MOCART2.0在距骨骨软骨损伤自体骨软骨移植术后评价中的应用  

Application of MOCART 2.0 Evaluation System in the Postoperative Evaluation of Autogenous Osteochondral Transplantation for Talar Osteochondral Injury

作　　者：桂琦[1] 宋关阳[2] 刘亮[1] 王雪松[2] Gui Qi;Song Guanyang;Liu Liang;Wang Xuesong(Department of Orthopedics,Beijing Luhe Hospital Affiliated to Capital Medical University,Beijing 101149,China;Department of Sports Medicine,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京潞河医院骨中心,北京101149 [2]北京积水潭医院运动医学科,北京100035

出　　处：《中国运动医学杂志》2022年第12期911-919,共9页Chinese Journal of Sports Medicine

摘　　要：目的:探讨软骨修复组织的磁共振观察评价系统2.0版本(MOCART2.0)评分在距骨骨软骨移植术后评价中的应用,以及影响距骨骨软骨损伤自体骨软骨移植手术术后磁共振影像学评价的因素。方法:选取自2016年1月至2019年12月因距骨骨软骨损伤在北京积水潭医院行距骨自体骨软骨移植术的48例患者作为研究对象。根据入组及排除条件,纳入术后2年再行关节镜探查的患者共25例。收集患者手术前后的一般临床资料、疼痛视觉模拟评分(VAS)及美国足踝外科学会评分(AOFAS)、踝关节磁共振扫描图像、二次探查术中影像资料等,根据MOCART2.0评价系统,对患者二次探查时的MRI进行评价,并得出MOCART2.0分项目得分及总分。应用Spearman相关性分析对MOCART2.0与临床评分、二次探查结果进行相关性分析,通过年龄段、性别、体重指数(BMI)、体重分别对患者进行分组,应用非参数检验及卡方检验等统计学方法,探讨MOCART2.0评分的影响因素。结果:共纳入25例患者,平均随访时间为14.4±3.6个月。术前与最终随访VAS、AOFAS评分存在显著性差异(P<0.05)。MOCART2.0评分项目中,总分平均为67.2±21.5,最终随访AOFAS得分与MOCART2.0总分相关系数为0.548,P=0.005;二次探查Outbridge分级与MOCART2.0总分相关系数为0.578,P=0.002。术后AOFAS评分分别与软骨填充度、边缘整合及软骨下骨改变相关性较高。以BMI为24 kg/m2分为两组,MOCART2.0总分存在显著性差异。结论:MOCART2.0骨软骨移植术后磁共振评价系统与距骨骨软骨移植患者术后临床评分及二次手术探查的镜下形态学改变存在相关性。BMI是MOCART2.0总分的影响因素之一。Objective To explore the application of Magnetic Resonance Observation of Cartilage Repair Tissue version 2.0(MOCART 2.0) score in the postoperative autogenous osteochondral transplantation for talar osteochondral injury,and to find the factors affecting the postoperative evaluation of MRI in talar osteochondral transplantation.Methods Forty-eight patients who underwent talar osteochondral transplantation in Beijing Jishuitan Hospital between January 2016 and December 2019 were selected.According to the inclusion and exclusion criteria,25 patients who underwent arthroscopic exploration two years after their operation were included.Their general clinical data,visual analogue scale(VAS)scores and American Orthopedic Foot and Ankle Society(AOFAS) ankle-hindfoot,midfoot,hallux and lesser toes clinical rating system scores,magnetic resonance imaging(MRI),secondary exploration data,and MOCART 2.0 scores were collected.The correlation of MOCART 2.0 scores to clinical scores and secondary exploration results was analyzed using the Spearman correlation analysis.The influencing factors of MOCART 2.0 scores were explored using Non-parametric test and Chi square test.Results The average follow-up time was 14.4 ± 3.6 months.There were significant differences in the average VAS and AOFAS scores before the operation and at the final follow-up(P<0.05).In the MOCART2.0 score system,the average total score was 67.2 ± 21.5.The correlation coefficient between the final AOFAS score and the total score of MOCART 2.0 was 0.548(P=0.005),while that between the secondary exploration Outbridge grade and the total score of MOCART 2.0 was 0.578(P=0.002).The AOFAS score at the final follow-up were of significant correlation with filling degree,marginal integration and subchondral bone changes of the repair tissue in MOCART 2.0 system.Moreover,significant differences were observed in the total score of MOCART 2.0 between patients with BMI more or less than 24 kg/m2.Conclusion There is a correlation of the MOCART 2.0 score to the postoperativ

关 键 词：距骨骨软骨损伤 自体骨软骨移植 磁共振评估 术后评价 关节镜检查 

分 类 号：R687.3[医药卫生—骨科学]