自体带骨膜髂骨移植治疗HeppleⅤ型距骨骨软骨损伤的中短期效果

Short-and Medium-Term Effects of Autogenous Iliac Bone Transplantation for HeppleⅤOsteochondral Lesion of the Talus

目的观察自体带骨膜髂骨移植治疗HeppleⅤ型距骨骨软骨损伤(OLT)的中短期临床效果。方法回顾性分析新乡医学院第一附属医院2014年7月至2017年7月收治的20例合并软骨下骨囊肿的OLT患者临床资料。内踝截骨,取同侧带骨膜髂骨修复缺损部位。术前及术后12、24个月,测量踝关节活动范围(ROM),采用美国足踝外科协会(AOFAS)踝-后足评分系统评估关节功能,采用视觉模拟评分(VAS)评估关节疼痛程度。定期复查,观察截骨处及植骨处愈合情况。结果术后12、24个月,患者ROM均较术前增加(均P<0.001),踝关节VAS评分均比术前降低(均P<0.001),AOFOS踝-后足评分系统得分均较术前提高(均P<0.001)。术后12个月与24个月,患者以上3项指标相比,差异无统计学意义(均P>0.05)。术后患者X线及MRI检查结果显示病灶区被移植物填充,骨囊肿消失,无明显关节间隙狭窄。结论自体带骨膜髂骨移植可减轻HeppleⅤ型OLT患者疼痛,改善踝关节功能,中短期疗效可。

Objective To observe the short-and medium-term effects of autologous iliac bone transplantation on HeppleⅤosteochondral lesion of the talus(OLT).Methods The clinical data of 20 OLT patients with subchondral bone cysts admitted to the First Affiliated Hospital of Xinxiang Medical University from July 2014 to July 2017 were retrospectively analyzed.The patients were treated by osteotomy of medial malleolus and Ipsilateral iliac bone transplantation for talus cartilage defects.Before surgery and 12 and 24 months after surgery,the range of motion(ROM)of ankle joint was measured,the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scoring system was used to assess joint function,and the visual analog scale(VAS)was used to assess joint pain.The healing of the osteotomy and bone graft was checked regularly.Results In the 12th and 24th month after operation,the ROM improved compared with that before operation(both P<0.001),the ankle VAS score decreased compared with that before operation(both P<0.001),and AOFOS ankle-hindfoot score increased compared with that before operation(both P<0.001).There was no statistical difference in the above 3 indexes between 12th month and 24th month after operation(all P>0.05).Postoperative radiographs and MRI showed that the lesion area was filled with grafts,bone cysts disappeared,and there was no obvious joint space stenosis.Conclusion Autologous iliac bone transplantation could reduce the pain of HeppleⅤtype OLT patients,and improve their ankle joint function.