外踝"Y"形截骨术联合自体骨软骨移植术治疗距骨外侧骨软骨损伤的疗效分析

Lateral malleolar Y-osteotomy combined with autologous osteochondral transplantation for treatment of lateral talus osteochondral lesions

目的探讨外踝"Y"形截骨术联合自体骨软骨移植术治疗距骨外侧骨软骨损伤的疗效。方法回顾性分析2016年1月至2021年12月西安交通大学附属红会医院足踝外科诊疗中心接受外踝"Y"形截骨术联合自体骨软骨移植术治疗的14例距骨外侧骨软骨损伤患者资料。男10例,女4例;年龄(41.9±12.8)岁;左侧5例,右侧9例;均为Hepple分型Ⅴ型。术后记录并发症发生情况;末次随访时采用美国足踝外科协会(AOFAS)踝-后足评分、Karlsson-Peterson评分、疼痛视觉模拟评分(VAS)评估疗效,并与术前进行比较。结果14例患者术后获18.0(18.0,22.5)个月随访。术后出现左踝关节活动受限1例,嘱患者加强踝关节功能锻炼,末次随访时功能得到改善。未出现延迟愈合、骨不连、感染、继发性骨关节炎等并发症。末次随访时AOFAS踝-后足评分90.0(87.0,95.0)分、Karlsson-Peterson评分(88.9±3.5)、疼痛VAS评分1.0(0,2.0)分均较术前(51.6±15.0)、(50.4±6.7)、(5.7±0.9)分显著改善,差异均有统计学意义(P<0.05)。结论外踝"Y"形截骨术联合自体骨软骨移植术治疗距骨外侧骨软骨损伤可以获得满意的疗效,可以明显改善患者临床症状及踝关节功能。

ObjectiveTo evaluate the clinical efficacy of lateral malleolar Y-osteotomy combined with autologous osteochondral transplantation in the treatment of lateral talus osteochondral lesions.MethodsA retrospective study was conducted to analyze the clinical data of 14 patients who had undergone lateral malleolar Y-osteotomy combined with autologous osteochondral transplantation from January 2016 to December 2021 at Department of Foot&Ankle Surgery,Xi'an Honghui Hospital.This cohort included 10 males and 4 females,with an age of(41.9±12.8)years.The lesions were on the left in 5 cases and on the right in 9,and all classified as Type V according to the Hepple classification.The anteroposterior and lateral radiographs of the affected ankle were evaluated pre-operatively and at the final follow-up;the incidence of complications was recorded.The American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot score,Karlsson-Peterson Score,and visual analogue scale(VAS)were utilized to assess clinical outcomes at the final follow-up in comparison with the preoperative values.ResultsFollow-ups for the 14 patients lasted for 18.0(18.0,22.5)months.One patient experienced limited mobility of the left ankle joint after operation,but obtained functional improvement at the final follow-up after being engaged in targeted ankle joint exercises according to the medical advice.There were no instances of delayed union,nonunion,infection,or secondary osteoarthritis.At the final follow-up,the AOFAS ankle-hindfoot score was 90.0(87.0,95.0)points,the Karlsson Peterson score(88.9±3.5)points,and the VAS score 1.0(0,2.0)point,significantly better than the preoperative values[(51.6±15.0)points,(50.4±6.7)points,and(5.7±0.9)points](P<0.05).ConclusionIn the treatment of lateral talus osteochondral lesions,lateral malleolar Y-osteotomy combined with autologous osteochondral transplantation can significantly ameliorate patients'symptoms and enhance their ankle joint function,demonstrating satisfactory clinical efficacy.