同侧股骨髌股关节面非负重区骨软骨柱移植修复距骨骨软骨缺损的回顾性临床观察

retrospective clinical observation on repair of osteochondral lesions of talus with non-weight bearing area osteochondral columns from patellofemoral joint surface of ipsilateral femoral condyle

目的探讨从同侧股骨髌股关节面非负重区获取骨软骨柱,行自体骨软骨移植术修复距骨骨软骨缺损的临床效果。方法回顾性分析2014年5月~2017年3月新乡医学院第一附属医院收治的距骨骨软骨缺损患者22例,所有患者均行踝关节X线、CT或MRI进行术前评估距骨病变程度,采用踝关节镜下明确软骨缺损的位置及面积,清理缺损区边缘,加行内踝截骨,应用自体骨软骨移植系统取同侧股骨髌股关节面非负重区骨软骨柱修复距骨骨软骨缺损。采用视觉疼痛量表(VAS)对术前、术后末次随访踝关节疼痛进行评分;采用美国足踝外科协会踝-后足评分(AOFAS)对术前及术后末次随访踝关节功能进行评分;术后行踝关节X线及MRI检查。结果 21例患者获得随访,1例患者失访。术后随访10~20个月,患者踝关节VAS评分从术前(5.95±1.04)分降至术后末次随访(1.50±0.96)分,差异有高度统计学意义(P<0.01);AOFAS评分从术前(53.28±14.93)分上升至术后末次随访(84.47±9.31)分,差异有高度统计学意义(P<0.01)。结论从同侧股骨髌股关节面非负重区获取骨软骨柱,行自体骨软骨移植术治疗距骨骨软骨缺损的效果较好,能减轻患者踝关节疼痛,改善踝关节功能。

Objective To investigate the clinical effect of using autologous osteochondral transplantation with non-weight bearing area osteochondral columns which derived fromthe patellofemoral joint surfaceof ipsilateral femoral condyle for repairing osteochondral lesions of the talus(OLT).Methods From May 2014 to March 2017,in the First Affiliated Hospital of Xinxiang Medical University,22 OLT patients were retrospectively reviewed,all patients underwent preoperative assessment of the extent of talus lesions by X-ray,CT or MRI.Then the position and area of osteochondral lesions were determined by arthroscopy in all patients,the edge of the defect area and medial malleolus osteotomy was cleared,osteochondral autograft transfer system was used to repair osteochondral lesions of the talus with non-weight bearing area osteochondral columns from the patellofemoral joint surface of ipsilateral femoral condyle.Visual analogue scale(VAS)was used to assess ankle pain preoperatively and during the last follow-up postoperatively.American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score was used to evaluate ankle function preoperativly and the last follow-up postoperatively.X-ray and MRI of ankle joint were observed to understand the recovery of osteochondral lesions area postoperatively.Results A total 21 patients received follow-up,1 patient lost follow-up.After treatment they received follow-up for 10-20 months,the VAS reduced from(5.95±1.04)points before surgery to(1.50±0.96)points at last follow-up,the difference was statistically significant(P<0.01).The AOFAS improved from(53.28±14.93)points before surgery to(84.47±9.31)points at last follow-up,the difference was statistically significant(P<0.01).Conclusion Osteochondral autografts is effective in the treatment of OLT,it can reduce the pain of the ankle and improve the function of the ankle joint.