Hepple V期距骨软骨病的自体带骨膜髂骨移植

Autogenous grafting of iliac bone block with periosteum for Hepple stage V osteochondral lesions of the talus

摘要:

［目的］ 介绍内踝截骨入路自体带骨膜髂骨移植治疗 Hepple Ⅴ期距骨软骨病的手术技术和初步临床效果。［方法］ 2018 年 1 月—2019 年 12 月手术治疗 26 例 Hepple Ⅴ期距骨软骨病患者。踝关节内侧作弧形切口，应用微型摆锯先后在内踝的水平面、矢状面及冠状面做三平面截骨，暴露距骨后刮除病变骨软骨形成骨槽，取带骨膜髂骨，修整成形后嵌压入受区骨槽。 复位内踝，垂直截骨面置入 3 枚空心螺钉固定。［结果］26 例患者手术顺利且无不良并发症，随访 24~47 个月。末次随访时， VAS 疼痛评分、AOFAS 踝关节背伸活动度较术前显著改善（P<0.05）。术后 CT 提示骨软骨病变与截骨面愈合良好。［结论］三平面截骨术技术可有效暴露距骨软骨病灶，术后截骨面愈合良好，手术具有确切的中期临床疗效。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of autogenous grafting of iliac bone block with periosteum for Hepple stage V osteochondral lesions of the talus (OLT) by medial malleolus osteotomy approach. [Methods] From Janu- ary 2018 to December 2019, 26 patients received the abovesaid surgical treatment for Hepple stage V OLT. After three-plane osteotomy of the medial malleolus, involving the horizontal plane, sagittal plane and coronal plane, were conducted by using a mini oscillating saw, the OLT was exposed, and debrided to form a regular bone hole. A bone block with intact periosteum was harvested from the iliac and trimmed to meet the receipt site in shape, and embedded into the bone hole in the recipient area. Finally, the medial malleolus was reduced and fixed with 3 cannulated screws perpendicular to the osteotomy surface respectively. [Results] Twenty-six patients were successfully operated on without serious complications and were followed up for 24 months. At last follow-up, the VAS and AOFAS scores, as well as extension-flexion range of motion of the ankle significantly improved compared with those before operation (P<0.05) . In addition, the CT showed good healing between osteochondral lesion and osteotomy surfaces at the latest follow up. [Conclusion] The three-plane osteotomy technique does effec- tively expose the OLT, while autogenous grafting of iliac bone block with periosteum achieves sound clinical outcomes in mid-term for OLT.