同侧股骨髌股关节面非负重区骨软骨柱移植修复距骨骨软骨缺损的回顾性临床观察
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摘要
目的探讨从同侧股骨髌股关节面非负重区获取骨软骨柱,行自体骨软骨移植术修复距骨骨软骨缺损的临床效果。方法回顾性分析2014年5月~2017年3月新乡医学院第一附属医院收治的距骨骨软骨缺损患者22例,所有患者均行踝关节X线、CT或MRI进行术前评估距骨病变程度,采用踝关节镜下明确软骨缺损的位置及面积,清理缺损区边缘,加行内踝截骨,应用自体骨软骨移植系统取同侧股骨髌股关节面非负重区骨软骨柱修复距骨骨软骨缺损。采用视觉疼痛量表(VAS)对术前、术后末次随访踝关节疼痛进行评分;采用美国足踝外科协会踝-后足评分(AOFAS)对术前及术后末次随访踝关节功能进行评分;术后行踝关节X线及MRI检查。结果 21例患者获得随访,1例患者失访。术后随访10~20个月,患者踝关节VAS评分从术前(5.95±1.04)分降至术后末次随访(1.50±0.96)分,差异有高度统计学意义(P<0.01);AOFAS评分从术前(53.28±14.93)分上升至术后末次随访(84.47±9.31)分,差异有高度统计学意义(P<0.01)。结论从同侧股骨髌股关节面非负重区获取骨软骨柱,行自体骨软骨移植术治疗距骨骨软骨缺损的效果较好,能减轻患者踝关节疼痛,改善踝关节功能。
Objective To investigate the clinical effect of using autologous osteochondral transplantation with non-weight bearing area osteochondral columns which derived fromthe patellofemoral joint surfaceof ipsilateral femoral condyle for repairing osteochondral lesions of the talus(OLT). Methods From May 2014 to March 2017, in the First Affiliated Hospital of Xinxiang Medical University, 22 OLT patients were retrospectively reviewed, all patients underwent preoperative assessment of the extent of talus lesions by X-ray, CT or MRI. Then the position and area of osteochondral lesions were determined by arthroscopy in all patients, the edge of the defect area and medial malleolus osteotomy was cleared, osteochondral autograft transfer system was used to repair osteochondral lesions of the talus with non-weight bearing area osteochondral columns from the patellofemoral joint surface of ipsilateral femoral condyle. Visual analogue scale(VAS) was used to assess ankle pain preoperatively and during the last follow-up postoperatively.American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hindfoot score was used to evaluate ankle function preoperativly and the last follow-up postoperatively. X-ray and MRI of ankle joint were observed to understand the recovery of osteochondral lesions area postoperatively. Results A total 21 patients received follow-up, 1 patient lost followup. After treatment they received follow-up for 10-20 months, the VAS reduced from(5.95±1.04) points before surgery to(1.50±0.96) points at last follow-up, the difference was statistically significant(P < 0.01). The AOFAS improved from(53.28±14.93) points before surgery to(84.47±9.31) points at last follow-up, the difference was statistically significant(P < 0.01). Conclusion Osteochondral autografts is effective in the treatment of OLT, it can reduce the pain of the ankle and improve the function of the ankle joint.
Objective To investigate the clinical effect of using autologous osteochondral transplantation with non-weight bearing area osteochondral columns which derived fromthe patellofemoral joint surfaceof ipsilateral femoral condyle for repairing osteochondral lesions of the talus(OLT). Methods From May 2014 to March 2017, in the First Affiliated Hospital of Xinxiang Medical University, 22 OLT patients were retrospectively reviewed, all patients underwent preoperative assessment of the extent of talus lesions by X-ray, CT or MRI. Then the position and area of osteochondral lesions were determined by arthroscopy in all patients, the edge of the defect area and medial malleolus osteotomy was cleared, osteochondral autograft transfer system was used to repair osteochondral lesions of the talus with non-weight bearing area osteochondral columns from the patellofemoral joint surface of ipsilateral femoral condyle. Visual analogue scale(VAS) was used to assess ankle pain preoperatively and during the last follow-up postoperatively.American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hindfoot score was used to evaluate ankle function preoperativly and the last follow-up postoperatively. X-ray and MRI of ankle joint were observed to understand the recovery of osteochondral lesions area postoperatively. Results A total 21 patients received follow-up, 1 patient lost followup. After treatment they received follow-up for 10-20 months, the VAS reduced from(5.95±1.04) points before surgery to(1.50±0.96) points at last follow-up, the difference was statistically significant(P < 0.01). The AOFAS improved from(53.28±14.93) points before surgery to(84.47±9.31) points at last follow-up, the difference was statistically significant(P < 0.01). Conclusion Osteochondral autografts is effective in the treatment of OLT, it can reduce the pain of the ankle and improve the function of the ankle joint.
