自体骨软骨移植治疗距骨软骨损伤

Treatment of osteochondral lesions of the talus with autologous osteochondral transplantation

目的探讨自体骨软骨移植治疗距骨软骨损伤的临床疗效。方法回顾性选取2012年1月至2017年12月首都医科大学附属北京友谊医院收治的HeppleⅤ型距骨软骨损伤患者共12例,所有患者均取同侧膝关节非负重区骨软骨柱作为供体,进行自体骨软骨移植手术治疗,术后进行回顾性随访。术前及术后3、6、12、24个月分别进行视觉模拟评分(VAS)和美国骨科足踝协会(AOFAS)评分,对踝关节疼痛和功能进行评价和分析。结果所有患者均获随访,随访时间24~28个月,平均随访25个月,随访期间复查MRI显示受区骨软骨柱位置良好,无脱落,软骨表面平整,未见感染、踝关节不稳、供区疼痛等并发症。VAS评分由术前的8.28±0.60分降至末次随访时的1.62±0.16分,差异有统计学意义(P<0.05)。AOFAS评分由术前的61.25±3.82分升至末次随访时的88.67±2.02分,差异有统计学意义(P<0.05)。结论自体骨软骨移植治疗HeppleⅤ型距骨软骨损伤疗效良好,可明显减轻患者的疼痛,提高踝关节功能,且安全性高。

Objective To evaluate the clinical effect of autologous osteochondral transplantation in the treatment for osteochondral lesions of the talus(OLT).Methods From January 2012 to December 2017,12 cases of OLT(Hepple V)were treated with autologous osteochondral transplantation in Beijing Friendship Hospital.Osteochondral cylinders were harvested from the non-weight bearing surface of the ipsilateral knee.All the patients were followed up and analyzed retrospectively.Visual Analogue Score(VAS)and American orthopedic foot and ankle society(AOFAS)score were recorded before surgery and 3,6,12,24 months after the surgery.And the pain and function of the ankle were analyzed.Results All patients were followed up for 24 to 28 months,with an average of 25 months.During the follow-up period,MRI examination results showed that the implanted osteochondral cylinders were well positioned,and there were no cases of detachment and the cartilage surface was smooth.And there were no cases of infection,ankle instability and pain of the donor zone.VAS score was significantly reduced from 8.28±0.60 before operation to 1.62±0.16 at the last follow-up after operation.The differences were statistically significant(P<0.05).AOFAS score was significantly increased from 61.25±3.82 before operation to 88.67±2.02 at the last follow-up after operation.The differences were statistically significant(P<0.05).Conclusion Autologous osteochondral transplantation is effective and safe in the treatment of OLT(HeppleⅤ).It can reduce the pain of the patient and improve the function of the ankle obviously.