自体基质诱导软骨生成术与外侧韧带稳定术治疗距骨骨软骨损伤合并踝关节不稳效果分析  

Analysis on effect of autologous matrix induced chondrogenesis and lateral ligament stabilization in treatment of talar osteochondral injury combined with ankle instability

作　　者：刘玉杰 朱鹏飞[1] 党丽君 曲平艳 LIU Yujie;ZHU Pengfei;DANG Lijun;QU Pingyan(Second Department of Foot and Ankle Surgery,Tangshan Municipal Second Hospital,Tangshan,Hebei 063000,China)

机构地区：[1]河北省唐山市第二医院足踝外二科,063000

出　　处：《重庆医学》2022年第9期1520-1523,1529,共5页Chongqing medicine

摘　　要：目的探讨自体基质诱导软骨生成术(AMIC)与外侧韧带稳定术(LLS)治疗距骨骨软骨损伤(OLT)合并踝关节不稳的临床效果。方法研究纳入了90例接受AMIC治疗的患者,平均随访时间(4.2±1.5)年。收集患者年龄、体重指数(BMI)、损伤大小等资料,根据手术方式分为AMIC组和AMIC+LLS组,对患者进行Tegner评分、美国骨科足踝协会(AOFAS)评分和Cumberland踝关节不稳定评定问卷(CAIT)评分,术后复查踝关节磁共振,并根据软骨修复组织的磁共振(MOCART)1和2.0评分对所有移植物进行评估。结果患者平均年龄(33.4±12.7)岁,平均BMI(26.2±3.7)kg/m^(2)。与AMIC组相比,AMIC+LLS组患者AOFAS评分和Tegner评分更低,临床结果更差,且术后CAIT评分和AOFAS评分明显相关。当CAIT评分大于24分(无功能性踝关节不稳)时,AMIC+LLS组AOFAS评分与AMIC组患者的评分差异无统计学意义(P>0.05),且两组之间的MOCART 1和2.0评分差异无统计学意义(P>0.05)。结论在OLT合并踝关节不稳的患者中同时进行AMIC和LLS手术,如果术后踝关节达到稳定,其临床效果与单独的AMIC术相近。充分稳定踝关节在治疗OLT患者中意义重大。Objective To investigate the clinical effect of autologous matrix induced chondrogenesis(AMIC)and lateral ligament stabilization(LLS)in the treatment of talar osteochondral injury(OLT)combined with ankle instability.Methods Ninety patients treated with AMIC were included in this study.The average follow-up time was(4.2±1.5)years.The data such as age,body mass index(BMI)and injury size of the patients were collected.The patients were divided into the AMIC group and AMIC+LLS group according to the operation method.The patients conducted the Tegner scoring,American Orthopaedic Foot and ankle Association(AOFAS)scoring and Cumberland ankle instability Assessment Questionnaire(CAIT)scoring.The ankle MRI was rechecked after operation,all grafts were evaluated according to magnetic resonance imaging(MOCART)1 and 2.0 scores of cartilage repair tissue.Results The average age of the patients was(33.4±12.7)years old,and the average BMI was(26.2±3.7)kg/m^(2).Compared with the AMIC group,the AOFAS and Tegner scores in the AMIC+LLS group were lower,the clinical outcomes were worse,moreover the postoperative CAIT and AOFAS scores were significantly correlated.When the CAIT score>24 points(non-functional ankle instability),there was no statistically significant difference in the AOFAS score between the AMIC+LLS group and AMIC group(P>0.05),morever there was no statistically significant difference in the MOCART 1 and 2.0 scores between the two groups.Conclusion AMIC and LLS are performed simultaneously in the patients with OLT combined with ankle instability,if the ankle reach stable after operation,the clinical effect is similar to that of AMIC alone.Sufficiently stablizing ankle has the important significance in the treatment of OLT patients.

关 键 词：关节软骨 踝关节不稳定 外侧韧带稳定 骨软骨损伤 距骨 

分 类 号：R687.3[医药卫生—骨科学]