骨软骨损伤的最新治疗策略之：骨软骨自体移植系统OATS

骨软骨损伤的最新治疗策略之：骨软骨自体移植系统OATS

OATS是“骨软骨自体移植系统”。这是两种类型的软骨移植手术操作之一，另一个程序是“Mosaicplasty镶嵌成形术”。

软骨移植手术涉及将健康软骨从膝关节的非重量区域转移至膝关节软骨受损区域。

在Mosaicplasty镶嵌成形术中，软骨和骨骼的移植物（骨软骨柱plugs）是从健康的软骨区域中取出的，并移植以取代膝关节受损的软骨。使用多个微小的骨软骨柱，一旦嵌入，类似于镶嵌图案，因此名称。

使用骨软骨自体移植系统OATS的过程，骨软骨柱plugs更大。因此，外科医生只需要将一两个健康的软骨和骨骼塞进膝关节受损区域即可。

骨软骨自体移植系统OATS的适应症

不建议每个人都采用骨软骨自体移植系统OATS治疗方案。骨软骨自体移植系统OATS通常用于＜50岁的患者，并且软骨损伤面积最小，通常是由于创伤（外伤）和可用的健康软骨进行移植。

骨软骨自体移植系统OATS手术操作过程

在骨软骨自体移植系统OATS手术中，手术通常从关节镜检查开始。关节镜检查是在全身麻醉下在医院手术室进行的。外科医生在膝关节上切开一个小切口，并插入关节镜。关节镜是由小型镜头，光源和摄像机组成的小型光纤观察仪器，使外科医生能够视觉检查膝关节。

如果外科医生决定可以实施该手术操作，则拔除镜头，并在膝关节上进行开放切口。外科医生准备软骨受损区域。外科医生使用一种特殊的取材工具。使用特制的髓心取材工具，将软骨损伤区域清理彻底以适合拟取材的软骨移植柱。然后，外科医生从膝关节非负重区域打孔（选择直径大小合适）取材健康的软骨和软骨下骨移植柱。该软骨移植柱被转移到取材器中，并植入膝盖受损区域的准备好的移植孔中。随后，成功的骨软骨自体移植系统OATS手术将使骨骼和软骨能够生长到膝关节受损的区域，从而成功解决了患者的膝关节疼痛。

骨软骨自体移植系统OATS术后如何恢复

以下是术后恢复的过程：

?您将在麻醉恢复室醒来，然后转回病房。

?将有绷带缠绕在手术的膝关节周围。通常，您可以在第二天拆除绷带，但将无菌伤口辅料留在适当的位置。这些也都会去掉。

1.恢复后，您的静脉留置针将被去掉，并骨科医生将向您展示几次锻炼方法。

2.您的骨科医生会在出院前见到您，并解释手术中发现的问题以及手术期间的操作细节。

3.必要时你将使用止痛药，应按照指示服用。

4.手术后膝关节肿胀是正常的。你可以居家通过冰敷疗法缓解，有助于减少肿胀（每天20分钟3-4次，直到肿胀减少）。坐下时请抬高腿。

5.您将使用CPM机器（持续被动运动）进行膝关节连续的被动屈伸练习，并给出有关适当使用的说明。

6.请在手术后10-14天预约以监控您的恢复进度，并进行伤口拆线。

7.去除伤口辅料绷带后，您可能会淋浴。

8.重要的是要遵守您的康复锻炼计划，这样才能确保良好满意的恢复效果。

骨软骨自体移植系统OATS手术的风险和并发症

全身麻醉风险极为罕见。有时，由于气管插管，患者的喉咙会感到不适。如果您有任何特定的关于麻醉方面的问题，请与麻醉师术前、术后及时沟通。

与骨软骨自体移植系统OATS手术特别相关的风险可能包括：

1.术后出血。

2.深静脉血栓形成（DVT）。

3.感染。

4.膝关节僵硬（活动受限）。

5.切口附近皮肤的麻木。

6.对血管、神经损伤和慢性疼痛综合征。

What is OATS?

OATS is “osteochondral autograft transfer system“. It is one of the two types of cartilage transfer procedures and the other procedure is “Mosaicplasty“. Cartilage transfer procedures involve moving healthy cartilage from a non-weight-bearing area of the knee to a damaged area of the cartilage in the knee. In mosaicplasty, plugs of cartilage and bone are taken from a healthy cartilage area and moved to replace the damaged cartilage of the knee. Multiple tiny plugs are used and once embedded, resemble a mosaic pattern, hence the name. With the OATS procedure, the plugs are larger. Therefore, the surgeon only needs to move one or two plugs of healthy cartilage and bone to the damaged area of the knee.

Indications of OATS

OATS is not recommended in everyone. OATS is typically used for patients aged ＜50 and with minimal cartilage damage, usually because of trauma, and available healthy cartilage for transfer.

OATS Procedure

In the OATS procedure, the surgery usually begins with an arthroscopic examination. Arthroscopy is performed in a hospital operating room under general anesthesia. Your surgeon makes a tiny incision over the knee and inserts an arthroscope. The arthroscope is a small fiber-optic viewing instrument made up of a tiny lens, light source and video camera to enable the surgeon to visually examine the knee.

If the surgeon decides the procedure can be performed, the scope is removed and an incision is made over the knee. The surgeon prepares the damaged area of cartilage. Using a special coring tool, surgeon makes a hole in the cartilage sized to fit the plug exactly. Your surgeon then harvests the plug of healthy cartilage and bone from the non-weight-bearing part of the knee. This plug is transferred to the cored hole and implanted into the prepared hole of the damaged area of the knee. Over time, a successful OATS surgery will enable the bone and cartilage to grow into the damaged area of the knee successfully resolving the patient‘s knee pain.

Postoperative Recovery following OATS

Below are the steps to your post-operative recovery:

• You will wake up in the recovery room and then be transferred back to the ward.
• A bandage will be wound around the operated knee. You will usually be able to remove this the next day but leave the steri-strips in place. These will fall off.
• Once you are recovered, your IV will be removed and you will be shown several exercises to do.
• Your surgeon will see you prior to discharge and explain the findings of the operation and what was done during surgery.
• Pain medication will be provided and should be taken as directed
• It is normal for the knee to swell after the surgery. You will be sent home with a cryocuff cold therapy unit. Elevating the leg when you are seated and placing ice-packs or the cryocuff on the knee will help to reduce swelling. (20 min 3-4 times a day until swelling has reduced)
• You will be sent home with a CPM machine (continuous passive motion) and given instructions on proper usage.
• You may shower once the bandage is removed. Leave the steri strips intact.
• Please make an appointment 10-14 days after surgery to monitor your progress and remove your sutures.
• It is important to be compliant with your rehabilitation exercises to ensure a good outcome.

Risks and Complications of OATS

General anesthesia risks are extremely rare. Occasionally, patients have some discomfort in the throat because of the tube that supplies oxygen and other gasses. Please discuss with the anesthetist if you have any specific concerns.

Risks specifically related to the OATS surgery may include:

• Postoperative bleeding
• Deep Vein Thrombosis (DVT)
• Infection
• Stiffness
• Numbness of part of the skin near the incisions
• Injury to vessels, nerves and a chronic pain syndrome

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