关节镜下克氏针钻孔和微骨折锥治疗小范围距骨软骨损伤的临床疗效观察

Efficacy and safety of minimally invasive operation for small area talar osteochondral injury:arthroscopic Kirschner wire drilling versus microfracture cone

目的探讨关节镜克氏针钻孔手术和关节镜微骨折锥手术治疗小范围距骨软骨损伤疗效及安全性差异。方法本次研究纳入上海市同仁医院2016年1月—2020年6月收治的小面积距骨软骨损伤(面积<1.5 cm 2)患者共66例,其中采用关节镜克氏针钻孔手术治疗28例设为克氏针组,采用关节镜微骨折锥手术治疗38例设为微骨折锥组,比较两组足踝功能优良率、疼痛VAS评分、AOFAS评分、AAS评分、MRI评估、Berndt-Harty损伤分期、并发症发生情况及手术操作便捷性和费用。结果术后两组足踝功能优良率差异无统计学意义(P>0.05);两组末次随访时疼痛VAS评分显著低于术前,而AOFAS评分和AAS评分均显著高于术前(P<0.05);两组末次随访时,VAS、AOFAS及AAS评分组间差异无统计学意义(P>0.05);治疗后MRI矢状位骨髓水肿最大面积较治疗前均有减小,但其与疼痛VAS评分及AOFAS评分并无相明显关性(P=0.745,r=0.055);两组末次随访时Berndt-Harty损伤分期组间差异无统计学意义(P>0.05);随访过程中未见切口感染或神经肌肉损伤出现,切口均实现一期愈合,无再次手术病例。两组手术时长差异无明显统计学意义(P>0.05);克氏针钻孔组费用较微骨折锥组高。结论关节镜克氏针钻孔和微骨折锥手术治疗小范围距骨软骨损伤疗效及安全性良好,均具有临床应用价值,应具体根据软骨损伤情况及术者操作经验合理选用相应术式。

Objective To compare efficacy and safety of arthroscopic Kirschner wire drilling and microfracture cone in the treatment of small area talar osteochondral injury.Methods Clinical data of 68 patients with small area talar osteochondral injury treated in Shanghai Tongren Hospital from January 2016 to June 2020 were retrospectively analyzed,including 28 cases treated with arthroscopic Kirschner wire drilling(Kirschner group)and 38 cases treated with arthroscopic microfracture cone(microfracture cone group).The excellent and good rate in ankle function,pain VAS score,AOFAS score,AAS score,MRI,Berndt Harty injury stage of ankle joint before and after operation,incidence of complications,convenience of procedures and cost were compared between two groups.Results There was no significant difference in the excellent and good rate in ankle function between 2 groups(P>0.05).The pain VAS scores at the last follow-up were significantly lower than those before operation in both groups(P<0.05).The AOFAS score and AAS score at the last follow-up in 2 group were significantly higher than those before operation(P<0.05).There was no significant difference in the clinical index above at the last follow-up between 2 groups(P>0.05).The maximum area of sagittal bone marrow edema on MRI was reduced after treatment,but it was not correlated significantly with the VAS score or AOFAS score(P=0.745,r=0.055).There was no significant difference in the Berndt Harty injury stage of ankle joint at the last follow-up between 2 groups(P>0.05).No wound infection or neuromuscular injury was found and all the incisions healed in one stage and there was no re-operation cases in two groups.There was no significant difference in operation length between the two groups(P>0.05).The medical cost in Kirschner wire drilling group was higher than that in the microfracture cone group.Conclusion Arthroscopic Kirschner wire drilling and arthroscopic microfracture cone in the treatment of patients with small area talar osteochondral injury possess satisfactory overall efficacy and safety,however,the appropriate operation should be selected according to the condition of cartilage injury and the operator s experience.