自体骨软骨移植治疗踝部骨折

Treatment of acute osteochondral fractures of the talus using autologous osteochondral transplantation

[目的]探讨自体骨软骨移植术治疗踝部骨折伴随的距骨骨软骨骨折的临床效果。[方法]18例单侧踝部骨折伴随的Ⅲ、Ⅳ型距骨骨软骨骨折，男10例，女8例，年龄18～49岁，平均33．5岁。骨折区清创后钻孔，自同侧膝关节非负重区钻取骨软骨柱，采取打压固定技术将骨软骨柱植入受区的孔中。观察研究患者踝关节的功能、X线以及MRI表现。[结果]随访平均28（17—40）个月。7例行多柱移植，11例行单柱移植。根据Baird和Jackson踝关节评分系统进行功能评分平均96．3±3．5分，优14例，良3例，可1例，优良率为94．4％；1例患者X线片示踝关节发生创伤性关节炎，发生率为5．6％（1／18），MRI显示发生距骨剥脱性骨软骨炎，占5．6％（1／18）。膝关节无长期供区并发症。[结论]骨软骨移植治疗踝部骨折伴随的Ⅲ、Ⅳ型距骨骨软骨骨折是一种有效的手术方法。

[ Objective] To study the clinical results of treatment of local osteochondral fracture lesions on the talus dome associated with ankle fracture using autologous osteochondral transplantation. [ Method] There were 18 patients with osteochondral fracture defects of the talus dome associated with ankle fracture, male 10, female 8, with the average age 33.5 years （18 -49 years）. Transplantation procedure was osteochondral cylinders from non - weight bearing surface of the ipsilateral knee and implant the donor graft into the recipient holes of talus cartilaginous defects with press - fit technique. The outcomes were assessed on the basis of ankle functional rating score, radiographic findings and MRI findings. [ Result] The patients were followed up for 17 to 40 months （mean, 28 months）. The ankle functional rating score was measured by the Baird and Jackson functional rating score system. The averaged scores was 96.3 ±3.5 ,excellent in 14 cases, good in 3 cases and fair in 1 case. The rate of being excellent and good was 94.4%. The rate of posttraumatic arthritis was 5.6% （ 1/18 ） and osteochondritis dissecans was 5.6% （ 1/18 ）. [ Conclusion] Autogenous osteochondral transplantation using ipsilateral knee osteochondral grafts is an effective surgical procedure on treating acute local osteochondral fracture lesions of the talus associated with ankle fracture.