膝关节软骨缺损骨软骨自体移植术后康复

近日骨科病区对一位软骨缺损患者进行了膝关节骨软骨移植手术，骨科医生习惯称这种方法为马赛克。至于为何这么称，大家一看手术示意图就全明白了。这是一个关节切开手术，手术本身对关节就是一个损害，术后如何促进软骨的修复？康复如何早期介入？何时负重？等等，这些都对病区治疗师提出了较高的要求。首先让我们先来了解这个手术方法。  

自体移植又称马赛克移植(autograft or mosaicplasty)

　　Wagner H.在1964首先使用自体移植的技术，将身体非承重部位，或是运动时很少会用到的软骨连带软骨下骨组织（软骨栓子osteochondral plug）取下，称为osteochondral graft，植入受损部位，来治疗软骨的缺损。例如股骨末端的关节前侧面所取下的软骨组织，便可以用来填补于承受重力面的关节面，本方法称为mosaicplasty (Hangody, et al., 2001)，为目前较理想的治疗方法，能够避免异种或异体移植，所引发的免疫系统的排斥反应。但必须牺牲自体其它部位的软骨组织，造成新的伤害。若受损部位较大，所需的osteochondral graft较多，但身体可取的osteochondral graft有限，这便成了自体移植的限制。

术后康复Postoperative rehabilitation
节选自：
Autologous osteochondral grafting—Technique and long-term results
Injury, Volume 39, Issue 1, Supplement 1, April 2008, Pages 32-39
László Hangody, Gábor Vásárhelyi, László Rudolf Hangody, Zita Sükösd, György Tibay, Lajos Bartha, Gábor Bodó
原文如下:
Autologous osteochondral mosaicplasty permits immediate full range of motion (ROM), but requires
two weeks non-weightbearing and a further 2−3 week partial weightbearing (30−40 kg) period after
the operation. The initial non-weightbearing phase is recommended to prevent graft subsidence during
osseous integration. This period may be supported by controlled passive motion (CPM) to promote
cartilage metabolism and lessen soft-tissue oedema around the joint. Partial weightbearing supports
fibrocartilage repair among implanted cylindrical plugs, further enhancing secure graft incorporation.Normal daily activity can be achieved in 8−10 weeks.High-demand sporting activity should be delayed till after 5−6 months. This protocol can be modified easily in accordance with established guidelines for concurrent ACL reconstruction, high tibial osteotomy,meniscus reinsertion, meniscus resection,etc