188例住院距骨骨软骨损伤患者的临床特点流行病学分析

Analysis on clinical characteristics and epidemiology of 188 inpatients with osteochondral lesions of the talus

目的调查分析188例住院踝关节距骨骨软骨损伤(osteochondral lesions of the talus,OLT)患者的病例资料临床特点及流行病学,为OLT的临床防治提供参考依据。方法回顾性分析首都医科大学附属北京积水潭医院足踝外科2018年3月至2021年3月收治住院的OLT患者的临床病例资料,统计患者基本信息、损伤原因、病灶位置,分析其大小、病程、手术方式及结果随访资料等。按手术方式分组比较,进行统计分析。结果本研究共纳入188例住院OLT患者,男130例(69.1%),女58例(30.9%)。其中,18~40岁为发病高峰,达138例(73.4%);144例(76.6%)患者的BMI大于25 kg/m^(2);病程平均(29.1±7.8)个月;创伤性损伤160例(85.1%),退变性损伤28例(14.9%);内侧软骨损伤142例(75.5%),外侧软骨损伤46例(24.5%);左踝84例(44.7%),右踝104例(55.3%);HeppleⅠ、Ⅱ型75例(39.9%),HeppleⅢ、Ⅴ型113例(60.1%);115例(61.2%)患者的病灶大于1.5 cm^(2)。67例(35.6%)患者采用微骨折手术治疗(关节镜微骨折组),84例(44.7%)患者采用自体骨软骨移植术治疗(自体骨软骨移植组),37例(19.7%)患者采用带骨膜髂骨移植术治疗(带骨膜髂骨移植组)。术后18个月自体骨软骨移植组和带骨膜髂骨移植组患者的AOFAS评分均明显高于关节镜微骨折组,且VAS评分低于关节镜微骨折组,差异均具有统计学意义(P<0.05)。结论OLT患者以创伤性损伤占多数,中青年好发,男性多于女性,内侧损伤多于外侧,HeppleⅢ、Ⅴ型损伤建议手术治疗。

Objective To investigate and analyze the clinical characteristics and epidemiology of 188 hospitalized patients with osteochondral lesions of the talus(OLT),in order to provide a reference for the clinical prevention and treatment of OLT.Methods The medical records of OLT patients admitted to the department of foot and ankle surgery,Beijing Jishuitan Hospital,Capital Medical University,from March 2018 to March 2021 were retrospectively analyzed,and the basic information of the patients,the cause of the injury,the location and size of the lesion,the operation method,and the follow-up data(outcomes)were collected.Comparison was made according to different surgical methods.Results A total of 188 hospitalized OLT patients were included in this study.There were 130 males(69.1%)and 58 females(30.9%).The incidence peak was near the age of 18-40 years,reaching 138 cases(73.4%).There were 144 cases(76.6%)with a BMI value greater than 25 kg/m^(2);the average course of disease was(29.1±7.8)months.There were 160 traumatic cases(85.1%)and 28 cases with degenerative injury(14.9%),142 cases(75.5%)of medial injuries and 46 cases(24.5%)of lateral injuries;84 cases(44.7%)with left ankle and 104 cases(55.3%)with right ankle;75 cases(39.9%)of HeppleⅠ-Ⅱtype,113 cases of HeppleⅢ-Ⅴtype and of whom 115 cases(61.2%)had lesions larger than 1.5 cm^(2).According to Hepples MRI classification,there were 67 patients(35.6%)were treated with microfracture surgery(microfracture group),84 patients(44.7%)were treated with autologous osteochondral transplantation(autologous osteochondral transplantation group)and 37 patients(19.7%)were treated with periosteal iliac bone transplantation(periosteal iliac bone transplantation group).At 18 months after operation,the AOFAS scores of the autologous osteochondral transplantation group and the periosteal iliac bone transplantation group were significantly higher than those of the microfracture group,whereas the VAS scores were significantly lower than those in the microfracture group,with statistical differences(P<0.05).Conclusion The majority of OLT patients admitted to the unit treated by the author were traumatic injuries,which tend to occur in young and middle-aged people.There were more males than females,with more medial injuries than lateral ones.HeppleⅢ-Ⅴinjuries are recommended for surgical treatment.