MRI术前定量评估距骨骨软骨损伤范围对术式选择及中长期随访结果的影响  

Effect of MRI preoperative quantitative assessment of the range of talus osteochondral injury on surgical selection and medium-to long-term follow-up results

作　　者：刘洪达[1] 闫荣亮[1] 高岩[1] 陈江华[1] 曲平艳 王磊[1] 彭义[1] 曹立海[1] 杜晓健[1] 曲家富[1] Liu Hongda;Yan Rongliang;Gao Yan;Chen Jianghua;Qu Pingyan;Wang Lei;Peng Yi;Cao Lihai;Du Xiaojian;Qu Jiafu(Second Department of Foot and Ankle Surgery,The Second Hospital of Tangshan,Tangshan 063000,Hebei Province,China)

机构地区：[1]唐山市第二医院足踝外二科,河北省唐山市063000

出　　处：《中国组织工程研究》2024年第33期5388-5395,共8页Chinese Journal of Tissue Engineering Research

基　　金：河北省卫生计生委项目(20181284),项目负责人:刘洪达。

摘　　要：背景:距骨骨软骨损伤是一种常见的运动系统疾病,该损伤类型会影响患者的日常生活和工作能力,如不及时治疗可能加重病情。手术治疗是常用的治疗方法,但术式选择和中长期随访结果的评估一直是临床上的难题。目的:探究术前T1ρ技术定量评估距骨骨软骨损伤范围对术式选择及中长期随访结果的影响。方法:回顾性选择2019年1月至2022年8月唐山市第二医院收治的距骨骨软骨损伤患者154例作为研究对象。术前MRI检查距骨骨软骨损伤部位,比较不同分型患者的T1ρ值及T2值;再根据T1ρ值选择不同的手术方式,将T1ρ值<45 ms采用微骨折手术治疗设为A组(n=73),T1ρ值≥45 ms采用自体骨软骨移植治疗设为B组(n=81)。比较不同术式下患者的一般临床特征及疗效,多因素Logistic回归分析患者术后复发的重要因素,限制性立方样条图分析T1ρ值与患者术后复发的关系,y=1-1/(1+e-z)回归方程建立预测模型,十字交叉验证法验证模型稳定性。结果与结论:①154例患者中距骨骨软骨损伤分型Ⅰ型36例,Ⅱ型37例,Ⅲ型40例,Ⅳ型41例,4个分型患者的T1ρ值及T2值相比差异均有显著性意义(P<0.05),两两比较差异亦有显著性意义(P均<0.05);②154例患者治疗后局部肿胀7例(4.6%),疼痛加重3例(2.0%),创口感染5例(3.3%),软骨愈合不良2例(1.3%);③A、B组治疗后美国骨科足踝协会评分、目测类比评分、跖屈活动度、背伸活动度、软骨下骨骨髓水肿体积、白细胞介素6、白细胞介素8、C-反应蛋白、降钙素原、血小板衍生生长因子、转化生长因子β1水平、疗效方面比较差异均有显著性意义(P<0.05),其中B组的疗效总有效率为90%,比A组总有效率(85%)高(P<0.05);④年龄(OR=1.589,95%CI:0.305-1.252,P=0.036)、白细胞介素6(OR=1.737,95%CI:0.974-5.254,P=0.049)、白细胞介素8(OR=1.385,95%CI:1.066-4.355,P=0.034)、C-反应蛋白(OR=1.957,95%CI:1.323-2.178,P=0.035)、转化生长�BACKGROUND:Talus cartilage injury is a common motor system disease.This type of injury will affect the patient’s daily life and work ability,and may worsen the condition if left untreated.Surgical treatment is commonly used,but the selection of surgical methods and the evaluation of medium-and long-term follow-up results have always been difficult clinical problems.OBJECTIVE:To explore the influence of T1ρtechnique on the range of quantitative evaluation of talus osteochondral injury on the choice of surgical method and the results of medium-and long-term follow-up.METHODS:A total of 154 patients with osteochondral injury of talus admitted to The Second Hospital of Tangshan from January 2019 to August 2022 were retrospectively selected as the study subjects.The lesion site of talus was examined by MRI before operation,and the T1ρand T2 values of different types were compared.Different surgical methods were selected according to the different T1ρvalues.Group A(n=73)was treated with microfracture surgery with T1ρ<45 ms;group B(n=81)was treated with autogenous bone and cartilage transplantation with T1ρ≥45 ms.The general clinical characteristics and curative effects of patients under different surgical methods were compared;the important factors of postoperative recurrence were analyzed by multivariate Logistic regression,and the relationship between T1ρvalue and postoperative recurrence was analyzed by restricted cubic spline graph,y=1-1/(1+e-z)regression equation to build a prediction model.The stability of the model was verified by cross-checking method.RESULTS AND CONCLUSION:(1)Classification of talus osteochondral injury in 154 patients(type I:36 cases;type II:37 cases;type III:40 cases;type IV:41 cases),T1ρand T2 values of the four groups were statistically significant(P<0.05);pairwise comparison was also statistically significant(all P<0.05).(2)After treatment of 154 patients,7 cases(4.6%)had local swelling,3 cases(2.0%)had pain aggravation,and 5 cases(3.3%)had wound infection.There were 2 cases(1.

关 键 词：T1ρ技术定量 距骨骨软骨损伤 分型 微骨折术 自体骨软骨移植 随访 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R684