自体带骨膜髂骨移植术治疗较大范围距骨骨软骨损伤的疗效分析

Efficacy analysis of autogenous iliac bone with periosteum graft for a large range ofosteochondral lesions of talus

目的评价自体带骨膜髂骨移植术治疗较大范围距骨骨软骨损伤的临床疗效。方法回顾性分析自2017-09—2020-03采用自体带骨膜髂骨移植术治疗的31例较大范围距骨骨软骨损伤。比较术前与末次随访时踝关节活动度、踝与后足功能AOFAS评分、疼痛VAS评分、MOCART评分。结果31例均获得随访,随访时间平均23.2(13~35)个月。末次随访时CT显示所有患者距骨穹窿关节面平整,囊性变已基本填充愈合;MRI检查证实17例移植区域无明显异常信号,14例存在轻微异常信号;MOCART评分由术前(37.3±4.6)分增加至(62.6±4.1)分,差异有统计学意义(P<0.05)。5例因瘢痕粘连或跟腱挛缩导致术后踝关节活动受限,经过康复锻炼后明显改善。1例因内固定刺激而提前取出内踝截骨端内固定物。随访期间未出现骨不愈合、骨畸形愈合、内固定断裂、移植骨坏死等并发症。末次随访时踝关节活动度、踝与后足功能AOFAS评分、疼痛VAS评分较术前明显改善,差异有统计学意义(P<0.05)。结论自体带骨膜髂骨移植治疗较大范围的距骨骨软骨损伤可以取得满意的短期临床疗效,不会出现自体骨软骨移植相关的供区并发症。

Objective To evaluate the efficacy of the autogenous iliac bone with the periosteum graft for a large range of osteo⁃chondral lesions of the talus.Methods Thirty one patients with a large range of osteochondral lesions of the talus who under⁃went the autogenous iliac bone with the periosteum graft from September 2017 to March 2020 were retrospectively evaluated.The range of ankle joint motion,AOFAS ankle hindfoot score,VAS score,and MOCART score were compared preoperatively and at last follow-up.Results Follow-up was obtained in all cases,the mean follow-up was 23.2(range,13-35)months.Most of the cystic cavity in the talus was filled and achieved bone union at the last follow-up.Seventeen patients without anomalous signals and 14 mildly abnormal signals in the graft area were confirmed postoperatively by MRI.At last follow-up,the MO⁃CART score was improved from(37.3±4.6)to(62.6±4.1),and the difference was statistically significant(P<0.05).Five patients with limited ankle joint movement by Achilles tendon or scar contracture,were significantly improved through rehabilitation,in⁃ternal fixation of one patient was removed due to irritation.No patients had postoperative complications such as nonunion,mal⁃union,osteonecrosis of graft bone,and broken hardware at last follow-up.The range of ankle joint motion,AOFAS ankle hind⁃foot score,and VAS score improved at the final follow-up compared with preoperative values(P<0.05).Conclusion The autog⁃enous iliac bone with the periosteum graft for a large range of osteochondral lesions of the talus is an effective and relatively bone graft donor complication-free method,with the satisfactory short term clinical efficacy.