双平面截骨加自体骨软骨移植治疗距骨骨软骨损伤合并距骨囊肿的临床效果

The clinical effect of autologous osteochondral transplantation via biplanar osteotomy for osteochondral lesions of the talus combined with subchondral cysts

目的探讨内踝双平面截骨加自体骨软骨移植治疗内侧距骨骨软骨损伤合并距骨囊肿的临床效果。方法回顾性分析2015年12月至2018年12月于新疆医科大学第一附属医院骨科中心行双平面截骨加自体骨软骨移植治疗的25例内侧距骨骨软骨损伤合并距骨囊肿患者的临床资料。男性21例,女性4例,年龄36.5岁(范围:21~47岁)。所有患者于关节镜下评估软骨损伤范围及深度,Outerbridge分级为Ⅱ~Ⅳ度。手术经内踝前内侧切口,行内踝双平面截骨,下翻截骨块显露软骨损伤部位,完整切除异常软骨,使用刮勺彻底切除硬化囊壁,将来自同侧膝关节健康软骨移植至距骨软骨损伤区。收集患者术前及末次随访时的视觉模拟评分(VAS)、美国足踝外科协会踝-后足评分(AOFAS-AH)、Karlsson-Peterson踝关节评分、膝关节Lysholm评分,记录并发症情况及影像学检查结果。数据分析采用配对样本t检验。结果25例患者均获得随访,随访时间25.6个月(范围:12~36个月)。患者术后踝关节疼痛及功能情况明显改善,VAS由术前的(6.5±1.3)分降至术后的(1.9±1.3)分(t=8.13,P=0.00);AOFAS-AH评分由术前的(62.4±3.3)分升至术后的(88.0±2.4)分(t=-31.51,P=0.00);Karlsson-Peterson踝关节评分由术前的(59.8±2.7)分升至术后的(85.2±3.5)分(t=-25.50,P=0.00),差异均有统计学意义。膝关节Lysholm功能评分术前为(92.5±1.3)分,术后为(92.0±1.3)分,差异无统计学意义(t=1.93,P=0.065)。随访中无感染、移植软骨坏死、囊肿残留、截骨端不愈合、供区持续疼痛等并发症发生。结论双平面截骨加同侧膝关节自体骨软骨移植治疗骨软骨损伤合并距骨囊肿的临床效果满意,可明显缓解患者踝关节疼痛并改善踝关节功能。

Objective To examine the clinical effect of autologous osteochondral transplantation via biplanar osteotomy for osteochondral lesions of the talus combined with subchondral cysts.Methods A retrospective analysis of 25 patients who underwent autogenous osteochondral transplantation via biplanar osteotomy for treatment of talus osteochondral injury combined with subchondral cysts at Department of Orthopaedics,First Affiliated Hospital of Xinjiang Medical University from December 2015 to December 2018 were conducted.There were 21 males and 4 females,aged 35.5 years(range:21 to 47 years).The extent and depth of cartilage damage of patients were evaluated under arthroscopy.The Outerbridge classification of patients were stageⅡ-Ⅳ.Through the anterior and medial incision of the medial malleolus,bilateral osteotomy of the medial malleolus was performed.The osteotomy block was turned down to reveal the cartilage damage site.The abnormal cartilage was completely removed and the sclerotic wall of cyst was completely removed with a spatula.Then the healthy cartilage from the same knee joint was transplanted to the talus cartilage damage area.The preoperative and postoperative visual analogue scale(VAS),American Orthopedic Foot Andankle Society-Ankle Hindfoot Scale(AOFAS-AH)and Karlsson-Peterson score and Lysholm score of knee joint were recorded.Data were analyzed by paired-samples t-test.Results All of patients were followed up for 25.6 months(range:12 to 48 months).The VAS decreased from 6.5±1.3 to 1.9±1.3(t=8.13,P=0.00).AOFAS-AH increased from 62.4±3.3 to 88.0±2.4(t=-31.51,P=0.00).Karlsson-Peterson scores increased from 59.8±2.7 to 85.2±3.5(t=-25.50,P=0.00).While there was no statistical different in Lysholm score of knee joint(92.5±1.3 vs.92.0±1.3,t=1.93,P=0.065).No complications like infection,translated cartilage necrosis,cycst residual,nonunion,persistent pain in donor site.Conclusion Autologous osteochondral transplantation via biplanar osteotomy has satisfactory effect for patients with osteochondral lesions of the talus combined with subchondral cysts.