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

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Autologous osteochondral mosaicplasty permits immediate full range of motion (ROM),

自体骨软骨马赛克移植术后的患者允许全范围的关节活动度训练 

but requirestwo weeks non weightbearing and a further 2−3 week partial weightbearing (30−40 kg) period after
the operation.

但是,术后2周的时间,患肢不能做负重的训练,术后第3 5周患肢部分负重30 40KG.

The initial non weightbearing phase is recommended to prevent graft subsidence during
osseous integration

最初的2周这个阶段不负重原因是:移植物与治疗部位发生骨性愈合之前 为了防止移植物下陷\脱落.

This period may be supported by controlled passive motion (CPM) to promote
cartilage metabolism and lessen soft tissue oedema around the joint.

这2周的时间主要行CPM治疗,促进软骨的代谢,减轻关节周围软组织的肿胀.

 artial weightbearing supports  fibrocartilage repair among implanted cylindrical plugs, further enhancing secure graft incorporation

部分负重有利于移植物部位的纤维软骨修复,进一步增强移植物与治疗部位的结合牢固程度.

.Normal daily activity can be achieved in 8−10 weeks.High demand sporting activity should be delayed till after 5−6 months.

一般需要8 10周的时间恢复正常的日常生活,高强度的体育运动要推迟到术后5 6个月进行.

This protocol can be modified easily in accordance with established guidelines for concurrent ACL reconstruction, high tibial osteotomy,meniscus reinsertion, meniscus resection,etc

这个康复计划是在目前确定的ACL重建术,高位胫骨截骨术,半月板移植,半月板切除术后的康复方案基础上改良制定的.

自体骨软骨移植对于那些软骨损伤面积大,而且深、火山口样、需要大量移植物的部位是不适合的，一般损伤面积大于4平方厘米的缺损手术成功率不高.

所以才会有ACI(自体软骨细胞移植术)技术的研究和发展的嘛  呵呵!

[em07]

希望能有翻译的啊～～

谢谢分享！记得以前骨科李箭教授在介绍膝骨关节炎的时候也介绍了这种方法，并且在膝关节镜下演示了这种治疗技术的图片和手术流程。康复的效果是有限的，能和相关学科联手做好残损层次的康复，会对患者的预后和回归社会的水平产生重大的影响。