改良双平面Chevron内踝截骨自体骨软骨移植治疗距骨软骨损伤合并骨囊肿的疗效分析  

Treatment of talar cartilage injury and bone cyst with modified biplane Chevron osteotomy and autogenous osteochondral transplantation

作　　者：赵良军[1] 许放 缪季峰 劳山[1] 赵劲民[1] 韦庆军[1] Zhao Liangjun;Xu Fang;Miao Jifeng;Lao Shan;Zhao Jinmin;Wei Qingjun(Department of Orthopaedics,The First Affiliated Hospital to Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院骨科,南宁530021

出　　处：《中华创伤骨科杂志》2021年第4期306-311,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨改良双平面Chevron内踝截骨自体骨软骨移植治疗距骨软骨柱损伤合并骨囊肿的疗效。方法回顾性分析广西医科大学第一附属医院骨科2016年2月至2019年2月收治的26例距骨软骨损伤合并骨囊肿患者资料。其中男16例,女10例;年龄22~50岁,平均36.2岁;按照Hepple分型:Ⅳ型5例,Ⅴ型21例。关节镜评估距骨软骨损伤程度和范围,Chevron内踝截骨暴露距骨内侧软骨损伤区,彻底清除不稳定软骨,新鲜化处理骨囊肿硬化壁,取同侧股骨内髁非负重区骨软骨柱植入至距骨软骨损伤区。通过比较术前、术后1年的美国足踝外科协会(AOFAS)的踝-后足评分、踝关节Karlsson评分、视觉模拟量表(VAS)和膝关节Lysholm评分评价疗效。结果26例患者均获随访,时间平均为20.6个月(12~30个月)。随访期间未出现切口感染、囊肿复发及畸形愈合等术后并发症,供侧膝关节未见明显疼痛及活动受限,患侧踝关节AOFAS的踝-后足评分由术前(64.3±3.9)分提高至术后1年(89.5±5.1)分,Karlsson评分由术前(60.5±5.5)分提高至术后1年(85.2±6.9)分,VAS评分由术前(6.2±1.1)分降至术后1年(1.8±0.9)分,差异均有统计学意义(P<0.05);膝关节Lysholm评分术前为(94.7±1.9)分,术后1年为(94.1±1.8)分,差异无统计学意义(P>0.05)。结论改良双平面Chevron内踝截骨自体骨软骨移植治疗距骨软骨损伤并骨囊肿可以有效缓解踝关节疼痛和改善踝关节功能,疗效满意。Objective To evaluate the clinical efficacy of the modified biplane Chevron osteotomy and autogenous osteochondral transplantation for the treatment of talar cartilage injury with bone cyst.Methods From February 2016 to February 2019,26 patients with talar cartilage injury and bone cyst were treated at Department of Orthopaedics,The First Affiliated Hospital to Guangxi Medical University.They were 16 males and 10 females,aged from 22 to 50 years(average,36.2 years).According to the Hepple classification,there were 5 cases of typeⅣand 21 cases of typeⅤ.The extent and range of talar cartilage injury were evaluated by arthroscopy,the modified biplane Chevron osteotomy of medial malleolus was performed to expose cartilage defects medial to the talus,unstable cartilage was removed thoroughly,sclerotic wall of the bone cyst was freshly treated,and an osteochondral column taken from the non-weight-bearing area of the ipsilateral femoral medial condyle was implanted into the injured area of talar cartilage.The clinical efficacy was evaluated by comparing the ankle-hindfoot scores of American Orthopedic Foot and Ankle Society(AOFAS),Karlsson ankle scores,visual analogue scale(VAS)and Lysholm ankle scores between preoperation and one year post-operation.Results All the 26 patients were followed up for an average of 20.6 months(from 12 to 30 months).Follow-up did not observe any postoperative complications like incision infection,cyst recurrence or malunion,or any obvious pain or movement limitation at the donor knee joint.The AOFAS ankle-hindfoot scores were significantly increased from preoperative 64.3±3.9 to 89.5±5.1 one year postoperation,the Karlsson scores were significantly increased from preoperative 60.5±5.5 to 85.2±6.9 one year postoperation,and the VAS scores were significantly decreased from preoperative 6.2±1.1 to 1.8±0.9 one year post-operation(all P<0.05).The Lysholm ankle scores before and after operation were 94.7±1.9 and 94.1±1.8,respectively,showing no significant difference(P>0.05).Conclusio

关 键 词：距骨 软骨 足损伤 移植 截骨 

分 类 号：R687.3[医药卫生—骨科学]