高尿酸血症对距骨软骨损伤微骨折术后疗效的影响

Effect of hyperuricemia on efficacy of microfracture surgery for talar osteochondral injuries

目的比较高尿酸血症和非高尿酸血症的距骨软骨损伤(OLTs)行关节镜微骨折术后的疗效差异并探讨血尿酸水平与疗效的相关性。方法选取2015年2月至2021年8月符合纳入排除标准的53例OLTs患者作为研究对象,按照术前血尿酸水平是否>420μmol/L分为高尿酸血症组(22例)和非高尿酸血症组(31例)。比较两组患者手术前后关节活动度(ROM)、美国足踝外科协会(AOFAS)评分、视觉模拟评分法(VAS)评分、软骨修复组织的磁共振评分系统(MOCART)评分及术后满意率。结果高尿酸血症组[(504.35±86.4)μmol/L]术前血尿酸水平高于非高尿酸血症组[(332.56±45.8)μmol/L],差异有统计学意义(P<0.05)。两组术后1年及末次随访ROM、AOFAS评分、VAS评分较术前均明显改善(P<0.001)。高尿酸血症组患者术前、术后1年、术后末次随访AOFAS评分低于非高尿酸血症组(P<0.05),术前、术后末次随访VAS评分高于非高尿酸血症组(P<0.05)。血尿酸水平与术后AOFAS评分呈负相关关系(r^(2)=0.076,P=0.041)。高尿酸血症组的术后末次随访MOCART评分低于非高尿酸血症组,差异有统计学意义(P<0.05),高尿酸血症组软骨缺损修复填充程度情况和修复组织与相邻软骨融合情况与非高尿酸血症组比较,差异有统计学意义(P<0.05)。结论关节镜下微骨折术治疗OLTs临床疗效好,合并高尿酸血症的患者术后临床疗效差于非高尿酸血症患者,血尿酸水平与微骨折术后AOFAS评分呈负相关。

Objective To compare the difference in the efficacies of arthroscopic microfracture operation for talar osteochondral injuries with hyperuricemia and non-hyperuricemia,and to explore the correlation between blood urate level and efficacy.Methods Fifty-three patients with talar osteochondral lesions meeting the inclusion and exclusion criteria from February 2015 to August 2021 were selected as the research subjects and divided into the hyperuricemia group(22 cases)and non-hyperuricemia group(31 cases)according to whether or not the preoperative blood uric acid level exceeding 420μmol/L.The joint range of motion(ROM),visual analog scale(VAS)score,American Foot and Ankle Surgery Society(AOFAS)score,magnetic resonance score of cartilage repair tissue(MOCART)score and postoperative satisfaction before and after surgery were compared between the two groups.Results The preoperative blood uric acid level in the hyperuricemia group was higher than that in non-hyperuricemia group,and the difference was statistically significant[(504.35±86.40)μmol/L vs.(332.56±45.80)μmol/L,P<0.05].The ROM score,VAS score and AOFAS score in postoperative 1 year follow up and last follow up in the two groups were significantly improved compared with before operation(P<0.001).The AOFAS scores before operation,in postoperative 1 year and postoperative last follow up in the hyperuricemia group were lower than those in the non-hyperuricemia group(P<0.05).The VAS scores before operation and postoperative last follow up in the hyperuricemia group were higher than those in the non-hyperuricemia group(P<0.05).The uric acid level was negatively correlated with the postoperative AOFAS score(r^(2)=0.076,P=0.041).The MOCART score in postoperative last follow up in the hyperuricemia group was lower than that in the non-hyperuricemia group,and the difference was statistically significant(P<0.05).The cartilage defect repair and filling degree and the fusion of repaired tissue with adjacent cartilage had statistical differences between the hyperuricemia group and nonhyperuricemia group(P<0.05).Conclusion Arthroscopic microfracture operation in treating talar osteochondral injuries has good clinical effect,the postoperative clinical effect in the patients with complicating hyperuricemia is lower than that in the patients with non-hyperuricemia and the blood uric acid level is negatively correlated with the AOFAS score after microfracture surgery.