中西医结合治疗距骨剥脱性骨软骨炎的个案报道

A case report on the treatment of osteochondritis dissecans of talus withcombination of Chinese and western medicine

目的:报道中西医结合治疗距骨剥脱性骨软骨炎的临床疗效并分析文献。方法:报道山东中医药大学附属医院显微骨科2016年-2018年间3例距骨剥脱性骨软骨炎住院患者,均采用中药内服配合病灶刮除加自体骨膜骨移植术治疗。中药治疗组方以活血化瘀,行气止痛为目的。手术治疗采用硬腰联合麻醉,取内踝纵行切口,于内踝截骨,截骨后下翻内踝,将距骨骨软骨剥脱区充分显露,以小刀切除已剥脱翘起骨软骨,并刨削毛糙区,以剥脱区为受区,内踝截骨2 cm处为供区。分别取骨柱,将供区骨柱打压入受区,并使骨膜与周围软骨位于同一平面,复位内踝,并以两枚空心钉固定。两者配合验证其临床疗效并回顾分析近年相关文献,从解剖、诊断及治疗加以综述。结果:3例患者伤口均为一期愈合,术后6个月症状较术前明显缓解,kofoed评分较前明显改善。从中国知网、万方、维普网检索近50篇文献,分析文献可知,距骨剥脱性骨软骨炎易被误诊漏诊,其主要手术治疗方案有微骨折术、钻孔术、自体软骨细胞移植术、自体骨软骨移植术、同种异体骨软骨移植术等。结论:采用中药内服配合病灶刮除加自体骨膜骨移植术治疗距骨剥脱性骨软骨炎,能缓解患者疼痛,提高功能活动度,值得临床推广。

Objective: To report the clinical efficacy of combination Chinese and western medicine in the treatment of osteochondritis dissecans of talus and to analyze the literature. Methods: This paper reports three cases of osteochondritis dissecans of talus in our hospital from 2016 to 2018. All of them were treated with traditional Chinese medicine of lesion scraping and autologous periosteum bone grafting. The treatment group of traditional Chinese medicine was aimed at promoting blood circulation and removing blood stasis, promoting qi and relieving pain. The operation was performed under combined epidural anesthesia, then medial malleolus was cut longitudinally and osteotomized at the medial malleolus. After osteotomy, the medial malleolus was turned down and the stripped area of talus osteochondral cartilage was fully exposed. The stripped and warped osteochondral cartilage was removed with a knife, and the rough area was planned, with the stripped area as the recipient area and two centimeters of medial malleolus osteotomy as donor site. Bone pillars were taken separately, after that the donor bone column was pressed into the recipient area, and the periosteum and surrounding cartilage were located in the same plane. Then the medial malleolus was reduced and fixed with two hollow nails. The clinical efficacy was verified by the combination of the two methods, meanwhile related literatures in recent years were reviewed from the aspects of anatomy, diagnosis and treatment. Results: All the three patients had primary healing, and the symptoms of kofoed score were significantly improved in six months after operation compared with that before operation. Nearly fifty literatures were retrieved from the CNKI, Wanfang, Weipu, and analysis of literatures showed that osteochondrosis of the talus was easy to be misdiagnosed and missed. Its major surgical treatment regimens included microfracture drilling and autologous chondrocyte transplantation and allograft osteochondral transplantation. Conclusion: The treatment of osteochondritis dissecans of talus with traditional Chinese medicine by lesion scraping and autologous periosteum bone grafting can alleviate the pain of patients and improve the functional activity, which is worthy of clinical promotion .