自体骨软骨单柱与双柱移植治疗Hepple V型距骨软骨损伤的疗效分析

Analysis of the effect of autologous osteochondral single-plug and double-plug transplantation on Hepple V osteochondral lesions of the talus

目的探讨自体单柱与双柱骨软骨柱移植术治疗Hepple V型距骨软骨损伤的疗效差异。方法回顾性分析2014年5月至2019年9月采用自体骨软骨移植术治疗并获得随访的30例Hepple V型距骨软骨损伤患者的资料,采用单柱移植术22例,双柱移植术8例;男23例,女7例;年龄26~52岁,平均(34.0±5.9)岁;病灶面积85.3~340.7mm^(2),平均(135.7±68.4)mm^(2);随访25~48个月,平均(31.7±5.5)个月。采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分与视觉模拟评分(visual analog scale,VAS)评价术前及各次随访时患者的足踝关节功能。术后1、2年随访时完善磁共振检查,根据软骨损伤修复评价标准(magnetic resonance observation of cartilage repair tissue,MOCART)评分,术后2年行踝内固定物取出术时行二次关节镜检查,计算国际软骨修复协会(International Cartilage Repair Society,ICRS)评分。结果末次随访时,单柱移植组与双柱移植组AOFAS踝-后足评分分别为(93.3±4.9)分和(94.1±6.0)分,VAS评分分别为(0.5±0.7)分和(0.6±0.9)分,两组患者的AOFAS功能评分和VAS评分较术前有显著改善(P<0.05)。单柱组和双柱组术后平均AFOAS评分差异无统计学意义(P_(术后1年)=0.623,P_(术后2年)=0.704),VAS评分差异无统计学意义(P_(术后1年)=0.738,P_(术后2年)=0.693)。在影像学和二次镜检方面,术后两组患者间评分差异无统计学意义(术后1年:P_(MOCART)=0.256;术后2年:P_(MOCART)=0.747)。分析ICRS亚组之间评分,两组患者ICRS的3个亚组评分差异无统计学意义(P_(1)=0.262,P_(2)=0.741,P_(3)=0.415)。结论自体骨软骨移植术是治疗Hepple V型距骨软骨损伤的有效手段,单柱与双柱移植的术后疗效、MRI及二次镜检结果没有显著差异,临床上可根据病灶几何形态灵活选用。

Objective To explore the relationship between the number of grafts and the efficacy of autologous osteochondral transplantation in the treatment of Hepple V osteochondral lesions of the talus.Methods The data of 30 patients with Hepple V osteochondral lesions of the talus treated with autologous osteochondral transplantation and followed up from May 2014 to September 2019 were analyzed retrospectively.22 cases were treated with single-plug transplantation and 8 cases with double-plug transplantation;there were 23 males and 7 females;the age was 26~52(34.0±5.9)years;the lesion area was 85.3~340.7(135.7±68.4)mm^(2);the follow-up time was 25~48(31.7±5.5)months.The ankle and hindfoot score of American Orthopaedic Foot and Ankle Society(AOFAS)and visual analog scale(VAS)were used to evaluate the foot and ankle function of patients before operation and at each follow-up.The MRI examination was improved at the follow-up of 1 and 2 years after operationaccording to the score of the evaluation standard of magnetic resonance observation of cartilage repair tissue(MOCART).The internal fixation of the ankle was taken out 2 years after operation,and the Second-look arthroscopic examination was performed during this operation.The score of the International Cartilage Repair Society(ICRS)was calculated.Results At the last follow-up,the AOFAS scores of single-plug transplantation group and double-plug transplantation group were(93.3±4.9)points and(94.1±6.0)points respectively,and the VAS scores were(0.5±0.7)points and(0.6±0.9)points,respectively;the functional scores of the two groups were significantly improved compared with those before operation(P<0.05).Comparing the two groups,there was no significant difference in AOFAS score between single-plug group and double-plug group(P_(1 year)=0.623,P_(2 years)=0.704),and there was no significant difference in VAS score(P_(1 year)=0.738;P_(2 years)=0.693).In terms of imaging and Second-look arthroscopic examination,there was no significant difference between the two groups(P_(MOCART),1year=0.256,P_(MOCART),2year=0.747).Analysis of the scores between the ICRS subgroups showed that there was no significant difference between the three subgroups of ICRS between the two groups(P_(1)=0.262,P_(2)=0.741,P_(3)=0.415).Conclusion Autologous osteochondral transplantation is an effective method for the treatment of Hepple V osteochondral lesions of the talus.There are no significant differences in postoperative efficacy,MRI and Second-look arthroscopic examination between single-plug and double-plug transplantation.It can be selected according to the geometric shape of the focus in clinical.