不同关节镜术式对小面积距骨骨软骨损伤患者疗效及安全性的影响

Influence of Different Kinds of Arthroscopic Operation on Clinical Efficacy and Safety of Patients with Small Area Talar Osteochondral Injury

目的探讨关节镜下克氏针钻孔术和微骨折术对小面积距骨骨软骨损伤患者疗效及安全性的影响。方法回顾性分析2012年1月至2017年12月保定市第一中心医院骨五科收治的114例小面积距骨骨软骨损伤患者的临床资料,根据手术方案不同分为两组:钻孔组(52例)采用关节镜下克氏针钻孔术治疗;微骨折组(62例)采用关节镜下微骨折术治疗。比较两组末次随访的疗效,手术前后视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)评分、踝关节运动评分(AMS)、踝关节Berndt-Harty软骨损伤分期及术后并发症的发生情况。结果末次随访时,钻孔组AOFAS评分优良率为88.46%(46/52),微骨折组为91.94%(57/62),两组比较差异无统计学意义(P>0.05)。治疗前后VAS、AOFAS及AMS评分的主效应差异有统计学意义(P<0.01);不考虑测量时间,两组间VAS、AOFAS及AMS评分的主效应差异有统计学意义(P<0.01);VAS、AOFAS及AMS评分的时点间与组间存在交互作用(P<0.01),两组治疗前后VAS、AOFAS及AMS评分的变化幅度不同。两组术前、末次随访时踝关节Berndt-Harty软骨损伤分期比较差异无统计学意义(P>0.05)。所有患者术后均未出现切口感染、神经肌肉损伤、严重不适症状及二次手术等,术后切口一期愈合;钻孔组和微骨折组术后并发症发生率比较差异无统计学意义[3.85%(2/52)比1.61%(1/62)](P>0.05)。结论关节镜下克氏针钻孔术和微骨折术对小面积距骨骨软骨损伤患者总体疗效及安全性接近。

Objective To investigate the influence of arthroscopic Kirschner wire drilling and arthroscopic microfracture on clinical efficacy and safety of patients with small area talar osteochondral injury.Methods The clinical data of 114 patients with small area talar osteochondral injury admitted to the Department Five of Orthopedics,Baoding First Central Hospital from Jan.2012 to Dec.2017 were retrospectively analyzed.According to different surgical schemes,they were divided into two groups:An arthroscopic Kirschner wire drilling group(52 cases)and an arthroscopic microfracture group(62 cases).The curative effect,visual analogue scale(VAS),American Society of Foot and Ankle Surgery(AOFAS)score,ankle motion score(AMS),Berndt-Harty cartilage injury stage at the last follow-up and postoperative complications of the two groups were analyzed.Results At the last follow-up,the excellent and good rate of AOFAS score was 88.46%(46/52)in the drilling group and 91.94%(57/62)in the microfracture group,and there was no significant difference between the two groups(P>0.05).The main effects of VAS,AOFAS and AMS score before and after treatment were statistically significantly different(P<0.01);regardless of the measurement time,the main effects of VAS,AOFAS and AMS score between the two groups were statistically significantly different(P<0.01);there was interaction of VAS score,AOFAS score and AMS score and between the time points and the groups(P<0.01),the changing amplitudes of VAS score,AOFAS score and AMS score of the two groups from before to after treatment were different.There was no significant difference in the stage of Berndt-Harty cartilage injury of the two groups before operation and at the last follow-up(P>0.05).There was no wound infection,neuromuscular injury,severe discomfort and secondary surgery in all patients,and the incision healed in the first stage after operation.There was no significant difference in the incidence of postoperative complications between the two groups[3.85%(2/52)vs 1.61%(1/62)](P>0.05).Conclusion The overall efficacy and safety of arthroscopic Kirschner wire drilling surgery and microfracture surgery for patients with small area of talus osteochondral injury are similar.