目的:探讨关节镜辅助下同侧髌股关节面骨软骨移植治疗距骨骨软骨损伤的方法及近期疗效。方法:回顾性分析2011年3月-2014年5月本院采用关节镜辅助下髌股关节面骨软骨移植治疗的11例HeppleⅢ~Ⅴ期距骨骨软骨损伤病例资料。其中男6例,女5例;年16~43岁,平均33岁。左足3例,右足8例。HeppleⅢ期6例,Ⅳ期3例,Ⅴ期2例。7例患者有外伤史。明确诊断至手术时间3 d~4个月,平均23.36 d。术前患侧踝关节疼痛视觉模拟评分(visual analogous scale,VAS)为(7.18±1.17)分,术前美国足踝外科协会(American orthopaedicfoot and anklesociety,AOFAS)评分为(61.64±14.00)分,供区膝关节术前Lysholm评分为(94.45±3.39)分。结果:术后切口均Ⅰ期愈合。11例均获随访,随访时间6~14个月,平均10个月。复查踝关节核磁共振(magnetic resonance imaging,MRI)示骨软骨柱与植骨床愈合良好,软骨面形态连续性良好,骨软骨愈合时间8~13周,平均10.55周。末次随访时VAS评分为(1.73±1.02)分,与术前比较差异有统计学意义(t=10.59,P=0.000);AOFAS评分为(91.27±6.60)分,与术前比较差异有统计学意义(t=-6.18,P=0.000)、供区膝关节Lysholm评分为(93.27±3.50)分,与术前比较差异无统计学意义(t=2.20,P=0.070)。随访期间无软骨剥脱、截骨块不愈合,无神经、血管损伤,无踝关节粘连及膝关节疼痛等并发症发生。结论:关节镜辅助下自体髌股关节面骨软骨移植治疗距骨骨软骨损伤近期疗效好、创伤较小、恢复快,是一种安全可靠的治疗方法。
Ojeive: o inveige he effiy of hoopy ied oeohondl uologou nplnion hveed fom lel femol ondyle of he knee fo he emen of oeoehondl leion of lu. Mehod: eopeive nlyi of inluive 11 e of Hepple Ⅲ~Ⅴ oeohondl leion of he lu pien, who eped hoopy ied oeohondl uologou nplnion hveed fom lel femol ondyle of he knee emen fom 2011 Mh o 2014 My, inluding 6 mle nd 5 femle wih ll vege ge w 33 ye old ( nge fom 16 o 43 ye old ) .3 lef nkle nd 8 igh nkle wee ffeed Hepple Ⅲ ge in 6 e, Ⅳ ge in 3 e, Ⅴ ge in 2 e.7 pien hd hioy of um.Definie dignoi o opeion ime nged fom 3 dy o 4 monh, wih n vege of 23.36 d. he d ide nkle pin viul nlogue le ( viul nlogou le, V ) efoe opeion w ( 7.18 ± 1.17 ) oe, peopeive OF ( mein ohopedi foo nd nkle oiey, OF ) oe w ( 61.64 ± 14.00 ) oe, nd Lyholm oe fo uppoed ide knee join efoe ugey w ( 94.45 ± 3.39 ) oe.eul: Opeion wee ll uefully ompleed nd he iniionheled well in ll e.11 e go follow up fom 6 o 14 monh (vege 10 monh ) .Poopeive follow- up (mgnei eonne imging, MI )howed oeohondl ol nd one ed heled well, he ilge ufe w in good hpe, nd he heling ime of one nd ilge wee 8-13 week, he vege wee 10.55 week. he l follow-up, V oe w ( 1.73 ± 1.02 ) oe, nd omped wih efoe opeion hee w iil ignifine ( =10.59, P=0.000 ) .OF oe w ( 91.27 ± 6.60 ) oe, w ignifinly ineed omped wih efoe opeion ( =-6.18, P=0.000 ), while Lyholm oe h no ignifin diffeene omped wih efoe opeion ( 93.27 ± 3.50, =2.20, P=0.070 ) .No ilge peeling off nd oeoomy unheling, no neve nd vul injuy, no nkle dheion nd knee join pin, o ny ohe ompliion wee found in follow up.onehion : hoopy ied oeohondl uologou nplnion hveed fom lel femol ondyle of he knee fo he emen of oeohondl leion of he lu of loeoehondl i good effe, le um, quike eovey, fe nd elile emen.