体外冲击波疗法联合自体骨软骨移植治疗Hepple-V期距骨骨软骨损伤的疗效  

Efficacy of extracorporeal shock wave therapy combined with osteochondral autologous transplantation in the treatment of Hepple-V stage osteochondral lesions of the talus

作　　者：刘核达[1] 刘林 黄飞 李鹏伟 李明 刘胜 李森田[1] LIU Heda;LIU Lin;HUANG Fei;LI Pengwei;LI Ming;LIU Sheng;LI Sentian(First Department of Foot and Ankle Surgery,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou,Hebei 061000)

机构地区：[1]河北省沧州中西医结合医院足踝一科,河北沧州061000

出　　处：《检验医学与临床》2024年第21期3229-3233,共5页Laboratory Medicine and Clinic

基　　金：河北省中医药管理局中医药类科研计划(2020508);河北省中西医结合骨关节病研究重点实验室(筹)。

摘　　要：目的观察体外冲击波疗法(ESWT)联合自体骨软骨移植(OAT)治疗Hepple-V期距骨骨软骨损伤(OLT)的疗效。方法选择2021年1月至2023年1月该院收治的60例OLT患者,按随机数字表法分为对照组和研究组,每组30例。对照组实施OAT治疗,研究组实施ESWT联合OAT治疗。比较两组软骨下骨骨髓水肿(BME)体积、视觉模拟量表(VAS)评分、白细胞介素-8(IL-8)水平、降钙素原(PCT)水平、血小板衍生生长因子(PDGF)水平、转化生长因子-β1(TGF-β1)水平、踝关节活动度(ROM)、不良反应及足、踝关节功能。结果治疗后3个月,两组的软骨下骨BME体积、VAS评分及IL-8、PCT、TGF-β1水平均小于治疗前(P<0.05),且研究组小于对照组(P<0.05)。治疗后3个月,两组的PDGF水平、跖屈ROM、背伸ROM、足踝结局评分、美国足踝关节外科协会评分均大于治疗前(P<0.05),且研究组大于对照组(P<0.05)。研究组的不良反应总发生率低于对照组(P<0.05)。结论ESWT联合OAT可改善Hepple-V期OLT患者的足、踝关节功能及踝关节ROM,缓解BME,减轻疼痛,降低不良反应发生率,且能调节IL-8、PCT、PDGF、TGF-β1水平。Objective To observe the efficacy of extracorporeal shock wave therapy(ESWT)combined with osteochondral autologous transplantation(OAT)in the treatment of Hepple-V stage osteochondral lesions of the talus(OLT).Methods A total of 60 patients with OLT treated in the hospital from January 2021 to January 2023 were selected and randomly divided into control group and study group,30 cases in each group using a random number table method.The control group received OAT treatment,while the study group received ESWT combined with OAT treatment.The volume of subchondral bone marrow edema(BME),visual analog scale(VAS)score,levels of interleukin-8(IL-8),procalcitonin(PCT),platelet-derived growth factor(PDGF),transforming growth factor-β1(TGF-β1),range of motion(ROM)of the ankle joint,complications,and foot and ankle joint function were compared between the two groups.Results After 3 months of treatment,the volume of subchondral bone BME,VAS score,and levels of IL-8,PCT and TGF-β1 in both groups were significantly lower than those before treatment(P<0.05),and these indicators were significantly lower in the study group compared with the control group(P<0.05).After 3 months of treatment,the levels of PDGF,plantarflexion ROM,dorsiflexion ROM,Foot and Ankle Outcome Score and American Orthopaedic Foot and Ankle Society scores in both groups were significantly higher than those before treatment(P<0.05),and these indicators were significantly higher in the study group compared with the control group(P<0.05).The overall incidence of adverse reactions in the study group was lower than that in the control group(P<0.05).Conclus ion ESWT combined with talus OAT can improve foot and ankle joint function and ankle ROM,alleviate BME,relieve pain,reduce the incidence of complications,and regulate IL-8,PCT,PDGF and TGF-β1 levels in patients with Hepple-V stage OLT.

关 键 词：体外冲击波疗法 自体骨软骨移植 Hepple-V期 距骨骨软骨损伤 疗效 

分 类 号：R681.3[医药卫生—骨科学] R446.1[医药卫生—外科学]