负重时间对小面积距骨骨软骨损伤微骨折术疗效的影响

EFFECT OF WEIGHT-BEARING TIME ON MICRO-FRACTURE THERAPY FOR SMALL SIZED OSTEOCHONDRAL LESION OF TALUS

目的通过术后早期及延迟负重比较,探讨小面积距骨骨软骨损伤(osteochondral lesion of the talus,OLT)行微骨折术后负重时间对疗效的影响,为指导术后康复锻炼提供依据。方法选择2010年3月-2011年9月收治的小面积OLT(<2 cm2)拟行微骨折术治疗的患者43例,随机分为术后早期负重组(n=22)和延迟负重组(n=21)。两组患者性别、年龄、体重指数、病程、损伤原因、术前疼痛视觉模拟评分(VAS)及美国矫形足踝协会(AOFAS)评分比较,差异均无统计学意义(P>0.05),具有可比性。两组患者均于关节镜下行关节面清理及微骨折术治疗。早期负重组患者术后即在"8"字护踝保护下完全负重,延迟负重组患者6周后开始逐渐负重。结果术中关节镜下测量,早期负重组软骨损伤面积为(1.24±0.35)cm2,延迟负重组为(1.25±0.42)cm2,损伤面积比较差异无统计学意义(t=0.09,P=0.93);两组软骨损伤分级比较差异亦无统计学意义(Z=—1.45,P=0.15)。术后两组患者均获随访,随访时间12～18个月,平均14.5个月。两组术后各时间点VAS及AOFAS评分均较术前显著改善(P<0.05);术后3、6、12个月两组间比较,差异均无统计学意义(P>0.05)。早期负重组回归工作时间为(6.35±1.93)个月,显著早于延迟负重组的(8.75±1.48)个月(t=—4.10,P=0.00)。结论对于小面积OLT,微骨折术后早期负重与延迟负重近期疗效相似,但早期负重患者回归工作时间显著提前。

Objective To evaluate the effect of weight-bearing time on micro-fracture therapy for small sized osteochondral lesion of the talus（OLT） by comparing early weight-bearing and postponed weight-bearing.Methods Between March 2010 and September 2011,43 patients with small sized OLT（ 2 cm2） scheduled for arthroscopic micro-fracture therapy were randomly divided into early weight-bearing group（n=22） and postponed weight-bearing group（n=21）.There was no significant difference in gender,age,body mass index,disease duration,disease cause,preoperative visual analogue scale（VAS） score,and preoperative American Orthopaedic Foot and Ankle Society（AOFAS） score between 2 groups（P 0.05）.All patients of 2 groups received micro-fracture treatment under arthroscopy.Full weight bearing began under the protection of ＂8＂ figure shaped splint at immediately after operation in early weight-bearing group,and weight bearing began at 6 weeks after operation in postponed weight-bearing group.Results The size of cartilage injury was（1.24 ± 0.35） cm2 in early weight-bearing group and was（1.25？± 0.42） cm2 in postponed weight-bearing group by arthroscopy measurement,showing no significant difference between 2 groups（t=0.09,P=0.93）;and there was no significant difference in cartilage injury grading between 2 groups（Z= —1.45,P=0.15）.The follow-up time was 12-18 months（mean,14.5 months） in 2 groups.VAS and AOFAS scores of each group at each time point after operation were all significantly improved when compared with preoperative scores（P 0.05）,but no significant difference was found between 2 groups at 3,6,and 12 months after operation（P 0.05）.The time of returning to work in early weight-bearing group [（6.35？± 1.93） months] was significantly shorter than that in postponed weight-bearing group [（8.75 ± 1.48）？months]（t= —4.10,P=0.00）.Conclusion For patients with small sized OLT,early weight-bearing and postponed weight-bearing after micro-fracture therapy under arthroscopy have similar short-term results.But patients undergoing early weight-bearing can earlier return to work than patients undergoing postponed weight-bearing.