛辛那提膝关节评分,疼痛视觉模拟评分和MOCART评分用于评估术后10年以上的结局.
    结果:前2年所有治疗组都有所改善,但是在MFx组中观察到评分的进行性和显着恶化,而两个AMIC®组保持稳定。MOCART评分在组间具有可比性。
    结论:在修复膝关节局灶性软骨缺损的手术后10年内,与微骨折相比,AMIC®手术可改善患者的预后。
    结果:gov标识符:NCT02993510。
    OBJECTIVE: Autologous matrix-induced chondrogenesis (AMIC®) and microfracture are established treatments for focal chondral defects in the knee, but there are little clinical data concerning these procedures over the long term. This study evaluates the outcomes of AMIC® compared to microfracture over 10-year follow-up.
    METHODS: Forty-seven patients were randomized and treated either with MFx (n = 13), sutured AMIC® (n = 17) or glued AMIC® (n = 17) in a prospective, randomized, controlled multicentre trial. The Modified Cincinnati Knee Score, a visual analogue scale for pain and MOCART score were used to assess outcomes over 10 years post-operatively.
    RESULTS: All treatment arms improved in the first 2 years, but a progressive and significant deterioration in scores was observed in the MFx group, while both AMIC® groups remained stable. MOCART scores were comparable between groups.
    CONCLUSIONS: The AMIC® procedure results in improved patient outcomes in comparison with microfracture up to 10 years following surgery for the repair of focal chondral defects in the knee.
    RESULTS: gov Identifier: NCT02993510.
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  • 文章类型: Journal Article
    距骨软骨损伤(OLTs)是常见的运动相关损伤。然而,很少有关于骨骼未成熟儿童OLT手术后恢复运动的报道。进行这项研究是为了评估骨骼未成熟儿童OLT微骨折后恢复运动的情况。
    这项研究涉及16例患者的17个脚踝(平均年龄,13.2年;范围,10-16岁)在磁共振成像(MRI)上有开放性胫骨骨phy,因直径<10mm的OLT进行了微骨折,并在关节镜下确认了病变的不稳定性。17个脚踝中有9个有额外的踝关节外侧韧带稳定。所有患者都参加了某种形式的运动。日本足外科学会(JSSF)评分,踝关节活动评分(AAS),回到运动率,病变大小,软骨下骨髓水肿分级,微骨折后评估软骨修复组织(MOCART)MRI评分。术后平均随访53.5个月。
    平均JSSF评分从术前的76.1分显着提高到最终随访时的94.9分(P<0.01)。从术前状态到最终随访,平均AAS没有变化。体育回报率为100%。病变面积从76.3mm2显著减小至56.7mm2(P=.02),体积从283.2mm3减小至185.6mm3(P=.05)。17例踝关节中8例骨髓水肿分级降低。MOCART总分从术后6个月到1年有显著改善(P=0.05)。
    在这项研究中,所有接受过微骨折的骨骼发育不成熟儿童都能够恢复体育活动,并显示出临床评分和MRI参数的改善。对于骨骼未成熟的运动员,微骨折可能被认为是直径<10mm的OLT的有效一线治疗方法。
    四级,回顾性病例对照研究。
    UNASSIGNED: Osteochondral lesions of the talus (OLTs) are among the common sports-related injuries. However, there are few reports on the return to sports after OLT surgery in skeletally immature children. This study was performed to evaluate the return to sports after microfracture for OLTs in skeletally immature children.
    UNASSIGNED: This study involved 17 ankles of 16 patients (mean age, 13.2 years; range, 10-16 years) with open tibial epiphyses on magnetic resonance imaging (MRI) who underwent microfracture for OLTs <10 mm in diameter and confirmation of lesion instability under arthroscopy. Nine of 17 ankles had additional lateral ankle ligament stabilization. All patients were participating in some form of sports. The Japanese Society for Surgery of the Foot (JSSF) score, Ankle Activity Score (AAS), return to sports rate, lesion size, grade of subchondral bone marrow edema, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score on MRI were evaluated after microfracture. The mean postoperative follow-up period was 53.5 months.
    UNASSIGNED: The mean JSSF score significantly improved from 76.1 points preoperatively to 94.9 points at the final follow-up (P < .01). The mean AAS showed no change from preoperative state to final follow-up. The return to sports rate was 100%. The lesion size significantly decreased from 76.3 to 56.7 mm2 in area (P = .02) and from 283.2 to 185.6 mm3 in volume (P = .05). The bone marrow edema grade decreased in 8 of 17 ankles. The total MOCART score showed a significant improvement from 6 months to 1 year postoperatively (P = .05).
    UNASSIGNED: All skeletally immature children who underwent microfracture for OLTs in this study were able to return to sports activity and showed improvements in clinical scores and MRI parameters. Microfracture may be considered an effective first-line treatment for OLTs <10 mm in diameter in skeletally immature athletes.