引文
[1]Chao J,Pao A.Restorative tissue transplantation options for osteochondral lesions of the talus:a review[J].Orthop Clin North Am,2017,48(3):371-383.
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[3]朱渊,徐向阳,刘津浩,等.踝关节镜下微骨折手术治疗距骨骨软骨损伤[J].第三军医大学学报,2015,37(3):211-214.
[4]Baums M H,Schultz W,Kostuj T,et al.Cartilage repair techniq ues of the talus:an update[J].World J Orthop,2014,5(3):171-179.
[5]Redondo ML,Beer AJ,Yanke AB.Cartilage restoration:microfracture and Osteochondral Autograft Transplantation[J].J Knee Surg,2018,31(03):231-238.
[6]Hangody L,Füles P.Autologous osteochondralmosaicplasty for the treatment of full-thickness defects of weightbearing joints:ten years of experimental and clinical experience[J].Bone Joint Surg Am,2003,85-A(Suppl 2):25-32.
[7]Choi WJ,Kim BS,Lee JW.Osteochondral lesion of the talus:could age be an indication for arthroscopic treatment?[J].Am J Sports Med,2012,40(2):419.
[8]方军杰,陈良,胡碧波,等.距骨骨软骨损伤的MRI诊断及骨软骨移植术后的动态随访分析[J].中国骨伤,2016,29(9):814-819.
[9]Lee RKL,Griffith JF,Law EKC,et al.Ankle traction during MRI of talar dome osteochondral lesions[J].AJR Am J Roentgenol,2017,209(4):874.
[10]Hepple S,Winson IG,Glew D.Osteochondral lesions of the talus:a revised classification[J].Foot Ankle Int,1999,20(12):789-793.
[11]Ramponi L,Yasui Y,Murawski CD,et al.Lesion size is a predictor of clinical outcomes after bone marrow stimulation for osteochondral lesions of the talus:a systematic review[J].Am J Sports Med,2017,45(7):1698-1705.
[12]Dawe EJ,Jukes CP,Ganesan K,et al.Ankle arthroscopy to manage sequelae after ankle fractures[J].Knee Surg Sports Traumatol Arthrosc,2015,23(11):3393.
[13]Martin KD,Stone JW,Amendola A.arthroscopic approaches to the ankle joint[J].Oper Tech Orthop,2014,24(3):144-151.
[14]徐龙,何仕诚.踝关节骨折的手术治疗与功能康复研究[J].中国医药导报,2013,10(35):56-58.
[15]Scott J,Huskisson EC.Graphic representation of pain[J].Pain,1976,2(2):175-184.
[16]C觟ster MC,Rosengren BE,Bremander A,et al.Comparison of the Self-reported Foot and Ankle Score(SEFAS)and the American Orthopedic Foot and Ankle Society Score(AOFAS)[J].Foot Ankle Int,2014,35(10):1031-1036.
[17]赵勇,王钢.踝关节扭伤的生物力学与运动学研究进展[J].中国骨伤,2015,28(4):374-377.
[18]Gianakos AL,Yasui Y,Hannon CP,et al.Current management of talar osteochondral lesions[J].World J Orthop,2017,8(1):12-20.
[19]Easley ME,Vineyard JC.Varus ankle and osteochondral lesions of the talus[J].Foot Ankle Clin,2012,17(1):21-38.
[20]Hannon CP,Baksh N,Newman H,et al.A systematic review on the reporting of outcome data in studies on autologous osteochondral transplantation for the treatment of osteochondral lesions of the talus[J].Foot Ankle Spec,2013,6(3):226-231.
[21]Vannini F,Cavallo M,Baldassarri M,et al.Treatment of juvenile osteochondritisdissecans of the talus:current concepts review[J].Joints,2014,2(4):188-191.
[22]冯乾.中药内服外洗治疗踝关节扭伤[J].中国医药导报,2007,4(30):64.
[23]Murawski C D,Kennedy J G.Operative treatment of osteochondral lesions of the talus[J].J Bone Joint Surg Am,2013,95(11):1045.
[24]Valderrabano V,Leumann A,Rasch H,et al.Knee-toankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint[J].Am J Sports Med,2009,37(Suppl1):105S.
[25]郭秦炜,梅宇,焦晨,等.自体骨-骨膜移植治疗HeppleⅤ型距骨骨软骨损伤的近期疗效[J].中华骨科杂志,2013,33(4):342-347.
[26]Haleem AM,Ross KA,Smyth NA,et al.Double-plug autologous osteochondral transplantation shows equal functional outcomes compared with single-plug procedures in lesions of the talar dome:a minimum 5-year clinical follow-up[J].Am J Sports Med,2014,42(8):1888-1895.
[27]Looze C A,Capo J,Ryan M K,et al.Evaluation and management of osteochondral lesions of the talus[J].Cartilage,2017,8(1):19.
