踝关节镜下微骨折治疗Hepple Ⅱ~Ⅲ型距骨骨软骨损伤的疗效分析

Efficacy analysis of ankle arthroscopic microfracture in the treatment of Hepple typeⅡ~Ⅲosteochondral lesions of the talus

目的 探讨踝关节镜下微骨折治疗Hepple Ⅱ~Ⅲ型距骨骨软骨损伤的疗效.方法 回顾性分析26例在2020年1月~2022年1月在我院行踝关节镜下微骨折治疗的Hepple Ⅱ~Ⅲ型距骨骨软骨损伤患者的资料,其中:男15例,女11例;左足16例,右足10例;年龄20~55岁,平均(28.5±10.7)岁;病程5~12个月,平均(7.9±3.1)个月.镜下行踝关节清理术,显露距骨骨软骨损伤的部位并行微骨折处理.使用美国足踝外科协会(American orthopedic foot and ankle society,AOFAS)踝-后足评分和疼痛视觉模拟评分(Visual analogue scale,VAS)及MRI检查评价临床疗效.结果 所有患者均顺利完成手术并获得有效随访,手术时间较短,术中无神经、血管损伤等并发症,随访时间12~24个月,平均(15.3±1.1)个月.术后VAS及AOFAS踝-后足评分都较术前明显改善(P<0.05).MRI检查显示,术后距骨骨软骨损伤面积较术前显著减小(P<0.05).结论 踝关节镜下行微骨折治疗HeppleⅡ~Ⅲ型距骨骨软骨损伤,可明显改善患者的关节疼痛程度及功能,效果确切且并发症少.

Objective To investigate the efficacy of ankle arthroscopic microfracture in the treatment of Hepple typeⅡ~Ⅲosteochondral lesions of the talus(OLT).Methods A retrospective analysis was performed for the data of 26 patients with Hepple typeⅡ~Ⅲ OLT who underwent ankle arthroscopic microfracture treatment in our hospital from January 2020 to January 2022,including 15 males and 11 females.There were 16 cases of left foot,and 10 cases of right foot;the age was 20~55 years,with an average of(28.5±10.7)years;the course of disease was 5~12 months,with an average of(7.9±3.1)months.Ankle joint debridement was performed under arthroscopy to expose the site of osteochondral injury of talus and microfracture treatment was performed.Clinical efficacy was evaluated using the American orthopedic foot and ankle society(AOFAS)ankle-hindfoot score,visual analogue scale of pain(VAS)and MRI examination.Results All patients successfully completed the operation and received effective follow-up,the operation time was short,there were no complications such as nerve and vascular injury during the operation,and the follow-up time was 12~24 months,with an average of(15.3±1.1)months.Postoperative VAS and AOFAS ankle-hindfoot scores were significantly improved compared with preoperative(P<0.05).MRI examination showed that the area of OLT after operation was significantly smaller than that before operation(P<0.05).Conclusion Ankle arthroscopic microfracture in the treatment of Hepple typeⅡ~Ⅲ OLT can significantly improve the degree of joint pain and function of patients,with definite effect and few complications.