外固定支架联合自体带骨膜髂骨植骨治疗距骨软骨损伤  

Autogenous periosteal iliac bone graft with external fixation for treatment of severe osteochondral lesion of talus

作　　者：杨衡 石波[2] 唐诗添[2] 王陶[2] 臧永辉 黄俊琪 YANG Heng;SHI Bo;TANG Shitian;WANG Tao;ZANG Yonghui;HUANG Junqi(Department of Orthopaedics,Jiange People's Hospital,Jiange,Sichuan 628300,P.R.China;Department of Orthopaedics,Mianyang Central Hospital,Mianyang,Sichuan 621000,P.R.China)

机构地区：[1]剑阁县人民医院骨科,四川剑阁628300 [2]绵阳市中心医院骨科,四川绵阳621000

出　　处：《华西医学》2023年第4期525-529,共5页West China Medical Journal

基　　金：四川省医学会骨科疾病专项科研课题项目(2019SAT25);绵阳市卫生健康委员会课题项目(201945)。

摘　　要：目的 探讨外固定支架联合自体带骨膜髂骨修复距骨软骨损伤的临床疗效。方法 回顾性分析2018年1月-2022年1月于绵阳市中心医院治疗的18例距骨软骨损伤患者资料。患者均取自体带骨膜髂骨移植,并采用外固定支架辅助支撑踝关节。评估术前、术后6个月随访时患者疼痛视觉模拟评分(Visual Analogue Scale, VAS)、关节活动度、美国足踝外科协会(American Orthopedic Foot and Ankle Society, AOFAS)踝-后足评分,比较手术前后MRI显示距骨软骨损伤变化,记录手术相关并发症等情况。结果 18例患者中男5例,女13例;平均年龄(50.7±5.4)岁;左侧6例,右侧12例;Hepple分型Ⅲ型8例,Ⅳ型10例。患者平均随访时间(17.6±8.2)个月。术前VAS评分(5.5±1.5)分,踝关节活动度(48.0±10.5)°,AOFAS评分(54.9±11.1)分;术后6个月VAS评分(2.1±0.9)分,踝关节活动度(64.8±7.8)°,AOFAS评分(82.6±8.7)分,较术前均明显改善,差异有统计学意义(P<0.05)。患者术前MRI示最大损伤面积为(2.6±0.6)cm2,最大损伤深度为(10.0±0.4)mm;术后1年随访MRI示距骨软骨损伤面积为(0.6±0.2)cm2,深度为(5.5±0.3)mm,与术前相比差异均有统计学意义(P<0.05)。至末次随访时均未发现切口感染、植骨区骨折、内踝不愈合等并发症。结论 自体带骨膜髂骨植骨可修复距骨软骨损伤,使软骨损伤面积减少。外固定支架可提供早期关节稳定,有利于软骨和骨愈合。Objective To explore the clinical efficacy of external fixation combined with autogenous periosteal iliac bone for repairing cartilage injury of the talus.MethodsThe data of18 patients with talus cartilage injury treated in Mianyang Central Hospital between January 2018 and January 2022 were retrospectively analyzed.All patients received autogenous periosteal iliac bone transplantation and external fixation brackets.The Visual Analogue Scale(VAS),joint range of motion,and the American Orthopedic Foot and Ankle Society(AOFAS)ankle posterior foot score were assessed before surgery and 6 months after surgery.The changes of cartilage damage of the talus on MRI before and after surgery were compared.The complications related to the operation were recorded.Results The patients included 5 males and 13 females,with an average age of(50.7±5.4)years.There were 6 cases injured on the left side and 12 cases injured on the right side.The Hepple's classification was type II in 8 cases and type IV in 10 cases.The average follow-up time was(17.6±8.2)months.The preoperative VAS score,ankle range of motion,and AOFAS score were 5.5±1.5,(48.0±10.5)^(2),and 54.9±11.1,respectively.Six months after surgery,the VAS score,ankle range of motion,and AOFAS score were 2.1±0.9,(64.8±7.8)^(2),and 82.6±8.7,respectively,and the differences from preoperative scores were all statistically significant(P<0.05).The preoperative MRI showed that the area of talus cartilage injury was(2.6±0.6)cm^(2),and the depth was(10.0±0.4)mm;the 1-year follow-up MRI showed that the area of talus cartilage injury was(0.6±0.2)cm²,and the depth was(5.5±0.3)mm,which statistically differed from those before surgery(P<0.05).By the last follow-up,no postoperative complications such as incision infection,bone graf fracture,and nonunion of the inner ankle were found.Conclusions Autogenous periosteal iliac bone graft can repair cartilage injury of the talus.External fixation stent provides early joint stability,avoiding uneven joint compression or joint impact.

关 键 词：距骨 软骨 骨移植 外固定 

分 类 号：R687.3[医药卫生—骨科学]