关节镜下生物可吸收内固定治疗不稳定性膝关节剥脱性骨软骨炎较开放固定及金属植入物可获得良好疗效：一项系统综述
简介
该系统性综述纳入39项研究（1070例患者、1097膝），比较开放与关节镜固定及不同植入物治疗不稳定膝关节剥脱性骨软骨炎的疗效。结果显示关节镜下可吸收植入物固定可获得较高的Lysholm和IKDC评分，并发症及再手术率低于金属植入物；开放或联合入路疗效变异较大，金属固定相关硬件并发症致再手术率高达22%。骨骼未成熟患者采用关节镜可吸收固定预后更佳，提示该术式…
英文摘要
PURPOSE: To systematically review studies evaluating the outcomes, complication rates, and revision rates among open, arthroscopic, and combined internal fixation techniques for unstable osteochondritis dissecans lesions of the knee, with specific attention to implant type and skeletal maturity. METHODS: A systematic search of PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature was conducted through December 2024, representing the most recent complete calendar year of published literature at the time of review, to identify English-language studies on internal fixation for unstable knee osteochondritis dissecans lesions. Inclusion criteria were ≥5 patients, ≥2-year follow-up, and isolated fixation. Extracted data included demographics, skeletal maturity, surgical approach, implant type, functional outcomes (Lysholm, International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], and Tegner), complications, and reoperations. Study quality was assessed using Methodological Index for Non-Randomized Studies criteria. RESULTS: Thirty-nine studies representing 41 cohorts, including 1070 patients and 1097 knees, met the inclusion criteria. Arthroscopic fixation (18 studies) showed high Lysholm and IKDC scores (Lysholm range: 85.3-98.9), with bioabsorbable implants associated with lower complication and revision rates than those seen in metal implants. Open fixation showed Lysholm scores ranging from 39 to 99, Tegner scores from 5 to 8.9, and KOOS and IKDC means of 94.5 and 96.2, respectively. Metal fixation was associated with hardware-related complications, contributing to reoperation rates of up to 22%. Combined open and arthroscopic approaches produced postoperative Lysholm scores ranging from 82.1 to 97, Cincinnati scores of 97, and IKDC values up to 96. Arthroscopic fixation with bioabsorbable implants in skeletally immature patients with salvageable lesions consistently resulted in favorable clinical outcomes and fewer reoperations, though statistical significance was not widely reported. CONCLUSIONS: Arthroscopic fixation, particularly with bioabsorbable implants, was consistently associated with favorable functional outcomes and lower revision rates across the included studies. Open and combined approaches showed greater variability, with higher complication and revision rates, especially when metal implants were used. Skeletally immature patients generally showed better healing and lower reoperation rates than mature patients. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.