自体骨软骨移植治疗Hepple Ⅴ型距骨骨软骨损伤的中长期疗效分析  

Mid-and-long-term outcomes of autologous osteochondral transplantation for Hepple Ⅴ osteochondral lesions of the talus

作　　者：杨帅 史尉利 陈临新[1] 皮彦斌[1] 赵峰[1] 江东[1] 谢兴[1] 焦晨[1] 胡跃林[1] 郭秦炜[1] YANG Shuai;SHI Weili;CHEN Linxin;PI Yanbin;ZHAO Feng;JIANG Dong;XIE Xing;JIAO Chen;HU Yuelin;GUO Qinwei(Department of Sports Medicine,Peking University Third Hospital,Institute of Sports Medicine of Peking University,Beijing Key Laboratory of Sports Injuries,Beijing,Engineering Research Center of Sports Trauma Treatment Technology and Devices,Ministry of Education,100191 Beijing,China)

机构地区：[1]北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,运动创伤治疗技术与器械教育部工程研究中心,北京100191

出　　处：《中华骨与关节外科杂志》2024年第7期577-583,共7页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金面上项目(82272482)。

摘　　要：目的:分析自体骨软骨移植治疗Hepple Ⅴ型距骨骨软骨损伤(OLT)的中长期疗效。方法:回顾性分析2016年3月至2017年11月于北京大学第三医院接受自体骨软骨移植治疗的20例Hepple Ⅴ型OLT患者的临床资料。其中男13例,女7例,年龄为18~53岁,平均(37.7±8.8)岁。比较患者术前及末次随访时疼痛视觉模拟评分(VAS)、美国足踝关节协会(AOFAS)踝-后足评分和踝关节活动评分(AAS)。记录患者术后行二次关节镜检查国际软骨修复协会(ICRS)评分及末次磁共振成像(MRI)检查软骨修复组织磁共振观察(MOCART)评分。随访过程中观察患者供区损伤症状,末次随访时采用Lysholm评分评估患者取骨侧膝关节功能。结果:本组20例患者随访60.9~81.9个月,平均(71.3±6.8)个月。末次随访时患者VAS评分、AOFAS踝-后足评分、AAS评分均较术前明显改善(P均<0.001)。末次随访时AOFAS踝-后足评分优16例,良3例,可1例,优良率95.0%(19/20)。20例患者术后均行踝关节MRI检查,末次MRI检查MOCAT评分为(72.5±7.5)分;11例(55.0%)患者术后行二次关节镜检查,ICRS评分为(9.7±0.9)分。6例(30.0%)患者膝关节取骨区有轻微不适感。末次随访时患者取骨侧膝关节VAS评分为0.0(0.0,0.0)分,Lysholm评分为96.5(92.0,99.5)分。结论:自体骨软骨移植治疗Hepple Ⅴ型OLT的中长期疗效良好,且关节镜和影像学结果满意,是一种安全有效的治疗方式。Objective:To analyze the mid-and-long-term outcomes of autologous osteochondral transplantation for Hepple Ⅴosteochondral lesions of the talus.Methods:From March 2016 to November 2017,the clinical data of 20 patients with Hepple Ⅴosteochondral lesions of the talus who were treated with autologous osteochondral transplantation in Peking University Third Hospital were retrospectively analyzed.There were 13 males and 7 females with an average age of(37.7±8.8)years(range,18-53 years).The visual analog scale(VAS)score,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,and ankle activity scale(AAS)were assessed and compared preoperatively and at the final follow-up.The International Cartilage Repair Society(ICRS)score from the second-look arthroscopy and the cartilage repair MR score(MOCART)from the last magnetic resonance imaging(MRI)examination were evaluated.The incidence of donor-site complications was recorded,and the Lysholm score was used to evaluate knee joint function.Results:Twenty patients were followed up for a period ranging from 60.9 to 81.9 months,with an average follow-up duration of 71.3±6.8 months.At the final follow-up,significant improvements were observed in VAS,AOFAS and AAS scores compared to preoperative values(all P<0.001).At the final follow-up,the AOFAS ankle-hindfoot score was excellent in 16 cases,good in 3 cases,and fair in 1 case.All 20 patients underwent postoperative ankle MRI,with an average MOCART score of 72.5±7.5;11 patients(55.0%)underwent second-look arthroscopy,and the ICRS score was 9.7±0.9.Six patients(30.0%)had mild discomfort in the knee bone graft area.At the final follow-up,the VAS score for the ipsilateral knee was 0.0(0.0,0.0),and the Lysholm score was 96.5(92.0,99.5).Conclusions:Autologous osteochondral transplantation has good mid-and long-term outcomes in the treatment of Hepple typeⅤtalar osteochondral lesions.Both arthroscopic and imaging results indicate satisfactory repair,confirming the procedure a safe and effective treatment method.

关 键 词：距骨骨软骨损伤 Hepple Ⅴ型 自体骨软骨移植 供区损伤 

分 类 号：R683[医药卫生—骨科学]