关节镜与MRI对距骨骨软骨损伤手术方式选择的相关性分析

Correlation analysis of arthroscopy and MRI assisted selection of surgical procedure of osteochondral lesions of the talus

目的探讨关节镜与MRI在距骨骨软骨损伤诊断方面的相关性及两者辅助下选择的手术方式的疗效。方法选取2010年8月至2013年7月在上海瑞金医院收治的40例距骨骨软骨损伤患者进行回顾性研究分析。患者均常规行MRI和关节镜检查,分别根据Hepple法和Bohndorf法进行分级,并分析二者的相关性;术后随访并评估,判断疗效。结果损伤根据Hepple的MRI分期：Ⅰ期5例,Ⅱ期12例,Ⅲ期8例,Ⅳ期6例,Ⅴ例9例;根据Bohndorf的关节镜分级：A级4例,B级4例,C级5例,D级17例,E级5例,F级5例。距骨骨软骨损伤的MRI分期与关节镜下分级两者之间无显著相关（r=0.26,P=0.24）;33例手术患者术后获6~35个月（平均15.7个月）的随访,随访率为82.5%。美国足踝外科协会（American Orthopaedic Foot and Ankle Society,AOFAS）踝与后足功能评分术前（42.16±10.23）分,术后（82.84±13.03）分,差异有统计学意义（P〈0.01）;优良率81.8%,且未发生明显并发症。结论 MRI和关节镜的联合应用是准确评价距骨骨软骨损伤的必需检查手段,且在对手术方式的选择方面具有指导意义。

Objective To summarize and analyze the correlation of MRI and arthroscopy assisted diagnosis of osteochondral lesions of the talus（OLT） and the therapeutic effect of MRI and arthroscopy assisted selection of surgical procedure for OLT. Methods The retrospective study was carried out for the 40 OLT patients treated in Ruijin Hospital in the duration of August 2010 to July 2013. All patients took both MRI and arthroscopic examination routinely before surgery. They were analyzed with both MRI Hepple’s staging and arthroscopic Bohndorf’s grading for evaluating the correlation of the two. And, the ankle-hindfoot scores of American Orthopaedic Foot and Ankle Society（AOFAS） were calculated respectively before and after surgery for comparison. Results According to MRI Hepple’s staging, there were 5 cases in stage I, 12 cases in stage II, 8 cases in stage III, 6 cases in stage IV, and 9 cases in stage V respectively. Meanwhile, based on arthroscopic Bohndorf’s grading, there existed 4 patients in grade A, 4 patients in grade B, 5 patients in grade C, 17 patients in grade D, 5 patients in grade E, and 5 patients in grade F respectively. There was no significant relation between the MRI Hepple’s staging and arthroscopic Bohndorf’s grading（r=0.26, P=0.24）. Of the 40 patients, 33 received the follow-up for 6~35 months, 15.7 months on average, and the follow-up rate was 82.5%. Before operation, the ankle-hindfoot score was（42.16±10.23）, while at the end of follow-up, the score was significantly increased, which was（82.84±13.03）（P〈0.01）, and the difference was significant in statistics; the excellence rate was 81.8%, and there was no obvious complications either. Conclusions The combination of MRI with arthroscopic examination is needed for the diagnosis of OLT and it is beneficial in guiding the selection of surgical procedure. The effect of surgical treatment for OLT was satisfactory.