机器人导航辅助下逆向钻孔术治疗距骨软骨损伤的疗效分析

Effect analysis of robot-assisted retrograde drilling treatment of talus cartilage injury

目的探讨机器人导航辅助下逆向钻孔术治疗距骨软骨损伤(osteochondral lesions of talus,OCLT)的疗效。方法回顾性分析2021年10月至2023年4月在深圳市第二人民医院足踝外科采用机器人导航辅助下逆向钻孔术治疗的10例OCLT患者资料,男9例,女1例,平均年龄32岁。分析比较患者术前和术后的CT及MRI下的OCLT病灶面积、视觉模拟评分法(visual analogue scale,VAS)评分、美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足评分。结果术后随访时间3~18个月,10例患者均获得平均8个月的随访,随访过程中无患者出现关节感染、神经损伤、活动性出血等并发症,术后3个月CT及MRI显示所有患者均未出现距骨骨质局部坏死、骨溶解或骨囊性变等严重征象,且病灶面积均显著小于术前,差异有统计学意义(P<0.01)。末次随访时VAS评分为3分,AOFAS评分为88.6分,较术前显著改善,差异有统计学意义(P<0.01)。结论采用机器人导航辅助下逆行钻孔术治疗距骨软骨损伤的疗效显著,且并发症少,软骨修复较常规微骨折恢复快,手术安全微创,手术时间显著减少。

Objective To investigate the short-term clinical effect of robot-assisted retrograde drilling in osteochondral injury of talus.Methods From October 2021 to April 2023,10 patients with talus cartilage injury treated by robot-assisted retrograde drilling were retrospectively analyzed,including 9 males and 1 female,with an average age of 32 years.and the changes of OCLT lesion area,VAS score,AOFAS score and other scales and complications were analyzed and compared between preoperative and postoperative CT and MRI.Results The postoperative follow-up time was 3 to 18 months,All the 10 cases were followed up for an average of 8 months,and no patients had complications such as joint infection,nerve injury,and active bleeding during the follow-up.CT and MRI showed no serious signs such as local necrosis of talus bone,osteolysis,or bone cystic change in all patients 3 months after surgery,and the lesion area was significantly smaller than before surgery,with statistical significance(P<0.01).At the last follow-up,VAS score was 3 points and AOFAS score was 88.6 points,which were significantly improved compared with those before operation,and the difference was statistically significant(P<0.01).Conclusion All patients with talus cartilage injury can get satisfactory results in the short term by retrograde drilling BMS with robot-assisted navigation and positioning.Moreover,the follow-up showed that robot-assisted navigation with retrograde drilling had good efficacy,fewer complications,faster recovery of cartilage repair than conventional microfracture,safe and minimally invasive surgery,and greatly reduced operative time.Therefore,robot-assisted navigation with retrograde drilling and bone marrow stimulation for talus cartilage injury is a safe and effective surgical method.