前踝截骨联合自体骨软骨移植治疗距骨软骨损伤的效果观察

The clinical effect of autologous osteochondral transplantation via anterior ankle osteotomy for osteochondral lesions of the talus combined with subchondral cysts

目的探讨前踝截骨联合自体骨软骨移植治疗距骨软骨损伤的临床效果。方法回顾性研究。纳入2014年1月—2017年1月徐州市中心医院骨科16例(16足)距骨软骨损伤患者的临床资料。其中,男6例、女10例,年龄18~67(33.4±11.1)岁;右侧7例,左侧9例。患者均采用前踝截骨联合自体骨软骨移植治疗距骨软骨损伤。比较术前及其末次随访时患者的视觉模拟评分法(VAS)评分、美国足踝外科协会(AOFAS)评分;术后2年采用软骨修复MR观察(MOCART)评分评价手术的治疗效果。结果术后患者切口均获得一期愈合。16例患者术后随访36~72(46.6±12.8)个月。末次随访时VAS评分由术前的(6.9±1.6)分改善为(0.8±0.8)分,AOFAS评分由术前的(60.7±10.8)分提升为(90.9±5.6)分,差异均有统计学意义(t=18.67、13.92,P值均<0.001),依据AOFAS评分评价踝关节功能优14例、良2例,优良率16/16。术后2年MRI示截骨面均愈合良好,原病灶缺损区均被移植物充填,MOCART评分为(65.0±10.2)分。结论前踝截骨联合自体骨软骨移植治疗距骨软骨损伤术后患者踝关节功能恢复好,症状减轻明显,临床疗效好。

Objective To investigate the clinical effect of anterior ankle osteotomy combined with autologous osteochondral transplantation in the treatment of talar cartilage injury.Methods The clinical data of 16 patients(16 feet)with talus cartilage injury in the Department of Orthopaedics of Xuzhou Central Hospital from January 2014 to January 2017 were included.Among them,6 were males and 10 were females.The patients were aged 18-67(33.4±11.1)years.Seven cases of talus cartilage injury were located on the right,and nine on the left.Anterior ankle osteotomy combined with autologous osteochondral transplantation was used to treat talar cartilage injury.Regular follow-up was performed after operation.The visual analogue scale(VAS)score and American Orthopaedic Foot and Ankle Society(AOFAS)score were compared before operation and at the last follow-up.The therapeutic effect of the operation was evaluated by using the magnetic resonance observation of cartilage repair tissue(MOCART)score at 2 years after surgery.Results All incisions healed in one stage.Sixteen patients were followed up for 36-72(46.6±12.8)months.At the last follow-up,the VAS score improved from(6.9±1.6)to(0.8±0.8),and the AOFAS score increased from(60.7±10.8)to(90.9±5.6),which was statistically significant compared with that before operation(t=18.67,13.92;all P values<0.001).At the last follow-up,ankle function was excellent in 14 cases and good in two cases,with an excellent and good rate of 16/16.Two years after surgery,MRI showed that the osteotomy surfaces healed well,and the defect areas of the original lesions were filled with grafts.The average MOCART score was(65.0±10.2).Conclusion Anterior ankle osteotomy combined with autologous osteochondral transplantation in the treatment of talar cartilage injury has good ankle function recovery,obvious symptom relief,and good clinical effect.