自体髂骨移植治疗重度距骨软骨缺损临床研究

Clinical study of autologous iliac bone grafting in treatment of severe talus cartilage defects

目的探讨自体髂骨移植治疗重度距骨软骨缺损的临床疗效分析。方法选择2012年7月至2017年7月入院符合入选标准(距骨内侧缺损面积>1.5cm2或病变深度>7mm)的距骨软骨缺损患者35例,经内踝截骨、取同侧髂骨移植修复缺损部位,患者术前、术后随访均行CT和MRI检查,测量踝关节活动范围(ROM),采用美国矫形足踝协会(AOFAS)及视觉疼痛量表(VAS)对术前术后踝关节的功能及疼痛评定治疗效果,将手术前后相关指标进行统计学分析。结果术后随访12~36个月,平均(20.6±8.3)个月。91.4%(32/35)的患者术后3个月踝关节肿痛消失,余患者肿痛消失时间较长,最终所有患者踝关节肿痛均消失,末次随访时,测量踝关节活动范围,ROM由术前平均(47.7±6.3)°增加到术后(63.4±7.4)°差异有统计学意义(P<0.01),AOFAS评分较术前显著提高(70.5±7.2,91.3±4.9,P<0.01),VAS评分较术前显著降低(7.2±1.2,1.7±1.1,P<0.01),随访MRI检查关节面修复满意,无明显术后并发症。结论对于距骨内侧缺损面积>1.5cm2或病变深度>7mm的患者,取同侧髂骨移植修复缺损是一种疗效明显的外科手术方法,可广泛应用于临床。

Objective To investigate the clinical effects of autologous iliac bone grafting in treatment of severe talus cartilage defects.Methods A total of 35 patients with talar cartilage defects who were admitted and treated in our hospital from July 2012 to July 2017(including the talus defect area>1.5cm 2 or lesion depth>7mm)were enrolled in the study,who were treated by internal malleolus osteotomy and ipsilateral iliac bone graft for talus cartilage defects.The CT and MRI were performed before and after surgery.The range of motion of the ankle joint(ROM)was measured.The American Orthopedic Foot Association(AOFAS)and Visual Pain Scale(VAS)were used to evaluate the therapeutic effects on ankle joint function and pain of patients before and after operation,moreover,the relevant indexes before and after surgery were statistically analyzed.Results The patients were followed up for 12~36 months after surgery,with an average time being(20.6±8.3)months.The ankle joint swelling and pain in 32 patients(91.4%)disappeared at 3m after operation,and the other patients had a longer time of swelling and pain disappearing,finally the ankle joint swelling and pain disappeared in all the patients.At the last follow-up,the range of motion of the ankle joint was measured.The ROM was increased from(47.7±6.3)°before surgery to(63.4±7.4)°after surgery(P<0.01).The AOFAS scores after surgery were significantly increased,as compared with those before surgery(91.3±4.9 vs 70.5±7.2,P<0.01),however,the VAS scores after surgery were significantly decreased,as compared with those before surgery(1.7±1.1 vs 7.2±1.2,P<0.01).Follow-up MRI was satisfactory for articular surface repair without significant postoperative complications.Conclusion For patients with talar defect area>1.5cm 2 or lesion depth>7mm,the ipsilateral iliac bone graft repair is an effective surgical method,therefor,which can be widely used in clinical practice.