自体带骨膜髂骨移植术治疗Hepple V型距骨骨软骨损伤的疗效分析

Treatment of Hepple type V osteochondral lesion of talus using autologous periosteal iliac bone graft

目的探讨自体带骨膜髂骨移植术治疗Hepple V型距骨骨软骨损伤的临床疗效。方法回顾性分析自2016-06—2020-03采用自体带骨膜髂骨移植术治疗的15例HeppleⅤ型距骨骨软骨损伤,术中显露局部软骨剥脱及软骨下距骨囊性变区,根据术前测量结果在病灶中心用环钻垂直于骨面钻出合适深度圆柱状骨槽作为植骨区,再用环钻取出与受区相匹配的圆柱状带骨膜骨条,骨膜面朝上打压植入距骨缺损面受区,尽量保证骨膜与软骨面相平。合并的距腓前韧带损伤采用带线锚钉修补并加强外侧伸肌支持带。结果 15例均获得平均21.5(6~36)个月随访,均未发生神经血管损伤、切口感染、深部感染、髂骨取骨区骨折、螺钉断裂、内踝不愈合等并发症,未残留长期麻木与慢性疼痛。术后MRI显示距骨软骨下囊肿消失,移植区关节面无明显台阶,移植骨条与周围正常软骨及软骨下组织间隙无异常信号。末次随访时MOCART评分为(56.9±5.3)分,踝与后足功能AOFAS评分为(94.4±6.7)分,疼痛VAS评分为(2.8±0.9)分,踝关节活动度为(59.9±4.2)°,均较术前明显改善,差异有统计学意义(P<0.05)。结论自体带骨膜髂骨移植术治疗Hepple V型距骨骨软骨损伤是一种安全、有效的手术方式,术后软骨修复与踝关节功能恢复满意。

Objective type V osteochondral lesion of the talus.MethodsFifteen patients with Hepple type V osteochondral lesion of the talus were treated from June 2016 to March 2020. Local cartilage dissection and subchondral talus cystic lesions were revealed during the operation, after that, according to the results of preoperative measurement, a terete bone trough with appropriate depth was drilled perpendicular to the bone surface in the center of the lesion, which was prepared as bone graft areas. The terete periosteum bone strip matching the recipient area was removed by trephine, and implanted into the receptacle of the talus defect as the periosteum of the bone strip was pressed upward and level with the surface of the cartilage. For patients with combined injuries to the anterior talofibular ligament, the lateral extensor support band was repaired and strengthened with wire anchors.ResultsAll the patients were followed up for 21.5 months on average(6-36 months). No neurovascular injury, incision infection,deep infection, iliac bone fracture, screw fracture, medial malleolus nonunion or other complications were found. In addition,there was no long-term residual numbness or chronic pain. Postoperative MRI showed that the subchondral cyst disappeared,there was no obvious step on the articular surface of the graft area, and there was no abnormal signal in the space between the graft bone and the surrounding normal cartilage and subchondral tissue. At the last follow-up, MOCART score was 56.9±5.3,AOFAS score of ankle and hind foot function was 94.4±6.7, VAS score was 2.8±0.9 and ankle range of motion was(59.9±4.2)°,all of which were significantly improved compared with those before surgery, and the difference was statistically significant(P<0.05).ConclusionAutologous periosteal iliac bone graft is a safe and effective surgical method for treatment of Hepple type V osteochondral lesion of the talus, it can lead to satisfactory cartilage repair and ankle function recovery.