经Chaput结节联合外踝截骨治疗距骨外侧骨软骨损伤的疗效分析

Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy in treatment of talus osteochondral lesions with autologous osteochondral transplantation

目的探讨经Chaput结节截骨联合外踝矢状位斜形截骨治疗距骨外侧穹隆或肩部骨软骨损伤的疗效。方法回顾性分析2017年1月至2019年12月大连市第二人民医院收治的11例距骨外侧穹隆或肩部骨软骨损伤患者资料。男9例,女2例;年龄22~45岁,平均32.6岁;Hepple分型:Ⅴ型11例;采用Chaput结节截骨联合外踝矢状位斜形截骨,自体股骨外侧髁骨软骨移植术治疗。通过比较患者手术前、后美国足踝外科协会(AOFAS)的踝-后足评分、视觉模拟评分(VAS)、国际膝关节文献委员会膝关节评估表(IKDC)评分及影像学方面的变化来评估疗效。结果所有患者术后获13~24个月(平均15.6个月)随访。患者均未诉明显不适,均恢复正常行走。末次随访时AOFAS的踝-后足评分[(94.3±2.9)分]、VAS评分[(1.2±0.4)分]较术前[(49.5±6.6)、(5.7±1.2)分]显著改善,差异均有统计学意义(P<0.05)。手术前、后膝关节IKDC评分比较差异无统计学意义(P>0.05)。影像学显示距骨囊性变消失、移植骨栓与距骨达到骨性愈合,关节间隙无狭窄。1例患者出现腓肠神经损伤症状。结论经Chaput结节截骨联合外踝矢状位斜形截骨治疗距骨后外侧骨软骨损伤,可明显缓解患者踝关节疼痛并改善踝关节功能。

Objective To evaluate the clinical outcomes of Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy in the treatment of talus osteochondral lesions with autologous osteochondral transplantation(AOT).Methods From January 2017 to December 2019,Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy were performed in the AOT treatment of 11 patients with talus osteochondral lesions.They were 9 men 2 women,with a mean age of 32.6 years(range,from 22 to 45 years).Their lesions were all Hepple type V.Their American Orthopaedic Foot and Ankle Society(AOFAS)score,visual analogue scale(VAS),International Knee Documentation Committee Knee Evaluation Form(IKDC)score,and imaging data were measured pre-and post-operatively for assessment of clinical outcomes.Results All the patients were followed up for 13 to 24 months(average,15.6 months).Their AOFAS(94.3±2.9)and VAS(1.2±0.4)scores at the final follow-up were significantly improved compared with the pre-operative values(49.5±6.6 and 5.7±1.2)(P<0.05).There was no significant difference between their pre-and post-operative IKDC scores for the ipsilateral knee joint(P>0.05).The imaging showed that the talus cystic change disappeared and the grafted bone was fully fused with the talus with no abnormal change in the joint space.Conclusion In the AOT treatment of talus osteochondral lesions,Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy can obviously relieve ankle pain and improve ankle function.