    UNASSIGNED: Level IV, retrospective case-control study.
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  • 文章类型: Journal Article
    关节镜下微骨折治疗距骨(OLTs)囊性骨软骨损伤是否有效仍存在争议。在这项研究中,我们将小的和浅的软骨下囊肿患者的结局参数与无囊肿患者的结局参数进行了比较,假设在初次微骨折治疗后可以发现相同的结局.
    从2018年到2021年,对作者医院接受关节镜微骨折治疗的所有50例OLT进行了回顾性审查。包括单个单侧有症状的病变,并分为囊肿组和非囊肿组,而亲吻性病变和关节炎性病变被排除。数字评定量表(NRS)得分,美国骨科足踝协会(AOFAS)踝足-后足评分,Tegner活动等级得分,足踝能力测量(FAAM)评分,磁共振(MR)成像结果用于描述结局.
    共纳入35名患者,囊肿组16例,非囊肿组19例。两组患者特征相似(P>.05)。在囊肿组中,平均囊肿深度为5.0±1.3mm。平均随访时间为36.2±10.2个月,两组NRS无显著差异,AOFAS,FAAM,或Tegner评分改善(P>.05)。囊肿组3例(19%)NRS评分无改善。
    OLT伴软骨下小囊肿和浅性囊肿可通过关节镜微骨折治疗,并可获得与非囊性病变相似的结果。一些囊性病变可能对微骨折治疗没有反应。
    三级,回顾性比较研究。
    UNASSIGNED: Whether arthroscopic microfracture is effective in treating cystic osteochondral lesions of the talus (OLTs) remains controversial. In this study, outcome parameters in patients with small and shallow subchondral cysts are compared to patients without cysts with the hypothesis that equivalent outcomes may be found after primary microfracture treatment.
    UNASSIGNED: From 2018 to 2021, all 50 OLTs treated with arthroscopic microfracture in the authors\' hospital were retrospectively reviewed for eligibility. Single unilateral symptomatic lesions were included and divided into the cyst and noncyst groups, whereas kissing lesions and arthritic lesions were excluded. Numeric rating scale (NRS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, Tegner activity level scores, Foot and Ankle Ability Measure (FAAM) scores, and magnetic resonance (MR) imaging results were used to describe outcomes.
    UNASSIGNED: A total of 35 patients were included, 16 in the cyst group and 19 in the noncyst group. The patient characteristics were similar between the 2 groups (P > .05). In the cyst group the average cysts depth was 5.0 ± 1.3 mm. After a mean follow-up duration of 36.2 ± 10.2 months, no significant differences were found between the 2 groups in NRS, AOFAS, FAAM, or Tegner score improvement (P > .05). Three patients (19%) in the cyst group had no NRS score improvement.
    UNASSIGNED: OLTs with small and shallow subchondral cysts can be treated with arthroscopic microfracture and achieve similar outcomes as noncystic lesions. A few cystic lesions may not respond to microfracture treatment.
    UNASSIGNED: Level III, retrospective comparative study.
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  • 文章类型: Journal Article
    背景:虽然微骨折已被证明是治疗膝关节软骨损伤的有效方法,支持其用于肩关节软骨缺损的证据仅限于短期结局研究.这项研究的目的是确定在至少5年的随访中,对于患有肱骨头局部软骨缺损的患者,微骨折是否可以缓解疼痛并改善肩关节功能。
    方法:在2006年2月8日和2016年8月之间接受了肱骨头局部软骨缺损的微骨折手术的患者。至少5年随访,收集术前和术后患者报告的结果(PRO)指标,包括美国肩肘外科医生(ASES),单一评估数字评估(SANE),手臂的快速残疾,肩和手(QuickDASH),简表-12(SF-12)物理组件摘要(PCS),疼痛的视觉模拟量表(VAS),和患者满意度(1=不满意,10=非常满意)。人口统计,损伤,和手术资料进行回顾性分析.手术失败定义为肱骨软骨缺损的翻修手术或转换为关节成形术。进行Kaplan-Meier分析以确定5年时的存活率。
    结果:共有17例患者符合纳入/排除标准。有15名男性和2名女性,平均年龄为51岁(范围36-69),平均随访9.4年(范围5.0-15.8)。ASES评分中位数从术前的62(范围:22-88)提高到术后的90(范围:50-100)(P=.011)。满意度中位数为8/10(范围:2-10)。患者年龄或缺损大小与PRO之间没有相关性。术后,患者报告娱乐和体育活动以及患肩睡眠能力显著改善(P≤0.05).三名患者失败,需要进行翻修手术。Kaplan-Meier分析确定5年的总生存率为80%。
    结论:所提出的研究说明了PRO的显着改善,提高进行娱乐和体育活动的能力,对于局灶性软骨肱骨头缺损,微骨折后平均9.4年的存活率为80%。
    BACKGROUND: While microfracture has been shown to be an effective treatment for chondral lesions in the knee, evidence to support its use for chondral defects in the shoulder is limited to short-term outcomes studies. The purpose of this study is to determine if microfracture provides pain relief and improved shoulder function in patients with isolated focal chondral defects of the humeral head at a minimum 5-year follow-up.
