骨软骨移植术对距骨骨软骨损伤术后凝血功能步态参数下肢力线的影响  

Effect of Osteochondral Grafting on Coagulation Function Gait Parametersand Lower Limb Force Lines after Osteochondral Injury of the Talus

作　　者：赵振拴[1] 李军[1] 于晓光[1] 刘国彬[1] 赵峰[1] ZHAO Zhenshuan;LI Jun;YU Xiaoguang(The First Hospital of Hebei Medical University,Hebei Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第一医院骨科,河北石家庄050000

出　　处：《河北医学》2023年第2期323-328,共6页Hebei Medicine

基　　金：河北省科技厅重点研发计划卫生健康创新专项,(编号:21377789D)。

摘　　要：目的:探讨骨软骨移植术对距骨骨软骨损伤(OLTs)术后下肢力线及踝关节功能的影响。方法:收集2018年7月至2020年9月我院104例OLTs患者临床资料进行回顾性分析,根据手术方案分为对照组(n=52)和观察组(n=52),分别行微骨折手术、骨软骨移植术。观察两组下肢力线改善程度、踝关节恢复优良率、并发症及手术前后凝血功能指标[D-二聚体(D-D)、纤维蛋白原(Fib)]、美国纽约特种外科医院(HSS)膝关节评分、视觉模拟评分法(VAS)、美国足踝外科医师协会(AOFAS)踝与后足功能评分、步态参数(标准化步幅、患足支撑时间百分比、步频)。结果:术后6个月、12个月观察组VAS评分低于对照组,HSS、AOFAS评分及标准化步幅、步频、患足支撑时间百分比高于对照组(P<0.05);术后3d两组D-D、Fib水平高于术前(P<0.05),术后3d、7d两组D-D、Fib水平比较,差异无统计学意义(P>0.05);术后12个月观察组下肢力线改善程度及踝关节恢复优良率优于对照组(P<0.05);术后12个月两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:骨软骨移植术有助于改善OLTs患者改善下肢力线及步态参数,恢复踝膝关节功能,且对凝血功能影响较小。Objective:To investigate the effect of osteochondral transplantation on lower limb alignment and ankle-knee joint function after talar osteochondral injury(OLTs).Methods:The clinical data of 104 patients with OLTs in our hospital from July 2018 to September 2020 were collected and analyzed retrospectively.According to the surgical plan,they were divided into the control group(n=52)and the observation group(n=52),who underwent microfracture surgery and osteochondral transplantation,respectively.The improvement degree of lower limb alignment,excellent and good rate of ankle joint recovery,complications,and coagulation function indexes[D-dimer(DD),fibrinogen(Fib)]before and after surgery were observed in the two groups,as well as the HSS joint scores,visual analog scale(VAS)scores,AOFAS scores,and gait parameters(normalized stride length,percentage of time supported by the affected foot,cadence).Results:The VAS score of the observation group was lower than that of the control group at 6 months and 12 months after surgery,and the HSS,AOFAS scores,standardized stride length,stride frequency,and the percentage of foot support time in the observation group were higher than those in the control group(P<0.05);The levels of DD and Fib in the two groups at 3 days after operation were higher than those before operation(P<0.05),and there was no significant difference in the levels of DD and Fib between the two groups at 3 days and 7 days after the operation(P>0.05);At 12 months after the operation,the improvement of lower limb alignment and the excellent and good rate of ankle joint recovery in the observation group were better than those in the control group(P<0.05);There was no significant difference in the incidence of complications between the two groups at 12 months after operation(P>0.05).Conclusion:Osteochondral grafting helps to improve lower limb force lines and gait parameters and restore ankle and knee function in patients with OLTs,with less impact on coagulation function.

关 键 词：骨软骨移植术 距骨骨软骨损伤 下肢力线 凝血功能 踝关节功能 

分 类 号：R687.3[医药卫生—骨科学]