内踝三平面截骨骨软骨移植治疗距骨软骨病

Triplane medial malleolus osteotomy and osteochondral autografting for osteochondral lesions of the talus

摘要:

［目的］ 探讨内踝三平面截骨骨软骨移植治疗距骨骨软骨损伤 （osteochondral lesions of the talus, OLT） 的临床疗效。 ［方法］2015 年 9 月—2017 年 9 月，采用内踝三平面截骨联合自距骨非负重区取移植物修复 OLT 治疗 23 例患者，总结临床和影像学结果。［结果］ 所有患者均顺利完成手术，术中无神经、血管损伤，手术时间平均 （69.43±12.63） min。随访 （37.13± 7.33）个月，末次随访时，VAS 评分显著下降（P<0.05），而 AOFAS 评分显著增加（P<0.05）。影像检查显示，末次随访时所有患者均截骨愈合，OLT 病灶修复良好，无显著踝关节退变。［结论］内踝三平面截骨联合距骨非负重区自体骨软骨移植治疗距骨骨软骨损伤，临床疗效满意，并发症发生率低。

Abstract:

[Objective] To evaluated the clinical efficacy of triplane medial malleolus osteotomy and osteochondral autografting for os- teochondral lesions of the talus (OLT) . [Methods] From September 2015 to September 2017, a total of 23 patients received triplane medial malleolus osteotomy combined with debridement and repair with osteochondral graft harvest from the non-weight-bearing area of the talus for OLT. The clinical and imaging consequences were summarized. [Results] All the patients were successfully operated on without nerve or vascular injuries, whereas with operation time of (69.43±12.63) min. At the latest follow-up lasted for (37.13±7.33) months, the VAS score decreased significantly (P＜0.05) , whereas AOFAS score increased significantly compared with those preoperatively (P＜0.05) . In term of radiographic assessment, all patients got osteotomy union by the time of last follow-up, with OLT lesion repaired well, whereas with- out significant ankle degeneration. [Conclusion] This triplane medial malleolus osteotomy combined with osteochondral autografting har- vested from non-weight-bearing area of talus does achieve satisfactory clinical outcomes with low complication rate for OLT.