自体胫骨远端松质骨植骨治疗Hepple Ⅲ~Ⅳ型距骨软骨损伤
摘要
目的回顾性分析经自体胫骨远端松质骨植骨治疗Hepple Ⅲ～Ⅳ型距骨软骨损伤的手术方法及其临床效果。方法自2014年6月至2017年8月,对20例(20足)获得完整随访的Hepple Ⅲ～Ⅳ型距骨软骨损伤,采用自体同侧胫骨远端松质骨植骨手术方式。其中,男12例,女8例;年龄18～52岁,平均年龄42.4岁;左足9例,右足11例。根据Hepple分型,Ⅲ型7例,Ⅳ型13例。采用美国足踝外科协会踝与后足评分(Amercian orthopaedic foot and ankle society,AOFAS)及疼痛评分(visual analogue scale,VAS)对手术疗效进行评定。结果 20例患者术后随访时间4～28个月,平均16.7个月。术前AOFAS评分平均(53.02±10.06)分,VAS评分平均(8.02±1.14)分;术后AOFAS评分平均(88.04±7.45)分,VAS评分平均(1.26±1.74)分;术前及术后各评分比较,差异具有统计学意义(P<0.05)。结论采用自体胫骨远端松质骨植骨治疗HeppleⅢ～Ⅳ型距骨软骨损伤是一种较有效的治疗方式,该手术可以有效缓解踝关节疼痛并改善踝关节功能。
引文
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[12]van Dijk CN,Reilingh ML,Zengerink M,et al.Osteochondral defects in the ankle:why painful?[J].Knee Surg Sports Traumatol Arthrosc,2010,18(5):570-580.
[13]Hannon CP1,Smyth NA,Murawski CD,et al.Osteochondral lesions of the talus:aspects of current management[J].Bone Joint J,2014,96-B(2):164-171.
[14]Giannini S,Buda R,FaldiniC,et al.Surgical treatment of osteochondral lesions of the talus in young active patients[J].J Bone Joint Surg(Am),2005,87(12):28-41.
[15]Gobbi A,Francisco RA,Lubowitz JH,et al.Osteochondral lesions of the talus:randomized controlled trial comparing chondroplasty,microfracture,and osteochondral autograft transplantation.Arthroscopy[J].2006,22(10):1085-1092.
[2]Zengerink M,Szerb I,Hangody L,et al.Current concepts:treatment of osteochondral ankle defects[J].Foot Ankle Clin,2006,11(1):331-359.
[3]Arianna L Gianakos,Youichi Yasui,Charles P Hannon,et al.Current management of talar osteochondral lesions[J].World J Orthop,2017,8(1):12-20.
[4]Haene R,Qamirani E,Story RA,et al.Intermediate outcomes of fresh talar osteochondral allografts for treatment of large osteochondral lesions of the talus[J].J Bone Joint Surg(Am),2012,94(12):1105-1110.
[5]Hintermann B,Wagener J,Knupp M,et al.Treatment of extended osteochondral lesions of the talus with a free vascularised bone graft from the medial condyle of the femur[J].Bone Joint J,2015,97-B(9):1242-1249.
[6]Hoffmann M,Schroeder M,Rueger JM.A novel computer navigation system for retrograde drilling of osteochondral lesions[J].Sports MedArthrosc,2014,22(4):215-218.
[7]Lee KB,Park HW,Cho HJ,et al.Comparison of Arthroscopic Microfracture for Osteochondral Lesions of the Talus With and Without Subchondral Cyst[J].Am J Sports Med,2015,43(8):1951-1956.
[8]Choi JI,Lee KB.Comparison of clinical outcomes between arthroscopic subchondral drilling and microfracture for osteochondral lesions of the talus[J].Knee Surg Sports Traumatol Arthrosc,2015,4(1):13-17.
[9]Georgiannos D,Bisbinas I,Badekas A,et al.Osteochondral transplantation of autologous graft for the treatment of osteochondral lesions of talus:5-to7-year follow-up[J].Knee Surg Sports Traumatol Arthrosc,2014.12(1):1-5.
[10]Leumann A,Valderrabano V,Wiewiorski M,et al.Bony periosteum-covered iliac crest plug transplantation for severe osteochondral lesions of the talus:a modified mosaicplasty procedure[J].Knee Surg Sports Traumatol Arthrosc,2014,22(6):1304-1310.
[11]Calder JD,Ballal MS,Deol RS,et al.Histological evaluation of calcaneal tuberosity cartilage-A proposed donor site for osteochondral autologous transplant for talar dome osteochondral lesions[J].Foot Ankle Surg,2015,21(3):193-197.
[12]van Dijk CN,Reilingh ML,Zengerink M,et al.Osteochondral defects in the ankle:why painful?[J].Knee Surg Sports Traumatol Arthrosc,2010,18(5):570-580.
[13]Hannon CP1,Smyth NA,Murawski CD,et al.Osteochondral lesions of the talus:aspects of current management[J].Bone Joint J,2014,96-B(2):164-171.
[14]Giannini S,Buda R,FaldiniC,et al.Surgical treatment of osteochondral lesions of the talus in young active patients[J].J Bone Joint Surg(Am),2005,87(12):28-41.
[15]Gobbi A,Francisco RA,Lubowitz JH,et al.Osteochondral lesions of the talus:randomized controlled trial comparing chondroplasty,microfracture,and osteochondral autograft transplantation.Arthroscopy[J].2006,22(10):1085-1092.