微骨折与骨软骨移植治疗距骨骨软骨病变比较

Comparison of microfracture versus osteochondral autograft transfer in the treatment of osteochondral lesions of the talus

[目的]研究微骨折术与骨软骨移植治疗小面积距骨骨软骨病变(osteochondral lesion of the talus,OLT)的疗效.[方法]回顾性分析本科2014年6月-2018年7月手术治疗小面积(0.80~1.20 cm^(2))OLT49例患者的临床资料,依据术前医患沟通结果,25例采用微骨折治疗,24例采用骨软骨移植治疗.比较两组围手术期、随访与影像资料.[结果]所有患者均顺利完成手术,无神经血管损伤等严重并发症.微骨折组的手术时间、切口长度、术中失血量、住院时间、术中透视次数均优于移植组(P<0.05).两组患者均随访12个月以上,微骨折组恢复行走活动时间和完全负重时间均显著早于移植组(P<0.05).与术前相比,末次随访时两组患者VAS评分均显著下降(P<0.05),而AOFAS和AAS评分均显著增加(P<0.05).末次随访时移植组的上述评分均显著优于微骨折组(P<0.05).影像方面,与术前相比,末次随访时两组患者Bemdt分期均有显著改善(P<0.05).末次随访时,移植组的Bemdt分期显著优于微骨折组(P<0.05).至末次随访时,两组均未见严重踝关节退变.移植组所有患者术后均未出现截骨不愈合或延迟愈合、内固定脱落或断裂等并发症.[结论]对于小面积OLT,微骨折术与骨软骨移植术均能缓解疼痛,改善踝关节功能,骨软骨移植手术效果更显著.

[Objective]To explore the clinical efficacy of microfracture(MF)versus osteochondral autograft transfer(OAT)in the treatment of small area osteochondral lesion of the talus(OLT).[Methods]A retrospective study was performed on 49 patients with small-area(0.80-1.20 cm2)OLT in our department from June 2014 to July 2018.According to the results of preoperative doctor-patient communication,25 patients were treated with MF,while the other 24 cases were treated with OAT.The perioperative,follow-up and imaging data of the two groups were compared.[Results]All patients were successfully operated without neurovascular injury and other serious complications.The MF group proved significantly superior to the OAT group in terms of operative time,incision length,intraoperative blood loss,hospital stay and intraoperative fluoroscopy times(P<0.05).All patients in both groups were followed up for more than 12 months.The MF group recovered walking activity and full weight-bearing activity significantly earlier than the OAT group(P<0.05).The VAS scores significantly decreased(P<0.05),whereas the AOFAS and A AS scores significantly increased in both groups at the latest follow-up compared with those preoperatively(P<0.05).At the latest follow-up,the OAT group was significantly superior to the MF in the abovementioned scores(P<0.05).Radiographically,the Bemdt grade was significantly improved in both groups at the latest follow-up compared to that before surgery(P<0.05).At the latest follow-up,the OAT group proved significantly superior to the MF group in term of Bemdt grade(P<0.05).No serious ankle degeneration was observed in both groups at the last follow-up,and none of the patients in the OAT group had complications such as nonunion or delayed union of osteotomy,loosening or fracture of internal implant.[Conclusion]For small OLT,both microfracture and osteochondral autograft transfer can relieve pain and improve ankle function,by contrast,the osteochondral autograft trans-fer is more effective.