内踝双平面三维截骨联合自体骨软骨移植治疗HeppleⅤ型距骨骨软骨损伤的临床疗效分析

Clinical effect of autologous osteochondral transplantation combined with medial malleolar biplane three-dimensional ankle osteotomy on osteochondral lesions of HeppleⅤtalus with subchondral cysts

目的探讨内踝双平面三维截骨联合自体骨软骨移植治疗HeppleⅤ型距骨骨软骨损伤的临床疗效。方法病例系列报告。纳入2019年1月—2020年1月徐州市中心医院骨科24例(24足)HeppleⅤ型距骨骨软骨损伤患者的临床资料, 其中男9例、女15例, 年龄21~62(29.5±10.3)岁, 右侧11例、左侧13例。患者均采用内踝双平面三维截骨联合自体骨软骨移植治疗距骨骨软骨损伤。术后定期随访, 观察术后供区疼痛、截骨处不愈合等并发症的发生情况。比较术前与术后随访时的疼痛视觉模拟评分法(VAS)评分、美国骨科足踝外科协会(AOFAS)踝-后足评分及踝关节Kofoed评分, 对手术治疗效果进行评价。结果术后患者切口均一期愈合。24例患者随访18~30(23.8±4.6)个月, 所有患者截骨处一期愈合, 无供区疼痛等并发症。末次随访时VAS评分由术前的(6.29±1.30)分改善到(0.88±0.61)分, AOFAS评分由术前的(60.92±13.06)分提高到(95.08±5.78)分, Kofoed评分由术前的(23.08±13.51)分提高到(95.96±5.09)分, 与术前比较差异均有统计学意义(t=23.30、15.87、27.07, P值均<0.001)。依据AOFAS评分, 踝关节功能优19例、良5例, 优良率100%(24/24);依据Kofoed踝关节评分, 踝关节功能优20例、良4例, 优良率100%(24/24)。结论内踝双平面三维截骨联合自体骨软骨移植治疗HeppleⅤ型距骨骨软骨损伤, 术后踝关节功能恢复好, 疼痛减轻明显。

Objective This study aimed to investigate the clinical efficacy of medial malleolar biplane three-dimensional osteotomy combined with autologous cartilage transplantation in the treatment of HeppleⅤtalar cartilage injury.Methods The clinical data of 24 patients(24 feet)with HeppleⅤtalar cartilage injury in the Department of Orthopaedics of Xuzhou Central Hospital from January 2019 to January 2020 were retrospectively analyzed,including nine males and 15 females,aged 21-62(29.5±10.3)years.There were 11 cases on the right side and 13 cases on the left side.All patients were treated with medial malleolar biplane three-dimensional ankle osteotomy combined with autologous osteochondral transplantation for talar cartilage injury.Regular follow-up was recommended after operation to observe the occurrence of donor site pain,nonunion at osteotomy site,and other complications.The visual analog scale(VAS),American Orthopedic Foot Ankle Surgery(AOFAS)score,ankle score,and Kofoed score were used to evaluate the effect of surgical treatment before operation and 1-year follow-up after operation.Results The incision of all patients healed in one stage without donor site pain and other complications after operation.Twenty-four patients were followed up for 18-30(23.8±4.6)months.At the last follow-up,the VAS score was improved from 6.29±1.30 to 0.88±0.61;the AOFAS score was increased from 60.92±13.06 to 95.08±5.78,and the Kofoed score was increased from 23.08±13.51 to 95.96±5.09.The difference was statistically significant compared with that before operation(t=23.30,15.87,27.07,all P values<0.001).Based on the AOFAS score,the ankle function was excellent in 19 cases and good in five cases,and the excellent and good rate was 100%(24/24).In addition,based on the Kofoed ankle score,the ankle function was excellent in 20 cases and good in 4 cases,and the excellent and good rate was 100%(24/24).Conclusion Biplane three-dimensional osteotomy of medial malleolus combined with autologous osteochondral transplantation is a reliable method for the treatment of HeppleⅤtalar cartilage injury,with good ankle function recovery and evident symptom relief.