摘要
[目的]探讨经内踝截骨带骨膜髂骨移植联合PRP关节腔注射治疗HeppleⅤ期距骨内穹隆骨软骨损伤的临床疗效。[方法] 2015年1月~2018年1月,采用内踝截骨、病灶清理、带骨膜髂骨移植联合PRP关节腔注射治疗HeppleⅤ期距骨内穹隆骨软骨损伤23例。术中经内踝截骨,显露距骨内穹隆,清理坏死软骨,去除病灶及软骨下骨囊肿,自同侧髂骨取带骨膜骨栓,采取打压固定技术将骨栓植入距骨受区,固定内踝截骨块。[结果]本组23例患者均顺利完成手术,并随访12~36个月,平均(19.57±6.45)个月,与术前相比,末次随访时VAS评分显著降低(P<0.05),AOFAS踝-后足评分显著增加(P<0.05),踝关节活动度(ROM)显著增加(P<0.05),并且无1例出现并发症,患者满意度较高。[结论]对于HeppleⅤ期距骨骨软骨损伤,经内踝截骨、病灶清理、带骨膜髂骨移植联合PRP注射可修复软骨缺损,减轻疼痛,改善关节功能,是一种有效的治疗方法。
[Objective] To introduce the surgical technique and primary clinical outcomes of medial malleolus osteotomy, periosteumiliac bone block autografting combined with intraarticular injection of platelet-rich plasm(PRP) for Hepple stage Ⅴ osteochondral lesion of talus. [Methods] From January 2015 to January 2018, 23 patients received medial malleolus osteotomy, focal debridement, periosteum-iliac bone block grafting combined intraarticular injection of PRP for Hepple stage Ⅴ osteochondral lesion of talus in our hospital. After osteotomy of the medial malleolus, the osteochondral lesion was exposed, and then the cartilage lesion and the subchondral cyst were debrided with a trephine to form a cycle osteochondral defect to the healthy tissue. A bone block with intact periosteum was harvested from iliac crest with the trephine, subsequently was embedded into the talus defect. After the medial malleolus reduced and fixed with cannulated screws,and the capsule was closed, PRP was injected into the articular cavity. [Results] All the 23 patients had operation conducted smoothly, and were followed up for 12-36 months with an average of(19.57±6.45) months. Compared with those before operation, the ⅤAS score significantly decreased, whereas the AOFAS ankle-hind foot score and ROM significantly increased at the latest follow up(P<0.05). The patients had no complications, and highly satisfied to this therapy. [Conclusion] This periosteum-iliac bone block autografting combined with intraarticular injection of PRP through medial malleolus osteotomy does relieve pain and improve joint function, is an effective treatment method for Hepple stage Ⅴ osteochondral lesion of talus.
作者
刘林
杨宗宇
刘核达
黄飞
崔亮
左俊水
袁令晨
李森田
齐少霞
LIU Lin;YANG Zong-yu;LIU He-da;HUANG Fei;CUI Liang;ZUJun-shui;YUAN Ling chen;LI Sen-tian;QI Shao-xia(Cangzhou Hospital of Integrated Chinese and Western Medicine,Cangzhou 061000,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2021年第2期154-157,共4页
Orthopedic Journal of China
基金
河北省沧州市科技局项目(编号:172302022)。
关键词
距骨骨软骨损伤
内踝截骨
髂骨骨膜移植
富血小板血浆
osteochondral lesion of talus
medial malleolus osteotomy
periosteum-iliac bone grafting
platelet-rich plasm
