可调式外固定牵伸联合关节镜下微骨折治疗距骨软骨损伤的效果分析

Adjustable external fixation traction combined with arthroscopic microfracture for treatment of osteochondral lesions of the talus

目的探讨可调式外固定牵伸联合关节镜下微骨折治疗距骨软骨损伤(OLT)的效果。方法回顾性分析2017年5月至2022年3月期间首都医科大学附属北京康复医院骨科收治的27例OLT患者资料。男16例,女11例;年龄(32.4±7.2)岁;软骨损伤部位:内侧23例,外侧4例;Hepple分期:Ⅰ期7例,Ⅱ期15例,Ⅲ期5例;病程为(10.6±3.3)个月。所有患者均采用可调式外固定牵伸联合关节镜下微骨折治疗。记录患者术后6、12个月的疼痛视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)踝-后足评分,术后1个月的白细胞介素-1(IL-1)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)等相关炎性因子水平,术后12个月损伤面积及并发症发生情况等。结果本组患者的随访时间为(16.2±6.7)个月。27例患者术前、术后6个月及术后12个月的AOFAS踝-后足评分分别为(61.52±6.75)、(84.15±5.56)、(95.67±4.30)分,疼痛VAS评分分别为(5.88±1.02)、(2.12±0.48)、(0.66±0.36)分,以上项目3个时间点之间两两比较差异均有统计学意义(P<0.05)。27例患者术后1个月IL-1为(32.37±6.64)pg/mL,IL-6为(34.04±7.12)pg/mL,TNF-α为(17.89±4.96)ng/L,均较术前[(96.63±14.80)pg/mL、(102.33±20.42)pg/mL、(54.48±9.33)ng/L]显著降低,差异均有统计学意义(P<0.05)。术后12个月27例患者的损伤面积为(28.66±6.52)mm2,较术前[(128.52±11.32)mm2]显著缩小,差异有统计学意义(P<0.05)。1例患者发生外固定针道感染,2例患者发生下肢深静脉血栓形成。结论可调式外固定牵伸联合关节镜下微骨折治疗OLT可以取得满意的效果,改善患者症状。

Objective To investigate the clinical effects of adjustable external fixation traction combined with arthroscopic microfracture in the treatment of osteochondral lesions of the talus(OLT).Methods A retrospective study was conducted to analyze the data of 27 OLT patients who had been treated at Department of Orthopedics,Beijing Rehabilitation Hospital from May 2017 to March 2022.There were 16 males and 11 females,aged(32.4±7.2)years.Lesion site:23 medial and 4 lateral cases;Hepple staging:7 cases at stageⅠ,15 cases at stageⅡ,and 5 cases at stageⅢ;disease duration:(10.6±3.3)months.All the patients were treated by adjustable external fixation traction combined with arthroscopic microfracture.Recorded were the patients'visual analogue scale(VAS)pain scores and American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores at 6 months and 12 months after surgery,levels of interleukin-1(IL-1),interleukin-6(IL-6)and tumour necrosis factor-α(TNF-α)at 1 month after surgery,lesion area at 12 months after surgery,and incidence of complications.Results The follow-up time for this cohort was(16.2±6.7)months.The AOFAS score was(61.52±6.75)points before surgery,(84.15±5.56)points at 6 months after surgery and(95.67±4.30)points at 12 months after surgery.The VAS score was(5.88±1.02)points before surgery,(2.12±0.48)points at 6 months after surgery and(0.66±0.36)points at 12 months after surgery.The two-by-two comparisons between the 3 time points for the above items were statistically significant(P<0.05).IL-1 was(32.37±6.64)pg/mL,IL-6(34.04±7.12)pg/mL,and TNF-α(17.89±4.96)ng/L at 1 month after surgery in the 27 patients,all of which were significantly lower than their preoperative levels[(96.63±14.80)pg/mL,(102.33±20.42)pg/mL,and(54.48±9.33)ng/L](P<0.05).The lesion area was(28.66±6.52)mm2 at 12 months after surgery,significantly smaller than the value before surgery[(128.52±11.32)mm2](P<0.05).Infection at the adjustable external fixation needle track occurred in 1 patient and lower limb thrombosis in 2 patients.Conclusion In the treatment of OLT,adjustable external fixation and traction combined with arthroscopic microfracture can achieve satisfactory results and improve symptoms for the patients.