自体带骨膜髂骨移植与同种异体骨骨粉联合PRP治疗距骨骨软骨损伤的治疗效果比较研究

Curative effect of autologous periosteal iliac bone graft and allogeneic bone powder combined with PRP on HeppleⅤtalus osteochondral injury

目的分析并对比自体带骨膜髂骨移植与同种异体骨骨粉联合富血小板凝胶(platelet rich gel,PRP)治疗HeppleⅤ型距骨骨软骨损伤(osteochondral injury,OLT)。方法选取浙江中医药大学附属金华中医院2018年10月至2022年10月收入的HeppleⅤ型OLT患者62例为研究对象,根据其治疗方式将其分为移植组(接受自体带骨膜髂骨移植治疗,31例)、联合组(接受同种异体骨骨粉联合PRP治疗,31例)。对患者进行术后12个月门诊随访研究,评估并比较两组患者术后12个月治疗效果、踝关节活动度(range of motion,ROM)、美国骨科足踝外科学会(American Society of Orthopedic Foot andAnkle Surgeons,AOFAS)踝-后足评分、疼痛评分、满意度、并发症发生率差异。结果移植组治疗总有效率(96.77%)与联合组(93.55%)相比,差异无统计学意义(P>0.05)。术后12个月两组ROM、AOFAS评分均改善(P<0.05),组间差异无统计学意义(P>0.05)。两组患者术后1个月、3个月、6个月、12个月,两组疼痛评分均较术前有所降低(P<0.05)。移植组患者主观总满意度(77.42%),低于联合组(96.77%,P<0.05)。移植组并发症总发生率(19.35%)与联合组(3.23%)相比,明显更高(P<0.05)。结论同种异体骨骨粉联合PRP可避免额外手术切口,患者主观满意度更高,术后并发症发生率低。

Objective To analyze and compare the treatment of HeppleⅤtalus osteochondral injury(OLT)with autologous periosteal iliac bone graft and allogeneic bone powder combined with platelet rich gel(PRP).Methods Totally 62 HeppleⅤOLT patients admitted to our hospital from October 2018 to October 2022 were selected as the research subjects.They were divided into a transplantation group(31 patients received autologous periosteal iliac bone transplantation treatment)and a combination group(31 patients received allogeneic bone powder combined with PRP treatment)based on their treatment methods.Conduct a 12 month postoperative outpatient follow-up study on patients,evaluate and compare the treatment effectiveness,ankle joint range of motion(ROM),American Society of Orthopedic Foot and Ankle Surgeons(AOFAS)ankle posterior foot score,pain score,satisfaction,and incidence of complications between the two groups of patients at 12 months after surgery.Results The total effective rate of the transplantation group(96.77%)was not significantly different from that of the combination group(93.55%,P>0.05).At 12 months after surgery,the ROM and AOFAS scores of both groups improved(P<0.05),and there was no statistically significant difference between the groups(P>0.05).At 1 month,3 months,6 months,and 12 months after surgery,the pain scores of both groups decreased compared to before surgery(P<0.05).The subjective overall satisfaction of patients in the transplantation group(77.42%)was lower than that in the combination group(96.77%,P<0.05).The total incidence of complications in the transplantation group(19.35%)was significantly higher than that in the combination group(3.23%,P<0.05).Conclusion Allogeneic bone powder combined with PRP can avoid additional surgical incisions,increase patient subjective satisfaction,and increase the incidence of postoperative complications.