距骨骨软骨病内踝“V”形截骨自体骨软骨移植

Osteochondral autografting through medial malleolus "V" shaped osteotomy approach for osteochondral lesions of the talus

摘要:

[目的] 探讨内踝“V”形截骨自体骨软骨移植治疗距骨软骨损伤 （osteochondral lesions of the talus, OLT） 的临床疗效。[方法]回顾分析 2018 年 1 月—2020 年 6 月，采用内踝“V”形截骨联合自体同侧股骨髁非负重区骨软骨移植术治疗 OLT 的 24 例患者，评价临床及影像资料。[结果]所有患者均顺利完成手术，无神经、血管损伤，手术时间平均（71.4±12.0）min， 术中失血量平均 （39.2±11.2） ml。随访时间平均 （24.2±6.6） 个月，与术前相比，术后 1 年及末次随访时疼痛 VAS 评分 [(6.1± 0.7), (1.0±0.9), (0.9±0.6), P＜0.001]、AOFAS 踝及后足评分 [(66.8±4.8), (89.5±5.4), (93.0±5.1), P＜0.001] 均显著改善，而膝关节 Lysholm 评分无显著变化（P＞0.05）。影像方面，磁共振软骨修复组织观察（magnetic resonance observation of cartilage repair tissue, MOCART）评分 [(43.3±7.0), (66.5±7.1), (69.2±6.5), P＜0.001] 显著增加，所有截骨均骨性愈合，OLT 病灶修复良好，Takaku 踝关节退变分级无显著变化（P＞0.05）。[结论]内踝“V”形截骨联合自体骨软骨移植治疗距骨骨软骨损伤疗效安全可靠。

Abstract:

[Objective] To investigate the clinical outcomes of osteochondral autografting through medial malleolus "V" shaped osteotomy approach for osteochondral lesions of the talus (OLT). [Methods] A retrospective study was conducted on 24 patients who received osteochondral autografting through medial malleolus "V" shaped osteotomy approach for OLT from January 2018 to June 2020. The clinical and imaging documents were evaluated. [Results] All the patients were successfully operated on without nerve or vascular injury, with average operation time of (71.4±12.0) min, and intraoperative blood loss of (39.2±11.2) ml, and were followed up for (24.2±6.6) months. Compared with those preoperatively, the VAS score for pain [(6.1±0.7), (1.0±0.9), (0.9±0.6), P＜0.001], AOFAS ankle and hindfoot scores [(66.8±4.8), (89.5±5.4), (93.0±5.1), P＜0.001] significantly improved, while knee Lysholm scores were not significantly changed at 1 year after surgery and the latest follow-up (P＞0.05). In term of imaging, the magnetic resonance observation of cartilage repair tissue (MOCART) score [(43.3± 7.0), (66.5±7.1), (69.2±6.5), P＜0.001] significantly increased, and all patients got osteotomy healed and OLT lesions repaired well, with the Takaku ankle degeneration grade unchanged significantly (P＞0.05). [Conclusion] The osteochondral autografting through medial malleolus "V" shaped osteotomy approach is safe and reliable in the treatment of osteochondral lesions of the talus.