骨软骨损伤：骨软骨自体移植OATS手术操作：关节镜技术和技术要点：2019年

骨软骨自体移植OATS手术操作：关节镜技术和技术要点：2019年

作者：Ryan Rowland, Michael Colello, Douglas J Wyland.

作者单位: Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina, U.S.A.

译者：陶可（北京大学人民医院骨关节科）

摘要

骨软骨自体移植系统（OATS; Arthrex，Naples，FL）是治疗膝关节关节软骨病变的绝佳选择。当前的文献表明，在早期到中期随访时，患者的功能改善，减轻疼痛以及满意度高，且可接受的并发症发生率低。尽管缺乏长期数据，但运动员的研究表明，OATS可以提供满意的体育回归率（OATS术后，患者可回归体育运动率高）。传统上，OATS的手术操作被认为是开放术式。而随着关节镜技术的发展，该过程现在可以通过关节镜完成。我们讨论这个现代操作。

Fig 1 Magnetic resonance imaging of the left knee. (A) T1-weighted image in the coronal plane showing evidence of an osteochondral defect (OCD) along the left medial femoral condyle. T2-weighted image in the coronal plane (B), T1-weighted image in the sagittal plane (C), and T2-weighted image in the sagittal plane (D) showing the same OCD along the left medial femoral condyle.

图1 左膝的磁共振成像。（a）冠状位中的T1加权图像显示沿左侧股骨髁的骨软骨缺损（OCD）的证据。冠状位T2加权图像（B），矢状面（C）中的T1加权图像以及矢状面（D）中的T2加权图像显示沿左侧股骨髁的同一骨软骨缺损OCD。

Fig 2 Photograph of the left knee flexed at 90° showing the lateral viewing portal (LVP), which is made at the intersection of the inferior pole (IP) of the patella with the lateral border of the patella (LBP).

图2 左膝关节在90°弯曲的照片，显示了外侧手术入口标记（LVP），该手术入口是在髌骨下极（IP）与髌骨外侧边缘（LBP）的相交处。

Fig 3 Arthroscopic image through the lateral viewing portal of the left medial femoral condyle showing the osteochondral defect (OCD).

图3 通过左侧股骨髁的外侧观察入口的关节镜图像显示骨软骨缺损（OCD）。

Fig 4 Arthroscopic image through the lateral viewing portal showing where a cannulated reamer is used to core out the site of the osteochondral defect on the left medial femoral condyle to prepare the recipient site (RS).

图4 通过外侧观察入口的关节镜图像显示了管状铰刀的位置，以打开左侧股骨髁上的骨软骨缺损位点，以准备受体（骨软骨移植柱）植入（RS）。

Fig 5 Arthroscopic image through the lateral viewing portal showing a measuring guide placed perpendicularly to the articular surface and the depth of the recipient site being measured at the 3-, 6-, 9-, and 12-o’clock positions of the left medial femoral condyle (MFC).

图5 通过外侧观察入口的关节镜图像显示垂直于关节表面的测量导向器以及在左膝内侧股骨髁（MFC）3-，6，6-，9-和12点钟位置测量的受体位点的深度。

Fig 6 Arthroscopic image through the lateral viewing portal showing an arthroscopic probe identifying the sulcus terminalis (ST) for donor-site harvest from the left knee.

图6 通过外侧观察入口的关节镜图像显示了关节镜探钩，以识别左膝关节供体部位边界（ST）。

Fig 7 Arthroscopic image through the lateral viewing portal showing the Osteochondral Autograft Transfer System graft harvester (Arthrex) on the left knee at the anterior border of the sulcus terminalis (ST) and photograph showing the graft harvester being impacted using a mallet to a depth of approximately 10 mm. Care is taken to remain perpendicular to the articular surface when obtaining graft from the donor site.

图7 通过外侧观察入口的关节镜图像显示了骨软骨自体移植系统OATS移植骨软骨柱取材器（Arthrex）在左膝关节供体部位边界（ST），并显示了取材器在取材区进入深度约10毫米。从取材区获得移植物时，请注意保持垂直于关节表面。

Fig 8 Osteochondral Autograft Transfer System donor plug from left sulcus terminalis. One should note the contoured appearance of the donor plug after it is rongeured to a depth 1 mm shorter than the prepared recipient site to ensure a flush finish.

图8 经骨软骨自体移植系统OATS在左膝供体部位所取得的骨软骨移植柱。应注意供体骨软骨移植柱的轮廓外观，在将其切成深度比准备好的接收器部位的深度短1毫米后，以确保齐平的效果。

Fig 9 Arthroscopic image through the lateral viewing portal showing the arthroscopic impactor being used to advance the donor graft (DG) into the recipient site on the left medial femoral condyle (MFC). One should note that overlap occurs between the impactor and the recipient site to prevent countersinking of the donor graft.

图9 通过外侧观察入口的关节镜图像显示了用于将供体移植物（DG）推向左侧股骨髁（MFC）上的受体部位的关节镜打击器。应该注意的是，打击器和接收者部位之间发生重叠，以防止供体移植物的碎裂。

Fig 10 Arthroscopic image through the lateral viewing portal showing the final result after impaction of the donor graft (DG) into the ipsilateral recipient site on the left medial femoral condyle. The well-contoured, flush appearance of the articular surface should be noted.

图10 通过外侧观察入口的关节镜图像显示了供体移植物（DG）在左膝股骨髁上的同侧受体部位安装后的最终结果。应注意关节表面的外观齐全、光滑。

Osteochondral Autograft Transfer Procedure: Arthroscopic Technique and Technical Pearls

Abstract

The Osteochondral Autograft Transfer System (OATS; Arthrex, Naples, FL) is an excellent option for the treatment of articular cartilage lesions within the knee. Current literature suggests that at early-term to midterm follow-up, patients experience improved function, alleviation of pain, and good satisfaction with acceptable complication rates. Although long-term data are lacking, studies in athletes have shown that the OATS can provide an adequate rate of return to sports. The OATS procedure has traditionally been considered an open procedure. However, with the advancement of arthroscopic techniques, the procedure can now be completed arthroscopically. We discuss this modern operation.

文献出处：Ryan Rowland, Michael Colello, Douglas J Wyland. Osteochondral Autograft Transfer Procedure: Arthroscopic Technique and Technical Pearls. Arthrosc Tech. 2019 Jun 11;8(7):e713-e719. doi: 10.1016/j.eats.2019.03.006.