距骨骨软骨病内踝“V”形截骨自体骨软骨移植

Osteochondral autografting through medial malleolus"V"shaped osteotomy approach for osteochondral lesions of the talus

[目的]探讨内踝“V”形截骨自体骨软骨移植治疗距骨软骨损伤(osteochondral lesions of the talus,OLT)的临床疗效。[方法]回顾分析2018年1月—2020年6月,采用内踝“V”形截骨联合自体同侧股骨髁非负重区骨软骨移植术治疗OLT的24例患者,评价临床及影像资料。[结果]所有患者均顺利完成手术,无神经、血管损伤,手术时间平均(71.4±12.0)min,术中失血量平均(39.2±11.2)ml。随访时间平均(24.2±6.6)个月,与术前相比,术后1年及末次随访时疼痛VAS评分[(6.1±0.7),(1.0±0.9),(0.9±0.6),P<0.001]、AOFAS踝及后足评分[(66.8±4.8),(89.5±5.4),(93.0±5.1),P<0.001]均显著改善,而膝关节Lysholm评分无显著变化(P>0.05)。影像方面,磁共振软骨修复组织观察(magnetic resonance observation of cartilage repair tissue,MOCART)评分[(43.3±7.0),(66.5±7.1),(69.2±6.5),P<0.001]显著增加,所有截骨均骨性愈合,OLT病灶修复良好,Takaku踝关节退变分级无显著变化(P>0.05)。[结论]内踝“V”形截骨联合自体骨软骨移植治疗距骨骨软骨损伤疗效安全可靠。

[Objective]To investigate the clinical outcomes of osteochondral autografting through medial malleolus"V"shaped osteoto⁃my approach for osteochondral lesions of the talus(OLT).[Methods]A retrospective study was conducted on 24 patients who received osteo⁃chondral autografting through medial malleolus"V"shaped osteotomy approach for OLT from January 2018 to June 2020.The clinical and imaging documents were evaluated.[Results]All the patients were successfully operated on without nerve or vascular injury,with average operation time of(71.4±12.0)min,and intraoperative blood loss of(39.2±11.2)ml,and were followed up for(24.2±6.6)months.Compared with those preoperatively,the VAS score for pain[(6.1±0.7),(1.0±0.9),(0.9±0.6),P<0.001],AOFAS ankle and hindfoot scores[(66.8±4.8),(89.5±5.4),(93.0±5.1),P<0.001]significantly improved,while knee Lysholm scores were not significantly changed at 1 year after surgery and the latest follow-up(P>0.05).In term of imaging,the magnetic resonance observation of cartilage repair tissue(MOCART)score[(43.3±7.0),(66.5±7.1),(69.2±6.5),P<0.001]significantly increased,and all patients got osteotomy healed and OLT lesions repaired well,with the Takaku ankle degeneration grade unchanged significantly(P>0.05).[Conclusion]The osteochondral autografting through medial malleolus"V"shaped osteotomy approach is safe and reliable in the treatment of osteochondral lesions of the talus.