自体骨软骨移植修复距骨软骨或骨软骨缺损

Treatment of chondral or osteochondral lesions of the talus using autologous osteochondral transplantation

目的探讨从同侧膝关节非负重面获取骨软骨柱,行自体移植修复距骨穹窿部局限性软骨或骨软骨缺损的临床效果。方法23例距骨穹窿部软骨病损的患者,包括创伤后软骨缺损11例,剥脱性骨软骨炎9例和局灶性骨关节炎3例。踝关节镜下明确缺损的部位、大小,行关节镜下或加用关节切开移植术,缺损区清创后钻孔,自同侧膝关节非负重区钻取骨软骨小柱,利用骨软骨自体移植系统(osteochondralautografttransfersystem,OATS)的专用器械,采取压配固定技术将移植物植入受区的孔中,行单柱或多柱镶嵌式移植修复距骨软骨缺损。结果术后随访15～30个月,平均22个月。利用标准VAS(visualanaloguescale)尺子评估踝关节疼痛程度,评分从术前平均4.9±1.2降至术后0.8±0.1(P<0.001)。测量踝关节跖屈和背伸角度,关节活动范围由术前平均44.3°±5.8°增加到术后65.6°±11.2°(P<0.001)。按Mazur等方法综合评定踝关节的状况,评分从术前平均(51.7±8.6)分提高到(92.4±6.3)分(P<0.001)。术后MR检查提示修复的关节面平滑,移植物与周围组织结合良好。结论以同侧膝关节非负重区的骨软骨移植修复距骨局限性软骨或骨软骨缺损是一种疗效明显的外科手术方法。

Objective To evaluate the clinical results from the treatment of local chondral or osteochondral lesions on the talus dome with autologous osteochondral transplantation or mosaicplasty harvested from the ipsilateral knee. Methods There were 23 patients with chondral defects of the talus dome includ- ing post-traumatic cartilage defects（n=11）, osteochondritis dissecans（n=9）, and local osteoarthritis（n=3）. The position and size of the defect were defined under ankle arthroscopy. The procedures consisted of debriding its edges and base drilled under ankle arthroscopy or arthrotomy, then harvesting osteochondral cylinders from non-weight bearing surface of the ipsilateral knee under arthroscopy, and using the osteochondral autograft transfer system （OATS） to implant the donor graft into the recipient holes of talus cartilaginous defects with press-fit technique. A single donor transplantation or the mosaicplasty was used. Results All the patients were followed up for 15 to 30 months （mean, 22 months）. The mean pain intensity measured by standard visual analogue scale （VAS） reduced from 4.9±1.2 to 0.8±0.1 at final follow-up （P〈0.001）. The ankle joints flexion and extension degree of the angle were measured to indicate that the range of motion（ROM） improved significantly from 44.3°±5.8° to 65.6°±11.2° compared with preoperative status （P〈0.001）. Finally, the overall status of the ankle were validated by the score described by Mazur et al. The scores improved from （51.7±8.6） points to （92.4±6.3） points （P〈0.001）. The grafts showed excellent bony integration with surrounding tissues and congruity of the articular surface through the ankle MRI. Conclusion Autogenous osteochondral transplantation of the talus using ipsilateral knee osteochondral grafts is a surgical procedure of true curative effects on treating local cartilage or osteochondral lesions of the talus.