摘要
目的探讨自体骨软骨移植术（AOT）治疗HeppleⅣ－Ⅴ型距骨骨软骨损伤（OLT）的中期临床疗效。方法对2011年10月至2013年9月收治的13例HeppleⅣ－Ⅴ型OLT患者资料进行回顾性分析，男9例，女4例；年龄19—46岁，平均31．7岁；Hepple分型：Ⅳ型5例，Ⅴ型8例；损伤区域直径0．5—2．0cm，平均1．1cm。利用自体骨软骨移植器械从同侧股骨外侧髁非负重区钻取骨软骨柱，行关节镜下或加用关节切开单柱或多柱镶嵌式移植术。比较患者手术前、后视觉模拟评分（VAS）、美国足踝外科协会（AOFAS）踝-后足评分、软骨组织修复核磁共振影像（MOCART）评分及国际膝关节文献委员会膝关节评估表（IKDC）评分，从临床功能与影像学表现两方面来评估手术疗效。结果所有患者均获随访，时间28—52个月，平均38．2个月。末次随访时VAS评分[（0．7±0．8）分]、AOFAS评分[（95．2±2．9）分]、MOCART评分[（6．6±0．9）分]与术前[（7．9±1．3）、（63．5±7．4）、（3．2±1．I）分]相比均改善，差异有统计学意义（P〈0．05）。手术前、后同侧膝关节IKDC评分比较[（98．5±0．7）分vs.（98．3±0．9）分]差异无统计学意义（P〉0．05）。术后MRI显示：肥厚洼软骨完全覆盖3例，正常厚度完全覆盖8例，部分缺损覆盖2例；与周边正常软骨信号强度一致4例，基本一致9例。所有患者均恢复正常行走及日常生活。结论AOT治疗HeppleⅣ－Ⅴ型OLT中期临床效果良好，安全可靠。
Objective To evaluate mid-term clinical outcomes of autologous osteochondral transplantation （AOT） for the treatment of osteochondral lesions of the talus （our） （Hepple types IV and V ）. Methods From October 2011 to September 2013, AOT procedure was performed in 13 patients with OLT （Hepple types IV and V ）. They were 9 men 4 women, with a mean age of 31. 7 years （range, from 19 to 46 years）. There were 5 cases of type IV and 8 ones of type V. The diameters of defective areas ranged from 0. 5 to 2.0 cm （average, 1.1 cm） . Osteoehondral plugs were harvested from the non-weight bearing area at the ipsilateral femoral lateral condyle. The arthroseopic single-plug or double-plug AOT procedure was conducted with a supplementary arthrotomy if necessary. Visual analogue scale （VAS）, American Orthopedic Foot and Ankle Society （AOFAS） score, Magnetic Resonance Observation of Cartilage Repair Tissue （MOCART） score, and the International Knee Documentation Committee Knee Evaluation Form （IKDC） score were measured pre- and post-operatively for assessment of clinical outcomes. Results After successful surgery, all the patients were followed up for 28 to 52 months （average, 38.2 months）. The VAS （0. 7 ±0. 8）, AOFAS （95.2 ±2. 9） and MOCART （6.6 s0.9） scores at the final follow-up were significantly improved compared with preoperation （7.9 ± 1.3, 63.5 ±7.4, 3.2 ± 1.1, respectively） （ P 〈 0.05）. There was no significant difference between pre- and post-operation in the IKDC score for the ipsilateral knee joint （98.5 ± 0.7 versus 98.3 ± 0. 9） （ P 〉 0.05）. Post-operative MRI showed complete hypertrophic cartilage layer filling in 3 cases, complete filling of the defect at the level of surrounding cartilage in 8 cases, and incomplete atrophic cartilage layer filling in 2 cases. Normal signal intensity of the repair tissue compared with the adjacent native cartilage was seen in 4 cases, and nearly normal activity in 9 cases. All the patients recovered
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2016年第8期685-691,共7页
Chinese Journal of Orthopaedic Trauma
关键词
踝关节
软骨
创伤和损伤
骨移植
Ankle joint
Cartilage
Wounds and injuries
Bone transplantation
