自体骨软骨移植术治疗膝关节局灶性骨软骨缺损：适应证、技术、疗效及未来方向
简介
自体骨软骨移植术（OAT）通过单次手术修复全层关节软骨缺损，适用于年轻活跃、病灶面积1–4 cm²的单极股骨髁、髌股关节或胫骨平台病变；当缺损＞3 cm²时疗效下降。该技术可提供透明软骨修复，术后6个月内重返运动率常超过85%，功能改善优于微骨折术，在合适患者中效果不亚于细胞或同种异体移植。成功的关键在于精细的受区准备、垂直取材和齐平植入，新兴生物辅助手段有…
英文摘要
➢ Osteochondral autograft transfer (OAT) restores hyaline cartilage and subchondral bone in a single stage, offering a durable joint-preserving option for focal full-thickness articular cartilage defects in young, active patients.➢ Optimal candidates have unipolar femoral condyle, patellofemoral, or tibial plateau lesions measuring 1 to 4 cm2; outcomes become less predictable once the defect size exceeds 3 cm2. Outcomes are further influenced by age, activity level, sex, alignment, instability, and meniscal deficiency, with older, lower-demand patients and those with larger lesions demonstrating comparatively inferior results.➢ Technical success requires meticulous recipient-site preparation, perpendicular graft harvest, and flush implantation; both arthroscopic and open approaches achieve reliable results.➢ OAT demonstrates high return-to-sport rates (often >85% within 6 months), significant functional improvements, and superiority over microfracture. Outcomes may be comparable or superior to cellular resurfacing or allograft techniques in appropriately selected patients.➢ Emerging biologic adjuncts, recess-filling strategies, and donor-site substitutes may enhance graft integration and reduce morbidity, although long-term clinical benefits remain unproven.