膝关节软骨缺损的现代治疗第二部分：采用局灶性表面置换植入物与自体骨软骨移植的结构性软骨修复
简介
结构性软骨修复策略为膝关节局灶性软骨缺损提供了机械性解决方案，适用于生物修复难以承受负重负荷的离散性病变，且关节其余部分相对完好。本文评估了聚焦表面植入物和骨软骨自体移植系统（OATS）作为结构性保关节干预手段的效果。现代金属及聚合物基植入物在短期至中期内可显著改善疼痛和功能，但注册研究和荟萃分析显示其生存率存在差异，翻修风险常与进行性骨关节炎或植入物相关并…
英文摘要
Structural cartilage restoration strategies provide mechanical solutions for focal knee chondral defects in which biologic repair alone is unlikely to withstand load-bearing demands. These approaches are most applicable to discrete lesions in otherwise preserved joints where restoration of articular congruity and immediate mechanical stability are required. This review evaluates focal resurfacing implants and osteochondral autograft transfer system procedures as structural joint-preserving interventions. Contemporary metal and polymer-based focal implants demonstrate meaningful short- to mid-term improvements in pain and function. However, registry data and meta-analyses reveal variable survivorship and revision risk, frequently related to progressive osteoarthritis or implant-related complications. Outcomes are highly dependent on appropriate patient selection and precise implant positioning. Osteochondral autograft transfer system procedures and mosaicplasty restore mature hyaline cartilage and subchondral bone using autologous osteochondral plugs. Long-term series extending beyond a decade support durable outcomes in small, contained lesions. Donor-site morbidity, graft contouring limitations, and size constraints, however, restrict broader applicability. Comparative data highlight trade-offs between mechanical resurfacing and cartilage transfer. Implants avoid donor harvest, but introduce device survivorship concerns and complex revision pathways. Autograft transfer offers established durability with native tissue, but carries technical constraints and harvest-related morbidity. Structural restoration strategies occupy a defined position within the cartilage preservation continuum. Their success depends on alignment between defect characteristics, patient activity demands, and the surrounding joint environment. When applied within appropriate indications, these techniques can provide durable symptom relief, though none of them eliminates the risk of progression to arthroplasty.