踝关节镜后方入路微骨折术联合富血小板血浆注射治疗距骨骨软骨损伤  

Posterior ankle arthroscopic microfracture with platelet-rich plasma injection for the treatment of osteochondral lesions of the talus

作　　者：陈城 傅绍菱 李学谦 王诚 梅国华[1] 苏琰[1] 薛剑锋[1] 邹剑[1] 张解元 顾文奇[1] 宋国勋 施忠民[1] Chen Cheng;Fu Shaoling;Li Xueqian;Wang Cheng;Mei Guohua;Su Yan;Xue Jianfeng;Zou Jian;Zhang Jieyuan;Gu Wenqi;Song Guoxun;Shi Zhongmin(Ankle Section,Department of Orthopedics,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院骨科-足踝外科,上海200233

出　　处：《中华创伤杂志》2022年第8期701-707,共7页Chinese Journal of Trauma

基　　金：上海交通大学“交大之星”计划医工交叉研究基金(YG2022ZD018);科技部国家重点研发计划(2018YFC2001504);上海市人工智能创新发展专项项目(2020-RGZN-02006);上海市“科技创新行动计划”生物医药领域科技支撑项目(19441902400)。

摘　　要：目的探讨踝关节镜后方入路微骨折术联合富血小板血浆(PRP)注射治疗距骨体后部距骨骨软骨损伤(OLT)的疗效。方法采用回顾性病例系列研究分析2019年9月至2020年10月上海交通大学附属第六人民医院收治的13例距骨体后部OLT患者的临床资料, 其中男10例, 女3例;年龄10~65岁[(38.2±15.9)岁]。依据Hepple分型:Ⅱ型4例, Ⅳ型3例, Ⅴ型6例。依据Elias分区:7区9例, 9区4例。病程为13~51个月[(26.2±11.4)个月]。均行踝关节镜后方入路微骨折术联合PRP注射治疗。记录手术时间, 并比较术前、术后3个月及1年视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)踝-后足评分及踝关节活动度(ROM)。术后1年软骨损伤修复情况采用软骨修复组织磁共振观察(MOCART)评分。观察并发症情况。结果患者均获随访12~25个月[(15.7±3.7)个月]。手术时间为50~90 min[(63.8±13.3)min]。VAS由术前3.0(3.0, 4.0)分减少至术后3个月及1年的1.0(0, 2.0)分、1.0(0, 1.5)分;AOFAS踝-后足评分由术前(66.1±11.8)分增加至术后3个月及1年的(84.8±9.5)分、(92.9±8.6)分;踝关节ROM由术前(48.5±7.5)°增加至术后3个月及1年的(61.9±10.3)°、(65.4±11.8)°(P均<0.05)。与术后3个月比较, 术后1年VAS差异无统计学意义(P>0.05);与术后3个月比较, 术后1年AOFAS踝-后足评分及踝关节ROM差异有统计学意义(P均<0.05)。依据AOFAS踝-后足评分, 优11例, 良1例, 可1例, 优良率为92%。术后1年MOCART评分为40~85分[(70.4±14.2)分]。所有患者术后无坏死、感染、神经血管损伤等并发症发生。2例在康复训练时有轻微一过性疼痛, 经非手术治疗后改善。结论对于距骨体后部OLT, 踝关节镜后方入路微骨折术联合PRP注射可减轻疼痛、改善踝关节功能, 同时有效修复软骨损伤, 短期疗效满意。Objective To investigate the efficacy of posterior ankle arthroscopic microfracture with platelet-rich plasma(PRP)injection for the treatment of posterior osteochondral lesions of the talus(OLT).Methods A retrospective case series study was conducted on clinical data of 13 patients with posterior OLT admitted to Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University from September 2019 to October 2020.There were 10 males and 3 females,aged 10-65 years[(38.2±15.9)years].According to Hepple′s classification,four patients were with type II,three with type IV,and six with type V.According to Elias′grid scheme,nine patients were in zone 7 and four patients in zone 9.The disease duration was 13-51 months[(26.2±11.4)months].All patients underwent posterior ankle arthroscopic microfracture with PRP injection.The operation time was recorded.The visual analogue scale(VAS),American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,and ankle range of motion(ROM)were compared before operation and at 3 months and 1 year after operation.The magnetic resonance observation of cartilage repair tissue(MOCART)score was used to evaluate the repair of cartilage injury at 1 year after operation.Complications were recorded.Results All patients were followed up for 12-25 months[(15.7±3.7)months].The operation time ranged from 50 to 90 minutes[(63.8±13.3)minutes].The VAS improved from 3.0(3.0,4.0)points before operation to 1.0(0,2.0)points at 3 months after operation and 1.0(0,1.5)points at 1 year after operation;the AOFAS ankle-hindfoot score was improved from(66.1±11.8)points before operation to(84.8±9.5)points at 3 months after operation and(92.9±8.6)points at 1 year after operation;the ankle ROM was improved from(48.5±7.5)°before operation to(61.9±10.3)°at 3 months after operation and(65.4±11.8)°at 1 year after operation(all P<0.05).There was no significant difference in VAS at 3 months and 1 year after operation(P>0.05).There were significant differences in AOFAS ankle-hindfoot scor

关 键 词：软骨 距骨 关节镜 富血小板血浆 最小侵入性外科手术 

分 类 号：R687.3[医药卫生—骨科学]