同侧股骨髁内侧髌股关节面自体骨软骨移植治疗距骨骨软骨损伤

Analysis on early results of using osteochondral autografts harvested from medial femoral condyle of the ipsflateral knee for the treatment of osteochondral lesion of the talus

目的评价同侧股骨髁内侧髌股关节面自体骨软骨移植治疗距骨骨软骨损伤的疗效及相关因素。方法回顾性分析2009年7月至2012年11月采用同侧股骨髁内侧髌股关节面自体骨软骨移植治疗15例距骨骨软骨损伤患者资料，男8例，女7例；年龄19-73岁，平均（49．6±17．2）岁。采用国际膝关节文献委员会（IKDC）及Lysholm评分系统对供区膝关节术前、术后功能进行评价；采用美国足踝外科协会（Orthopaedic FootandAnkle Society，AOFAS）踝与后足评分及视觉模拟评分（visualanaloguescale，VAS）对术前、术后踝关节功能及疼痛进行评价。年龄和随访时间两因素分别与各评分的改变量进行Spearman秩相关性检验。结果12例患者获得随访，平均随访（21．8±10．4）个月。术前膝关节IKDC、Lysholm、AOFAS踝与后足评分及VAS评分分别为（90．91±6．44）分、（95．33±8．00）分、（63．58±18．50）分、（7．25±1．54）分，术后分别为（85．63±11．89）分、（90．75±11．83）分、（90．33±4．98）分、（2．17±1．19）分。术后AOFAS踝与后足评分、Lysholm评分、IKDC评分改变量与年龄之间的相关系数分别为-0．74、-0．63、0．76。患者对手术非常满意4例（33％），满意5例（42％），一般3例（25％），满意率为75％。结论取同侧膝关节非负重区股骨髁内侧髌股关节面骨软骨移植治疗距骨骨软骨损伤术后患者踝关节功能恢复良好。患者年龄与术后踝关节、膝关节功能恢复有相关性。

Objective To evaluate the curative effect and related factors of the treatment for the os- teochondral lesion of talus （OLT） by the osteochondral autografts harvested from medial femoral condyle of the ipsilateral knee. Methods The data of 15 OLT patients was retrospectively analyzed who received the operation during July 2009 to November 2012. There were 8 males, and 7 females, with an average age of 49.6±17.2 years （range, 19-73 years）. International Knee Documentation Committee （IKDC） and Lysholm score were used to evaluate the knee function preoperatively and postoperatively respectively. The ankle functions and pain were assessed according to American Orthopaedic Foot and Ankle Society （AOFAS） ankle and hind-foot score and visual analogue scale （VAS） preoperatively and postoperatively respectively. Correla- tions between age or follow-up duration and all the score increments were further analyzed by Spearman rank correlation test. Results Twelve patients complete the follow up, with an average duration of 21.8±10.4 months. The average IKDC, Lysholm, AOFAS, and VAS were 90.91±6.44, 95.33±8.00, 63.58±18.50, and 7.25±1.54 respectively before operation, and 85.63±11.89, 90.75±11.83, 90.33±4.98, 2.17±1.19 respectively after operation. Correlation coefficients of age between AOFAS, Lysholm, and IKDC score increments were -0.74, -0.63, and -0.76, respectively. There were 4 cases which received excellent effect （33%）, 5 cases （42%） good and 3 （25%） fair. Conclusion The ankle joint function of patients with OLT recovered well by treated with osteoehondral autografts harvested from medial femoral condyle of the ipsilateral knee operation. A correlation was found between patients＇ age and postoperative functional recovery of ankle and knee joint.