关节镜下微骨折术与自体骨软骨移植术治疗距骨骨软骨损伤比较

目的 对比分析关节镜下微骨折术与自体骨软骨移植术对距骨骨软骨损伤患者踝关节功能及术后并发症的影响。方法 选取2017年1月至2021年1月临床收治的60例距骨骨软骨损伤患者随机分为A组与B组,A组给予自体骨软骨移植术治疗,B组给予关节镜下微骨折术治疗,比较两组患者治疗效果,术前、术后6个月视觉模拟评分（visual analogue scale, VAS）、Cobb角、美国矫形外科足踝协会（American Orthopaedic Foot and Ankle Society, AOFAS）踝-后足评分、踝关节活动度及术后并发症发生率。结果 A组患者治疗效果总有效率为93.33%,较B组（80.00%）显著提高（P<0.05）。术前两组VAS评分、Cobb角差异无统计学意义（P>0.05）,术后6个月均显著下降,且A组患者下降更显著（P<0.05）。术前两组AOFAS评分、踝关节活动度差异无统计学意义（P>0.05）,术后6个月均显著上升,且术后A组患者上升更显著（P<0.05）。A组患者术后并发症发生率为2.13%,较B组（17.02%）显著降低（P<0.05）。结论 与关节镜下微骨折术相比,自体骨软骨移植术治疗距骨骨软骨损伤效果更显著,可改善患者踝关节活动度,缓解疼痛,减少术后并发症发生,值得临床推广。

Comparison of arthroscopic microfracture and autologous osteochondral transplantation in treatmet of talar cartilage injury

Objective To compare and analyze the effects of arthroscopic microfracture surgery and autologous osteochondral transplantation on the ankle function and postoperative complications of patients with talar cartilage injury. Methods A total of 60 patients with talar cartilage injury who were clinically treated from January 2017 to January 2021 were selected and randomly divided into group A and group B. Group A was treated with autologous osteochondral transplantation, and group B was treated with arthroscopic microfracture. The treatment effect of the two groups of patients, visual analogue scale （VAS）, Cobb angle, American Orthopaedic Foot and Ankle Society （AOFAS） ankle-hindfoot score before operation and 6 months after operation, ankle range of motion, postoperative complication rate. Results The total effective rate of patients in group A was 93.33%, which was significantly higher than 80.00% in group B （P<0.05）. There was no significant difference in the VAS score and Cobb angle between the two groups before surgery （P>0.05）, and they both decreased significantly at 6 months after surgery, and the VAS score and Cobb angle of group A patients decreased more significantly at 6 months after surgery （P<0.05）. There was no significant difference in the AOFAS score and ankle range of motion between the two groups before surgery （P>0.05）, and they both increased significantly at 6 months after surgery, and the AOFAS score and ankle range of motion in group A increased more significantly at 6 months after surgery （P<0.05）. The incidence of postoperative complications in group A was 2.13%, which was significantly lower than 17.02% in group B （P<0.05）. Conclusion Compared with arthroscopic microfracture, autologous osteochondral transplantation has better effect in the treatment of talus cartilage injury. It can improve the range of motion of the ankle joint, relieve pain, and reduce postoperative complications. It is worthy of promotion.