骨软骨移植联合富血小板血浆治疗距骨软骨缺损

Osteochondral autograft transplantation combined with platelet-rich plasma for talus cartilage defect

[目的]介绍骨软骨移植联合富血小板血浆治疗距骨软骨缺损的手术技术及初步结果。[方法]对8例距骨软骨缺损行自体骨软骨移植联合富血小板血浆治疗。术前制定植骨方案。踝关节前侧入路暴露胫骨及距骨磨损的软骨面并预制植骨圆形凹槽,于股骨外侧髁非负重软骨面取大小与预制植骨凹槽相同的柱状软骨,挤压置入预制凹槽内部,同时注入富血小板血浆。[结果]8例患者均顺利完成手术,无严重并发症,术后平均随访时间为(24.5±4.4)个月,与术前相比,末次随访时踝关节VAS评分显著降低[(7.3±1.0),(1.0±0.3),P<0.05],AOFAS踝与后足评分显著增加[(43.3±4.4),(87.6±5.7),P<0.05]。术后24个月踝关节的生存率达到100%。[结论]骨软骨移植联合富血小板血浆治疗距骨软骨缺损技术可行,近期临床疗效良好。

[Objective]To introduce the surgical technique and preliminary results of osteochondral autografting combined with plate-let-rich plasma in the treatment of talus cartilage defect.[Methods]A total of 8 patients received the abovementioned surgical treatment for talus cartilage defect.Preoperative osteochondral autograft transplantation plan was developed.The worn cartilage surface of the talus was exposed and debrided through the anterolateral approach.Based on the aera of cartilage defect,1 to 3 circular bone slots were made on the recipient site.Osteochondral grafts,which harvested from the non-weight-bearing cartilage surface of the lateral femoral condyle con-sistent with the shape and size of the recipient bone slots,were packed into the bone slots in the talus cartilage defect aera to keep smooth with the articular surface,and then the incision was closed in layers.Finally,platelet rich plasma(PRP)prepared with autogenous blood was injected into the affected joint.[Result]All the 8 patients had operation performed successfully without serious complications,and fol-lowed up for(24.5±4.4)months in a mean.Compared with those preoperatively,the pain VAS score significantly decreased[(7.3±1.0),(1.0±0.3),P<0.05].AOFAS ankle and hindfoot score increased significantly at the latest follow-up[(43.3±4.4),(87.6±5.7),P<0.05].The salvage rate of the ankle was 100%24 months after surgery.[Results]The osteochondral autograft transplantation combined with platelet-rich plas-ma for the treatment of talus cartilage defect is feasible and does achieve satisfactory clinical consequences.