摘要
目的:观察采用自体带骨膜髂骨移植治疗伴有软骨下骨囊性缺损的距骨骨软骨损伤的临床疗效。方法 :回顾性分析2011年1月至2014年12月采用自体带骨膜髂骨移植治疗的22例伴有软骨下骨囊性缺损的距骨骨软骨损伤患者的临床资料,其中男18例,女4例;年龄34～58(46.4±6.9)岁;所有患者存在踝关节疼痛肿胀,7例踝关节活动部分受限,2例踝关节不稳,2例后足力线不良。所有患者的距骨骨软骨损伤位于距骨内侧,关节软骨损伤面积为64～132(101.6±27.1) mm~2,囊性病变直径9～15(10.5±1.8) mm。术前,术后12、24个月采用视觉模拟评分(VAS)评估关节疼痛,采用美国足踝外科(AOFAS)踝-后足评分系统评估关节功能。术后12个月取出内踝空心钉的同时行踝关节镜探查评估移植物愈合情况。结果:所有患者获得随访,时间24～60(42.5±9.9)个月。术后12个月MRI显示植骨愈合良好,部分可见散在的小的囊性区域。二次关节镜探查发现,植骨与距骨愈合良好,表面纤维软骨形成良好。术后24个月MRI显示植骨与周围骨质结合良好,仍可见散在的小的囊性区域,但较前有所减少。术后12个月VAS评分2.8±0.8,优于术前6.2±1.5,而与术后24个月2.6±0.8比较差异无统计学意义(P>0.05)。术后12个月AOFAS评分83.0±5.6,优于术前55.3±13.7,与术后24个月83.7±6.6比较差异无统计学意义(P>0.05)。结论:采用自体带骨膜髂骨移植治疗伴有软骨下骨囊性缺损的距骨骨软骨损伤可以获得良好的骨性愈合和表面纤维软骨形成,有效地缓解了患者的临床症状。
Objective:To evaluate clinical effect of autogenous iliac bone graft in treating osteochondral lesion of the talus with subchondral cyst. Methods:Twenty two osteochondral lesion of talus patients with subchondral cyst were collected from January 2011 to December 2014,including 18 males and 4 females aged from 34 to 58 years old with an average of(46.4± 6.9)years old. All patients manifested pain and swelling of ankle joint,7 patients manifested partially limited activity of ankle joint,2 patients manifested unstable of ankle joint,and 2 patients manifested poor force line of foot. All lesions located on the medial side of talus dome. The area of cartilage injury ranged from 64 to 132(101.6±27.1) mm~2,and diameter of subchondral cyst ranged from 9 to 15(10.5±1.8) mm. VAS score and AOFAS score were used to evaluate pain releases and recovery of ankle joint function before operation,12 and 24 months after operation. Healing condition of autograft was assessed under arthroscopy after removal of internal fixation at 1 year after operation. Results:All patients were followed up from 24 to 60 months with an average of(42.5 ±9.9) months. Postoperative MRI at 12 months showed autograft healed well but little cyst still seen. Bone grafting and talus healed well,and formation of fibrocartilage well under arthroscopy. Postoperative MRI at 24 months showed combination of bone grafting and surrounding bone well,and small cyst could seen but less than before. VAS score at 12 months after operation 2.8±0.8 was less than that of before operation 6.2±1.5,but had no differences compared with 24 months after operation 2.6 ±0.8(P>0.05). AOFAS score at 12 months after operation 83.0±5.6 was less than that of before operation 55.3±13.7,but had no differences compared with 24 months after operation 83.7±6.6(P>0.05). Conclusion:autogenous iliac bone graft in treating osteochondral lesion of the talus with subchondral cyst could have a good synosteosis and fibrous cartilage on surface,and relieve clinical symptoms.
引文
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