背景:很少发表关于微骨折与镶嵌成形的长期随机比较研究,只有2项研究报告了10年的随访。假设/目的:目的是比较微骨折与马赛克成形术/骨软骨自体移植在有症状的软骨损伤中的临床结果。零假设是结果在任何时间点都没有统计学差异。
方法:随机对照试验;证据水平,1.
方法:40例关节软骨缺损患者随机接受微骨折(n=20)或镶嵌成形术(n=20)的软骨修复。纳入标准如下:手术时年龄18至50岁,股骨髁或滑车上有1或2个有症状的局灶性全层关节软骨缺损,尺寸为2至6cm2。主要结果变量是手术前和12个月时记录的Lysholm膝关节评分,中位数5年,中位数10年,手术后至少15年。
结果:40名患者被纳入研究(28名男性,12名妇女;平均年龄,32年;范围,18-48岁)。中值尺寸为3.5cm2的缺陷(范围,2-5cm2)进行处理。所有受试者的Lysholm评分均显着增加-从平均53分(SD,16)在基线时至69(SD,21)至少15年随访(P=.001)。在12个月时,镶嵌成形组的平均Lysholm评分明显高于微骨折组,中位数5年,中位数10年,最低15年:77(SD,17)与61(SD,22),分别(P=0.01),在最后的后续行动中。在所有随访时间点,Lysholm平均评分差异具有临床意义(>10分).
结论:简而言之,中等,和长期(至少15年),马赛克成形术的结果更好,18~50岁患者膝关节远端软骨缺损(2~5cm2)的临床相关结局高于微骨折。
BACKGROUND: Few comparative randomized long-term studies on microfracture versus
mosaicplasty have been published, and only 2 studies reported a follow-up of 10 years. Hypothesis/Purpose: The purpose was to compare the clinical outcome of microfracture versus
mosaicplasty/osteochondral autograft transfer in symptomatic cartilage lesions. The null hypothesis was that the outcome was not statistically different at any point of time.
METHODS: Randomized controlled
trial; Level of evidence, 1.
METHODS: Forty patients with articular cartilage defects were randomized to undergo cartilage repair by either microfracture (n = 20) or mosaicplasty (n = 20). Inclusion criteria were as follows: age 18 to 50 years at the time of surgery, 1 or 2 symptomatic focal full-thickness articular chondral defects on the femoral condyles or trochlea, and size 2 to 6 cm2. The main outcome variable was the Lysholm knee score recorded before the surgery and at 12 months, median 5 years, median 10 years, and minimum 15 years after the surgery.
RESULTS: Forty patients were included in the
study (28 men, 12 women; median age, 32 years; range, 18-48 years). Defects with a median size of 3.5 cm2 (range, 2-5 cm2) were treated. A significant increase in the Lysholm score was seen for all subjects- from a mean 53 (SD, 16) at baseline to 69 (SD, 21) at the minimum 15-year follow-up ( P = .001). The mean Lysholm score was significantly higher in the mosaicplasty group than the microfracture group at 12 months, median 5 years, median 10 years, and minimum 15 years: 77 (SD, 17) versus 61 (SD, 22), respectively ( P = .01), at the last follow-up. At all follow-up time points, the difference in mean Lysholm score was clinically significant (>10 points).
CONCLUSIONS: At short, medium, and long term (minimum 15 years),
mosaicplasty results in a better, clinically relevant outcome than microfracture in articular cartilage defects (2-5 cm2) of the distal femur of the knee in patients aged 18 to 50 years.