摘要
背景:距骨骨软骨损伤常继发于踝关节运动扭伤或踝部骨折,临床上表现为踝关节周围的深部疼痛,负重、跑、跳后疼痛加重,踝关节伸屈活动受限。由于踝关节在运动中承受着巨大的压力,且软骨损伤后的自我修复能力比较受限,距骨软骨损伤后的有效治疗一直都是足踝外科中较为棘手的难题。目的:探讨关节镜辅助下带骨膜的胫骨移植治疗距骨骨软骨损伤的方法及疗效。方法:回顾分析2014年3月至2018年10月我院收治的29例行关节镜辅助下带骨膜胫骨移植治疗的距骨骨软骨损伤患者的病例资料,男19例,女10例;年龄22~48岁,平均(35.7±5.2)岁。比较手术前后患者AOFAS踝关节功能评分、Karlsson踝关节功能评分、VAS疼痛程度评分、踝关节活动度以及Cobb角。结果:所有患者伤口均呈Ⅰ期甲级愈合,未见感染或皮肤坏死,术后9~14周截骨端均已愈合,无关节间隙进行性狭窄征象及关节面塌陷。术后随访10~27个月,平均(15.9±2.6)个月。患者术后AOFAS踝及后足功能评分、Karlsson踝关节功能评分及踝关节活动度均明显高于术前,VAS疼痛评分及Cobb角低于术前,差异均具统计学意义(P<0.001)。结论:对距骨骨软骨损伤病例积极施以关节镜辅助下带骨膜胫骨移植术治疗,有利于中短期踝关节功能恢复及关节疼痛程度缓解,是较为有效的手术方式。
Background:Osteochondral lesions of the talus are often secondary to ankle sprain or ankle fracture,and presents clinically deep pain around the ankle,aggravated pain after weight bearing,running and jumping,and limited ankle flexion and extension.The effective treatment of osteochondral lesions of the talus has always been a difficult problem in foot and ankle surgery because the ankle joint is under great pressure during sports and its self-repairing capability after cartilage injury is limited.Objective:To explore the surgical technique and clinical outcomes of arthroscopic assisted tibial transplantation with periosteum in the treatment of talar osteochondral injury.Methods:A retrospective study was performed in 29 patients with talar osteochondral injury who were treated with arthroscopy-assisted tibial transplantation with periosteum in our hospital from March 2014 to October 2018.There were 19 males and 10 females with a mean age of(35.7±5.2)years(range,22-48 years).AOFAS ankle function score,Karls son ankle function score,VAS pain score,the range of motion of the ankle,and Cobb angle were recorded before and after the operation.Results:The wounds of all the patients were healed in stage I,without infection or skin necrosis.The bone was healed 9-14 weeks after the operation.There was no sign of progressive narrowing of joint space or collapse of articular surface.The mean duration of follow-up was(15.9±2.6)months(range,10-27 months).AOFAS ankle and hind foot function score and Karisson ankle function score and ankle mobility after the operation were significantly higher than those before operation,while VAS pain score and Cobb angle were significantly lower than before operation(P<0.001).Conclusions:Arthroscopic assisted tibial transplantation with periosteum is an effective method for the treatment of talar osteochondral injury.It is helpful for medium and short-term recovery of joint function and relief of joint pain.
作者
陈小强
刘建全
赵喆
李永胜
程翔宇
李文翠
CHEN Xiaoqiang;LIU Jianquan;ZHAO Zhe;LI Yongsheng;CHENG Xiangyu;LI Wencui(Department of Foot and Ankle&Hand Surgery,Shenzhen Second People's Hospital,Shenzhen 518035,Guangdong,China)
出处
《中华骨与关节外科杂志》
2021年第1期37-41,共5页
Chinese Journal of Bone and Joint Surgery
关键词
距骨骨软骨损伤
关节镜
带骨膜胫骨移植
近期疗效
Talar Osteochondral Injury
Arthroscopy
Tibial Transplantation with Periosteum
Short-term Effect
