自体膝关节骨软骨移植治疗距骨骨软骨损伤的临床疗效

Clinical efficacy of osteochondral lesion of talus treated by autogenous knee osteocartilage transplantation

目的探讨自体膝关节骨软骨移植术(OAT)治疗距骨骨软骨损伤(OLT)HeppleⅤ型20例患者的临床疗效。方法采用回顾性病例系列研究分析2018年9月至2021年9月重庆市中医骨科医院足踝外科收治的HeppleⅤ型OLT患者的临床资料20例。记录术前、术后6个月及末次(≥12个月)回访疼痛视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)踝-后足评分、膝关节Lysholm评分。通过VAS、AOFAS、Lysholm等术前、术后评分对踝和膝关节进行疼痛及功能评价。根据CT或MRI表现评估截骨区域、骨软骨移植区域的愈合情况、记录并发症情况。结果采用重复测量方差分析、LSD-t检验、Friedman检验、Wilcoxon秩和检验等进行分析。结果本组20例HeppleⅤ型OLT患者均获得随访,末次随访CT/MRI显示,植骨与周围骨质结合良好。VAS评分由术前6.5(6.0,8.0)分别降为术后6个月2.0(2.0,3.0)分及末次随访2.0(2.0,3.0)分,AOFAS踝-后足评分由术前59.0(48.0,64.0)分别增为术后6个月88.5(87.0,90.0)分及末次随访90.0(88.0,90.0)分(χ^(2)=33.78、33.56,均为P<0.05)。末次随访VAS评分、AOFAS踝-后足评分与术后6个月比较差异均无统计学意义(均为P>0.05)。术后6个月、末次随访Lysholm评分与术前比较以及末次随访与术后6个月比较,差异均无统计学意义(均为P>0.05)。AOFAS踝-后足评分术后6个月随访优良率为95%,所有患者术后均无相关并发症。结论自体骨软骨移植术(OAT)治疗HeppleⅤ型OLT,可明显减轻踝关节疼痛,改善功能,疗效满意,膝关节供区风险可控,有一定的临床实用价值。

Objective To investigate the clinical effect of 20 patients with osthondral lesion of the talus(OLT)of Hepple type Ⅴ treated with autogenous knee osteochondral autograft transplantation(OAT).Methods A retrospective case series study was used to analyze the clinical data of 20 patients with OLT of Hepple typeⅤadmitted to the Foot and Ankle Surgery Department of Chongqing Orthopaedic Hospital of Traditional Chinese Medicine from September 2018 to September 2021.Visual analogue scale(VAS),American Association of Foot and Ankle Surgery(AOFAS)ankle-posterior foot score and knee Lysholm score were recorded before surgery,six months after surgery and at the last visit(≥12 months).Preoperative and postoperative scores such as VAS,AOFAS and Lysholm were used to evaluate ankle and knee pain and function.CT or MRI findings were used to evaluate the healing of the osteotomy area and the osteochondral graft area,and to record the complications.Repeated measure ANOVA,LSD-t test,Friedman test and Wilcoxon rank sum test were used for analysis.Results Twenty patients with OLT of Hepple type Ⅴ were followed up,and CT/MRI at the last follow-up showed that the bone graft was well integrated with the surrounding bone.VAS score decreased from 6.5(6.0,8.0)before surgery to 2.0(2.0,3.0)at six months after surgery and 2.0(2.0,3.0)at the last follow-up,respectively.AOFAS ankle-posterior foot score increased from 59.0(48.0,64.0)before surgery to 88.5(87.0,90.0)at six months after surgery and 90.0(88.0,90.0)at the last follow-up(χ^(2)=33.78,33.56,both P<0.05).There was no statistically significant difference in VAS score and AOFAS score between the last follow-up and six months after surgery(all P>0.05).There was no statistically significant difference in Lysholm score between six months after surgery and the last follow-up or between the data before operation and after operation(all P>0.05).The excellent rate of AOFAS ankle-posterior foot score at six months after operation was 95%,and no postoperative complication was observed.Conclusion Autologous osteochondral transplantation(OAT)for OLT of Hepple type Ⅴ can significantly reduce ankle pain,improve function,achieve satisfactory results,and control the risk of knee joint donor site,which has certain clinical practical value.