关节镜下微骨折手术与自体骨软骨移植术在距骨软骨损伤患者中的应用效果

Application Effect of Arthroscopic Microfracture Surgery and Autogenous Osteochondral Transplantation in Patients with Osteochondral Lesion of the Talus

目的:探讨关节镜下微骨折手术与自体骨软骨移植术在距骨软骨损伤(OLT)患者中的应用效果。方法:选取2021年1月—2023年11月临沂市中心医院收治的84例OLT患者为研究对象,按照随机数字表法将其分为研究组与对照组,各42例。对照组行关节镜下微骨折手术,研究组行自体骨软骨移植术。比较两组关节功能、疼痛程度及关节活动度、步态参数、凝血功能指标、并发症发生情况。结果:术后6个月,研究组AOFAS踝与后足功能评分为(81.44±3.98)分,高于对照组的(76.24±4.10)分,差异有统计学意义(P<0.05)。术后6个月,研究组疼痛视觉模拟评分低于对照组,关节活动度大于对照组,标准化步幅及步频均高于对照组,差异均有统计学意义(P<0.05)。术前、术后3 d,两组D-二聚体、纤维蛋白原比较,差异均无统计学意义(P>0.05)。研究组并发症发生率为7.14%,低于对照组的9.52%,但两组比较,差异无统计学意义(P>0.05)。结论:与关节镜下微骨折手术比较,自体骨软骨移植术能够更好地改善OLT患者的踝关节功能及步态参数,提升踝关节活动度,减轻术后疼痛程度,具有一定安全性。

Objective:To investigate the application effect of arthroscopic microfracture surgery and autogenous osteochondral transplantation in patients with osteochondral lesion of the talus(OLT).Methods:A total of 84 OLT patients admitted to Linyi Central Hospital from January 2021 to November 2023 were selected as the study objects,and were divided into a study group and a control group according to random number table method,with 42 cases in each group.The control group underwent arthroscopic microfracture surgery,and the study group underwent autogenous osteochondral transplantation.The joint function,pain degree and joint motion,gait parameters,coagulation function index and complications were compared between the two groups.Results:Six months after operation,the AOFAS ankle and hindfoot function scores in the study group were(81.44±3.98)points,which was higher than(76.24±4.10)points in the control group,the difference was statistically significant(P<0.05).Six months after surgery,the pain visual analogue scale score of the study group was lower than that of the control group,the joint motion was higher than that of the control group,and the standardized stride length and step frequency were higher than that of the control group,with statistical significance(P<0.05).Before and 3 days after surgery,there was no significant difference in D-dimer and fibrinogen between the two groups(P>0.05).The incidence of complications in the study group was 7.14%,which was lower than 9.52%in the control group,but there was no significant difference between the two groups(P>0.05).Conclusion:Compared with arthroscopic microfracture surgery,autogenous osteochondral transplantation can better improve ankle function and gait parameters in OLT patients,improve ankle motion,reduce postoperative pain,and have certain safety.