前踝楔形截骨术联合自体带骨膜髂骨块移植术治疗HeppleⅤ型内侧距骨骨软骨损伤  

Anterior ankle wedge osteotomy combined with periosteum-iliac bone autografting in the treatment of Hepple typeⅤosteochondral lesions of the medial talus

作　　者：李飞[1] 刘伟[1] 帕尔哈提[1] 王雪[1] 王成伟[2] LI Fei;LIU Wei;Parr Hat;WANG Xue;WANG Chengwei(Department of Orthopaedics,the Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830002,China;Department of Orthopaedics,the Third Affiliated Hospital of Xinjiang Medical University,Urumqi 830002,China)

机构地区：[1]新疆医科大学第六附属医院骨病矫形外科,乌鲁木齐830000 [2]新疆医科大学第三附属医院骨科,乌鲁木齐830000

出　　处：《中华骨与关节外科杂志》2024年第12期1106-1111,共6页Chinese Journal of Bone and Joint Surgery

基　　金：新疆维吾尔自治区自然科学基金重点资助项目(2024D01D27);新疆医科大学第六附属医院科研专项基金(LFYKYZX2021009)。

摘　　要：目的:前踝楔形截骨术联合自体带骨膜髂骨块移植术治疗HeppleⅤ型内侧距骨骨软骨损伤的临床效果。方法:回顾性分析2019年1月至2024年1月于新疆医科大学第六附属医院采用前踝楔形截骨术联合自体带骨膜髂骨块移植术治疗的20例HeppleⅤ型内侧距骨骨软骨损伤患者的临床资料。其中男15例,女5例,年龄20~60岁,平均(35.5±7.9)岁。收集并比较患者术前及末次随访时疼痛视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)踝-后足评分、Karlsson-Peterson踝关节评分;记录末次随访时软骨修复组织磁共振观察(MOCART)评分及影像学检查结果;同时记录并发症发生情况。结果:20例患者均获得随访,随访时间12~24个月,平均(14.0±2.5)个月。末次随访时,VAS评分由术前的(7.2±1.2)分降低至(1.9±0.6)分,AOFAS踝-后足评分由术前的(74.1±4.8)分升高至(94.5±4.8)分,Karlsson-Peterson踝关节评分由术前的(58.2±2.5)分升高至(86.3±3.6)分,差异均有统计学意义(P均<0.05)。末次随访时,MRI示骨囊肿区填充完整,软骨面光滑,MOCART评分为(82.2±4.5)分。所有患者截骨处均骨性愈合,无骨不连、骨延迟愈合发生;同侧髂骨取骨区无疼痛、感染等并发症发生。结论:前踝楔形截骨术联合自体带骨膜髂骨块移植术治疗HeppleⅤ型内侧距骨骨软骨损伤,能够缓解患者踝关节疼痛,改善踝关节功能,临床效果较好。Objective:To evaluate the clinical outcomes of anterior ankle wedge osteotomy combined with periosteum-iliac bone autografting in the treatment of Hepple typeⅤosteochondral lesions of the medial talus.Methods:A retrospective analysis was conducted on the clinical data of 20 patients with Hepple typeⅤosteochondral lesions of the medial talus who underwent anterior ankle wedge osteotomy combined with periosteum-iliac bone autografting at the Sixth Affiliated Hospital of Xinjiang Medical University from January 2019 to January 2024.There were 15 males and 5 females with an average age of 35.5±7.9 years(range:20-60 years).Preoperative and final follow-up assessments included the visual analogue scale(VAS)score,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,and Karlsson Peterson ankle score were collected and compared preoperatively and at the final follow-up.Magnetic resonance observation of cartilage repair tissue(MOCART)and imaging results at the final follow-up were recorded,along with any complications.Results:Twenty patients were followed up for 12 to 24 months,with an average duration of科杂志,2024,17(12):1106-1111.14.0±2.5 months.At the final follow-up,the VAS score decreased from 7.2±1.2 preoperatively to 1.9±0.6,the AOFAS ankle-hindfoot score increased from 74.1±4.8 preoperatively to 94.5±4.8,and the Karlsson-Peterson ankle score increased from 58.2±2.5 preoperatively to 86.3±3.6(all P<0.05).MRI at the last follow-up revealed complete filling of the bone cyst area and a smooth cartilage surface.The MOCART score was 82.2±4.5.Bony union was achieved at the osteotomy site in all patients,with no occurrences of non-union or delayed union.No complications such as pain or infection occurred at the ipsilateral iliac bone harvesting site.Conclusions:The combination of anterior ankle wedge osteotomy with periosteum-iliac bone autografting is an effective treatment for Hepple typeⅤosteochondral lesions of the medial talus,relieving ankle joint pain and improving ankle joint fun

关 键 词：截骨术 移植术 距骨骨软骨损伤 

分 类 号：R683[医药卫生—骨科学]