带骨膜的自体胫骨远端松质骨植骨治疗Hepple Ⅲ-Ⅳ型距骨软骨损伤  

Autogenous distal tibial cancellous bone graft with periosteum for the treatment of cartilage injury of talus with Hepple Ⅲ-Ⅳ type

作　　者：刘占宗 曲家富[2] 张波[3] LIU Zhan-zong;QU Jia-fu;ZHANG Bo(Department of Orthopaedics,Luannan County Hospital,Tangshan 063000,Hebei,China)

机构地区：[1]滦南县医院骨科,河北唐山063000 [2]唐山市第二医院足踝外科,河北唐山063000 [3]江苏大学附属句容医院骨科,江苏镇江212400

出　　处：《中国骨伤》2018年第11期1061-1064,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨经带骨膜的自体胫骨远端松质骨植骨治疗HeppleⅢ-Ⅳ型距骨软骨损伤的手术方法及其临床效果。方法:自2014年6月至2017年8月,对25例HeppleⅢ-Ⅳ型距骨软骨损伤患者采用自体同侧胫骨远端松质骨植骨治疗,其中男14例,女11例;年龄18～52(38.4±3.1)岁;左足8例,右足17例。根据Hepple分型,Ⅲ型9例,Ⅳ型16例。术前及术后12个月采用美国足与踝协会踝与后足评分(AOFAS)及疼痛评分(VAS)对手术疗效进行评定。结果:25例患者获得随访,时间12～28(14.2±2.5)个月。术前AOFAS评分53.02±10.06、VAS评分8.02±1.14,与术后12个月AOFAS评分88.04±7.45、VAS评分1.26±1.74比较,差异有统计学意义(P<0.05)。根据AOFAS评分,优16例,良6例,差3例。结论:采用带骨膜的自体胫骨远端松质骨植骨治疗HeppleⅢ-Ⅳ型距骨软骨损伤是一种较有效的治疗方式,可以有效缓解踝关节疼痛及改善踝关节功能。Objective：To analyze the operative methods and clinical effects of autologous distal tibial cancellous bone graft with periosteum in treating cartilage injury of talus with Hepple Ⅲ-Ⅳ type. Methods：From June 2014 to August 2017,25 patients （25 feet） with Hepple Ⅲ to Ⅳ cartilage injury of talus were treated with autogenous ipsilateral distal tibial cancellous bone graft. Including 14 males and 11 females,aged from 18 to 52 years with an average of （38.4±3.1） years;left foot was in 8 cases and right foot was in 17 cases. According to Hepple classification,type Ⅲ of 9 cases,type Ⅳ of 16 cases. The curative effect was assessed by Amercian orthopedic foot and ankle society （AOFAS） and visual analogue scale （VAS） before operation and 12 months after operation. Results：All 25 patients were followed up for 12 to 28 months with an average of （ 14.2±2.5）months. AOFAS and VAS scores were improved from preoperative 53.02±10.06,8.02±1.14 to 88.04±7.45,1.26±1.74 at 12 months after operation （P〈0.05）. According to AOFAS standard, 16 cases got excellent results,6 good,3 poor. Conclusion：Autologous distal tibial cancellous bone graft with periosteum is an effective method for Hepple Ⅲ -Ⅳ cartilage injury of talus. It can effectively relieve ankle pain and improve ankle joint function.

关 键 词：距骨软骨损伤 胫骨远端 松质骨植骨 

分 类 号：R687.3[医药卫生—骨科学]