自体带骨膜髂骨移植治疗重度距骨软骨损伤  

Periosteum-covered iliac crest autografts for treatment of severe osteochondral lesions of talus

作　　者：马玉海[1] 刘彧 陈长松[1] 胡晓华[1] 尹华东[1] 何剑星 朱晓峰 邬春虎[1] Ma Yuhai;Liu Yu;Chen Changsong;Hu Xiaohua;Yin Huadong;He Jianxin;Zhu Xiaofertg;Wu Chunhu(Department of Orthopedics,Zhejiang Armed Police Corps Hospital,Hangzhou 310012,China)

机构地区：[1]武警浙江省总队医院骨科,杭州310012

出　　处：《中华创伤杂志》2021年第7期635-640,共6页Chinese Journal of Trauma

基　　金：浙江省医药卫生科研项目(2021432378);浙江省中医药科技项目(2021ZB236)。

摘　　要：目的探讨自体带骨膜髂骨移植治疗重度距骨软骨损伤(OCLTs)的临床疗效。方法采用回顾性病例系列研究分析2013年1月至2019年10月武警浙江省总队医院治疗的26例重度OCLTs患者临床资料,其中男21例,女5例;年龄17~49岁[(36.3 ± 10.9)岁]。左足11例,右足15例。均为Hepple Ⅲ~Ⅳ型OCLTs。患者均行自体带骨膜髂骨瓣移植治疗。比较术前、术后6个月及末次随访时(≥12个月)视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)踝 - 后足评分及踝关节关节活动度(ROM);比较术前及末次随访同一层面MRI距骨损伤面积,末次随访CT观察距骨骨质及关节面愈合情况;观察切口、截骨部位愈合及并发症情况。结果患者均获随访12~22个月[(16.2 ± 3.3)个月]。术后6个月及末次随访时,VAS分别为(2.4 ± 0.9)分、(1.7 ± 0.6)分,较术前(5.4 ± 1.2)分显著降低(P < 0.01),末次随访时VAS较术后6个月显著降低(P<0.01)。AOFAS踝 - 后足评分分别为(71.7 ± 7.8)分、(87.8 ± 6.2)分,较术前(66.5 ± 7.5)分显著提升(P<0.01),末次随访时AOFAS踝 - 后足评分较术后6个月显著提升(P<0.01)。踝关节ROM分别为(58.4 ± 5.5)°、(70.0 ± 4.9)°,较术前(42.3 ± 8.1)°明显改善(P<0.01),末次随访时踝关节ROM较术后6个月明显改善(P<0.01)。末次随访时同一层面MRI距骨损伤面积为0.67(0.55,0.89)cm2,较术前2.64(1.98,3.68)cm2明显改善(P<0.01)。距骨CT示移植距骨骨质融合,骨质未见明显缺损,关节面未见明显台阶。患者手术切口均Ⅰ期愈合。除8例患者残留局部软骨下骨骨髓水肿信号、2例出现内踝截骨延迟愈合外,未见切口感染、皮肤坏死、截骨不愈合、畸形愈合或严重踝关节紊乱。结论对于重度OCLTs,自体带骨膜髂骨移植治疗可有效缓解踝关节疼痛,改善踝关节功能,明显缩小损伤面积。Objective To explore the clinical efficacy of periosteum-covered iliac crest autografts for treatment of severe osteochondral lesions of talus(OCLTs).Methods A retrospective case series study was used to analyze the clinical data of 26 patients with severe OCLTs treated at Zhejiang Armed Police Corps Hospital from January 2013 to October 2019.There were 21 males and 5 females,aged 17-49 years[(36.3±10.9)years].All patients were treated using periosteum-covered iliac crest autografts.The visual analogue scale(VAS),American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score and ankle joint range of motion(ROM)were assessed before operation,6 months after operation and at the last follow-up(≥12 months).The area of talus injury with MRI at the same level was recorded before operation and at the last follow-up.The healing of talus and joint surface was detected with CT at the last follow-up.The healing of the incision and osteotomy site and complications were observed.Results All patients were followed for 12 to 22 months[(15.1±3.2)months].The VAS was(2.4±0.9)points and(1.7±0.6)points at postoperative 6 months and at the last follow-up,significantly lower than the preoperative(5.4±1.2)points(P<0.01).Meanwhile,the VAS at the last follow-up was significantly lower than that at postoperative 6 months(P<0.01).The AOFAS ankle-hindfoot score was(71.7±7.8)points and(87.8±6.2)points at postoperative 6 months and at the last follow-up,significantly lower than the preoperative(66.5±7.5)points(P<0.01).Meanwhile,the AOFAS ankle-hindfoot at the last follow-up was significantly lower than that at postoperative 6 months(P<0.01).The ankle ROM was(58.4±5.5)°and(70.0±4.9)°at postoperative 6 months and at the last follow-up,significantly improved when compared to the preoperative(42.3±8.1)°(P<0.01).Meanwhile,the ankle ROM at the last follow-up was significantly improved when compared to that at postoperative 6 months(P<0.01).The area of talus injury with MRI at the same level was 0.67(0.55,0.89)cm^(2) at the la

关 键 词：距骨 骨折 软骨 髂骨 骨移植 

分 类 号：R687.3[医药卫生—骨科学]