摘要
背景：大多数距骨骨软骨损伤都是由踝关节骨折和踝关节扭伤等创伤引起的,有关其分型和治疗的报道很多,但关于HeppleⅤ型即囊性变的距骨骨软骨损伤,特别是面积〉1.5 cm2的缺损的治疗和预后临床并不统一。目的：探讨经内踝截骨、松质骨植骨、富血小板血浆凝胶覆盖治疗HeppleⅤ型距骨骨软骨损伤的手术技巧及预后。方法：2013年10月至2014年11月,13例HeppleⅤ型内侧距骨骨软骨损伤行内踝截骨、囊腔病灶清理、松质骨打压植骨及富血小板血浆凝胶覆盖软骨缺损区域。男9例,女4例;年龄19~61岁,平均38.2岁。病程11~49个月,平均25个月。末次随访摄踝关节正侧位片,并同时行踝关节MRI检查,比较术前及术后末次随访时的直观模拟量表疼痛VAS评分及美国骨科足踝外科协会（AOFAS）踝与后足评分。结果：本组共12例患者获最终随访,随访时间9~22个月,平均15个月。影像学随访证实术后10~14周（平均12周）截骨端愈合,MRI检查则显示,除2例患者出现原病损处关节软骨有过度增生表现（踝关节功能良好）外,其余患者移植区愈合良好。患者VAS评分及AOFAS踝与后足评分均较术前明显改善（P〈0.05）。随访期间未见伤口感染、内固定失效、截骨端不愈合、畸形愈合等并发症。结论：对于面积〉1.5 cm2的HeppleⅤ型距骨骨软骨损伤,经内踝截骨、囊性变病灶清理、松质骨打压植骨及富血小板血浆凝胶覆盖可以显著缓解患者的疼痛并改善其功能,是一种安全有效的治疗方法。
Background： Most of osteochondral lesions of the talus（OLT） results from trauma of ankle fracture or ankle sprain. There are a lot of literatures on the classification and treatment of OLT, but there is no consensus of treatment or prognosis in Hepple type Ⅴ lesion, especially for lesion more than 1.5 mm2.Objective： To investigate surgical techniques and clinical outcomes of medial malleolar osteotomy and cancellous bone graft with platelet-rich plasma（PRP） gel covering for Hepple type Ⅴ OLT.Methods： From October 2013 to December 2014, 13 patients with Hepple type Ⅴ OLT underwent medial malleolar osteotomy, cyst debridement and cancellous bone graft with PRP gel covering. There were 9 males and 4 females with a mean age of 38.2 years old（range, 19-61 years）. The mean onset was 25 months（range, 11-49 months）. Ankle X-ray examination and MRI were obtained at the final follow-up. The VAS score and American Orthopaedic Foot and Ankle Society（AOFAS） ankle-hindfoot score were recorded before surgery and at the final follow-up.Results： Twelve patients got the final follow-up with a mean duration of 15 months（range, 9-22 months）. X-rays showed bone union at a mean time of 12 weeks（range, 10- 14 weeks） after treatment. MRI showed good recovery of cartilage at OLT lesion, except for 2 cases of excessive hyperplasia without ankle function disability. The mean VAS and AOFAS anklehindfoot scores improved significantly after surgery（P〈0.05）. No wound infection, implant failure, nonunion or malunion were found during follow-up.Conclusions： For lesion more than 1.5 mm2 in patients with Hepple type Ⅴ OLT, medial malleolar osteotomy, cyst debridement and cancellous bone graft with PRP gel covering is proved to be a safe and effective treatment. It can significantly re-lieve pain and improve ankle function.
出处
《中国骨与关节外科》
2015年第4期291-295,共5页
Chinese Journal of Bone and Joint Surgery
基金
上海市科委自然基金课题(项目编号:15ZR1431900)
关键词
距骨
骨软骨损伤
富血小板血浆
Talus
Osteochondral Lesion
Platelet-rich plasma