    METHODS: Patients who underwent microfracture procedure for isolated focal chondral defects of the humeral head with a minimum follow-up of 5 years between 02/2006 and 08/2016 were included. At minimum 5-year follow-up, pre- and postoperative patient-reported outcome (PRO) measures were collected, including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Short Form-12 (SF-12) Physical Component Summary (PCS), Visual Analog Scale (VAS) for pain, and patient satisfaction level (1 = unsatisfied, 10 = very satisfied). Demographic, injury, and surgical data were retrospectively reviewed. Surgical failure was defined as revision surgery for humeral chondral defects or conversion to arthroplasty. Kaplan-Meier analysis was performed to determine survivorship at 5 years.
    RESULTS: A total of 17 patients met inclusion/exclusion criteria. There were 15 men and 2 women with an average age of 51 years (range 36-69) and an average follow-up of 9.4 years (range 5.0-15.8). The median ASES score improved from 62 (range: 22-88) preoperatively to 90 (range: 50-100) postoperatively (P = .011). Median satisfaction was 8 out of 10 (range: 2-10). There was no correlation between patient age or defect size and PROs. Postoperatively, patients reported significant improvements in recreational and sporting activity as well as the ability to sleep on the affected shoulder (P ≤ .05). Three patients failed and required revision surgery. The Kaplan-Meier analysis determined an overall survivorship rate of 80% at 5 years.
    CONCLUSIONS: The presented study illustrates significant improvements for PROs, improved ability to perform recreational and sporting activities, and a survival rate of 80% at a mean of 9.4 years after microfracture for focal chondral humeral head defects.
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  • 文章类型: Meta-Analysis
    背景:距骨软骨病在即使是轻微创伤的患者中也很常见;及时诊断和治疗可以防止早期骨关节炎的发展。本系统评价和荟萃分析的目的是评估其他手术对骨软骨损伤关节镜下踝关节微穿孔的影响。
    方法:使用PubMed-Medline进行了系统的文献检索,CochraneCentral,和谷歌学者选择分析富血小板血浆(PRP)疗效的临床研究,透明质酸(HA),和骨髓浓缩物(BMC)程序。这篇综述包括了10篇遵循PRISMA指南的文章,共有464例患者。使用MINORS进行质量评估,所有研究都证明了高质量。
    结果:系统评价结果显示,所有接受PRP浸润治疗的患者均能获益,透明质酸,BMC。在接受PRP注射的患者中,AOFAS评分和VAS量表的效果最好。荟萃分析显示,接受关节镜微穿孔和PRP的患者在疼痛缓解和恢复日常活动方面有所改善,尽管没有报告统计学意义的结果(p=0.42)。
    结论:与对照组相比,所有治疗策略的评分均较好。在分析的各种治疗方法中,对于接受这种治疗的更大人群来说,添加PRP似乎是最有价值的,在减轻疼痛方面表现出优异的效果,临床结果,回到日常活动中。
    方法:II.
    BACKGROUND: Osteochondral lesions of the talus are common in patients suffering even minor trauma; timely diagnosis and treatment can prevent the development of early osteoarthritis. The objectives of this systematic review and meta-analysis were to evaluate the effects of additional procedures on arthroscopic ankle microperforations for osteochondral lesions.
    METHODS: A systematic literature search was conducted using PubMed-Medline, Cochrane Central, and Google Scholar to select clinical studies analyzing the efficacy of platelet-rich plasma (PRP), hyaluronic acid (HA), and bone marrow concentrate (BMC) procedures. Ten articles following PRISMA guidelines with a total of 464 patients were included in this review. Quality assessment using MINORS was performed, and all studies demonstrated high quality.
    RESULTS: The results of the systematic review showed benefits in all patients undergoing infiltrative therapy with PRP, hyaluronic acid, and BMC. The best results in terms of AOFAS score and VAS scale were found in patients undergoing PRP injection. The meta-analysis showed improvements in pain relief and return to daily activities in patients undergoing arthroscopic microperforations and PRP, although not reporting statistically significant results (p = 0.42).
    CONCLUSIONS: All treatment strategies reported better scores compared to the control groups. Among the various treatments analyzed, the addition of PRP appears to be the most valuable probably for the larger population receiving this treatment, showing excellent outcomes in pain reduction, clinical outcomes, and return to daily activities.
    METHODS: II.
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