胫骨远端前外侧截骨治疗距骨骨软骨损伤  

Anterolateral tibial osteotomy and osteochondral transplantation for talar lesions

作　　者：程宇[1] 徐明[1] 孙晗[1] 李骏坤 杨惠林[1] 张洪涛[1] 

机构地区：[1]苏州大学附属第一医院骨科,215006

出　　处：《中华创伤骨科杂志》2017年第9期746-749,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨通过胫骨远端前外侧截骨行距骨外侧自体骨软骨移植术治疗距骨骨软骨损伤的临床疗效。方法回顾性分析2011年10月至2015年6月通过胫骨远端前外侧截骨入路采用同侧股骨外侧髁髌股关节面自体骨软骨移植治疗的10例距骨外侧骨软骨损伤患者资料，男6例，女4例；年龄25—54岁，平均35．8岁；Hepple分型：V型7例，Ⅳ型3例；病灶面积为110—247mm2，平均178．6mm2；病灶深度为6～11mm，平均7．8mm.采用美国足踝外科协会（AOFAS）的踝．后足评分、视觉模拟评分（VAS）对术前、术后踝关节功能及疼痛进行评价。结果8例患者术后获得18，51个月（平均31．6个月）随访，术后6周截骨处均愈合良好，无感染、畸形愈合、内固定物断裂等并发症发生。AOFAS的踝．后足评分由术前平均65．5分提高至末次随访时91．3分，其中优4例，良4例。踝关节VAS评分由术前平均6．9分改善至末次随访时1．3分。结论胫骨远端前外侧截骨能充分暴露外侧的距骨骨软骨损伤病灶，便于行自体骨软骨移植，手术并发症少，术后功能恢复满意。Objective To evaluate the clinical effects of autologous osteochondral transplantation for talar lesions after anterolateral tibial osteotomy. Methods Between October 2011 and June 2015, 10 patients with osteochondral lesions on the lateral talar dome underwent autologous osteochondral transplantation after anterolateral tibial osteotomy. All donor grafts were harvested from the lateral femoral condyle of the ipsilateral knee. They were 6 men and 4 women, aged from 25 to 54 years（average 35.8 years）. According to Hepple classification, 7 patients belonged to stage V and 3 to stage IV. The lesion areas ranged from 110 mm2 to 247 mm2, averaging 178.6 ram2; the lesion depths ranged from 6 mm to 11 mm, averaging 7.8 mm. The ankle function and pain were assessed according to American Orthopaedic Foot and Ankle Society （AOFAS） an- kle-hindfoot score and visual analogue scale （VAS） preoperatively and postoperatively. Results The 8 pa- tients were followed up for an average of 31.6 months （from 18 to 51 months）. All the patients achieved bone union 6 weeks after operation and were free of infection, malunion or hardware failure. The average AOFAS and VAS scores were improved from preoperative 65.5 and 6.9 to 91.3 and 1.3 at the last follow-up, re- spectively. Four cases were rated as excellent and 4 as good. Conclusions Anterolateral tibial osteotomy can provide excellent exposure of the lateral talar lesions for autologous osteochondral transplantation without problems related to the osteotomy itself. Also it may lead to good functional recovery in a short term.

关 键 词：距骨 创伤和损伤 截骨术 移植 自体 

分 类 号：R687.3[医药卫生—骨科学]