[2]Prado MP,Kennedy JG,Raduan F,et al.Diagnosis and treatment of osteochondral lesions of the ankle:current concepts[J].Rev Bras Ortop,2016,51(5):489-500.
[3]朱渊,徐向阳,刘津浩,等.踝关节镜下微骨折手术治疗距骨骨软骨损伤[J].第三军医大学学报,2015,37(3):211-214.
[4]Baums M H,Schultz W,Kostuj T,et al.Cartilage repair techniq ues of the talus:an update[J].World J Orthop,2014,5(3):171-179.
[5]Redondo ML,Beer AJ,Yanke AB.Cartilage restoration:microfracture and Osteochondral Autograft Transplantation[J].J Knee Surg,2018,31(03):231-238.
[6]Hangody L,Füles P.Autologous osteochondralmosaicplasty for the treatment of full-thickness defects of weightbearing joints:ten years of experimental and clinical experience[J].Bone Joint Surg Am,2003,85-A(Suppl 2):25-32.
[7]Choi WJ,Kim BS,Lee JW.Osteochondral lesion of the talus:could age be an indication for arthroscopic treatment?[J].Am J Sports Med,2012,40(2):419.
[8]方军杰,陈良,胡碧波,等.距骨骨软骨损伤的MRI诊断及骨软骨移植术后的动态随访分析[J].中国骨伤,2016,29(9):814-819.
[9]Lee RKL,Griffith JF,Law EKC,et al.Ankle traction during MRI of talar dome osteochondral lesions[J].AJR Am J Roentgenol,2017,209(4):874.
[10]Hepple S,Winson IG,Glew D.Osteochondral lesions of the talus:a revised classification[J].Foot Ankle Int,1999,20(12):789-793.
[11]Ramponi L,Yasui Y,Murawski CD,et al.Lesion size is a predictor of clinical outcomes after bone marrow stimulation for osteochondral lesions of the talus:a systematic review[J].Am J Sports Med,2017,45(7):1698-1705.
[12]Dawe EJ,Jukes CP,Ganesan K,et al.Ankle arthroscopy to manage sequelae after ankle fractures[J].Knee Surg Sports Traumatol Arthrosc,2015,23(11):3393.
[13]Martin KD,Stone JW,Amendola A.arthroscopic approaches to the ankle joint[J].Oper Tech Orthop,2014,24(3):144-151.
[14]徐龙,何仕诚.踝关节骨折的手术治疗与功能康复研究[J].中国医药导报,2013,10(35):56-58.
[15]Scott J,Huskisson EC.Graphic representation of pain[J].Pain,1976,2(2):175-184.
[16]C觟ster MC,Rosengren BE,Bremander A,et al.Comparison of the Self-reported Foot and Ankle Score(SEFAS)and the American Orthopedic Foot and Ankle Society Score(AOFAS)[J].Foot Ankle Int,2014,35(10):1031-1036.
[17]赵勇,王钢.踝关节扭伤的生物力学与运动学研究进展[J].中国骨伤,2015,28(4):374-377.
[18]Gianakos AL,Yasui Y,Hannon CP,et al.Current management of talar osteochondral lesions[J].World J Orthop,2017,8(1):12-20.
[19]Easley ME,Vineyard JC.Varus ankle and osteochondral lesions of the talus[J].Foot Ankle Clin,2012,17(1):21-38.
[20]Hannon CP,Baksh N,Newman H,et al.A systematic review on the reporting of outcome data in studies on autologous osteochondral transplantation for the treatment of osteochondral lesions of the talus[J].Foot Ankle Spec,2013,6(3):226-231.
[21]Vannini F,Cavallo M,Baldassarri M,et al.Treatment of juvenile osteochondritisdissecans of the talus:current concepts review[J].Joints,2014,2(4):188-191.
[22]冯乾.中药内服外洗治疗踝关节扭伤[J].中国医药导报,2007,4(30):64.
[23]Murawski C D,Kennedy J G.Operative treatment of osteochondral lesions of the talus[J].J Bone Joint Surg Am,2013,95(11):1045.
[24]Valderrabano V,Leumann A,Rasch H,et al.Knee-toankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint[J].Am J Sports Med,2009,37(Suppl1):105S.
[25]郭秦炜,梅宇,焦晨,等.自体骨-骨膜移植治疗HeppleⅤ型距骨骨软骨损伤的近期疗效[J].中华骨科杂志,2013,33(4):342-347.
[26]Haleem AM,Ross KA,Smyth NA,et al.Double-plug autologous osteochondral transplantation shows equal functional outcomes compared with single-plug procedures in lesions of the talar dome:a minimum 5-year clinical follow-up[J].Am J Sports Med,2014,42(8):1888-1895.
[27]Looze C A,Capo J,Ryan M K,et al.Evaluation and management of osteochondral lesions of the talus[J].Cartilage,2017,8(1):19.