关节镜下微骨折联合自体富血小板血浆治疗Hepple Ⅲ～Ⅳ型距骨骨软骨损伤

目的探讨关节镜下微骨折联合自体富血小板血浆治疗HeppleⅢ~Ⅳ型距骨骨软骨损伤的临床效果。方法自2013年1月至2017年12月我院采用关节镜下微骨折联合自体富血小板血浆治疗的HeppleⅢ~Ⅳ型距骨软骨损伤患者15例,其中男11例,女4例;年龄15~48,平均(34.1±2.7)岁;右足10例,左足5例。根据Hepple分型,Ⅲ型9例,Ⅳ型6例。术前及术后12个月均采用疼痛视觉模拟评分(visual analogue scale,VAS)、美国美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)及MRI进行评估。结果15例患者均获得随访,随访时间12~23个月,平均(15.1±2.2)个月。术前AOFAS评分(54.3±8.9)分、VAS评分(7.1±2.3)分,术后12个月AOFAS评分(89.2±6.4)分、VAS评分(1.3±0.8)分,手术前后比较差异均有统计学意义(P<0.05)。术后12个月MRI检查见距骨软骨的损伤区域较平滑,周围水肿消失。结论采用关节镜下微骨折联合自体富血小板血浆治疗HeppleⅢ~Ⅳ型距骨骨软骨损伤可以有效缓解踝关节疼痛及改善功能,明显促进损伤软骨愈合,是一种较有效的治疗方式。     

自体松质骨移植联合富血小板血浆治疗距骨骨软骨损伤近期疗效分析

目的 探讨采用自体胫骨松质骨移植联合富血小板血浆治疗距骨骨软骨损伤的近期疗效.方法 回顾性分析自2016-10-2019-09采用自体胫骨松质骨移植联合富血小板血浆治疗的12例距骨骨软骨损伤,采用足踝功能AOFAS评分、疼痛VAS评分、软骨修复MRI评分对疗效进行评估.结果 12例均获得至少12个月随访,随访时间平均1...     

关节镜下微骨折治疗距骨骨软骨损伤的临床观察

目的:采用关节镜下清创和微骨折治疗距骨骨软骨损伤,观察其临床效果。方法:收集自2011年1月至2013年12月就诊的42例距骨骨软骨损伤患者,平均年龄35.9岁,其中男28例,女14例,34例有明确受伤史,MRI显示距骨骨软骨损伤≥3级,采用关节镜下清创和微骨折进行治疗。术前、术后1年和术后2年采用美国足踝外科(AOFAS)踝-后足评分系统评估关节功能,术后2年采用MRI检查评估距骨骨软骨恢复情况。结果 :术前MRI诊断3期23例,4期9例,5期10例。按照9宫格分区法,则骨软骨损伤位于4区25例,6区11例,1区4例,3区2例。伴有软骨下骨囊性变8例,均位于4区。采用美国足踝外科(AOFAS)踝-后足评分系统,术后1年73.3±3.9,较术前50.4±7.8明显提高(t=17.018,P=0.00);术后2年81.1±4.8,较术后1年明显提高(t=8.173,P=0.00)。术后2年复查MRI显示骨髓水肿消失。结论:采用关节镜下微骨折治疗距骨骨软骨损伤,可以较好地改善踝关节功能。     

踝关节骨折合并距骨软骨损伤的手术治疗

2010年1月～2012年8月,我科共收治踝关节骨折患者36例,术中发现有15例合并距骨软骨损伤,经治疗疗效满意,报道如下。1材料与方法1.1病例资料本组15例,男13例,女2例,年龄25～52岁。踝关节骨折按Lauge-Hansen分类:旋后内收型2例,旋后外旋型6例,旋前外展型3例,旋前外旋型4例。距骨软骨损伤按Berndt-Har-ty分类[1]:Ⅰ型3例,Ⅱ型5例,Ⅲ型3例,Ⅳ型4例。     

关节镜下清创结合微骨折术治疗局灶性距骨软骨损伤

目的探讨关节镜下清创结合微骨折术治疗局灶性距骨软骨损伤的临床疗效。方法对43例局灶性距骨软骨损伤患者进行治疗与随访。应用AOFAS评分和VAS疼痛评分对最终随访结果和术前评分进行对比,并对关节活动度和并发症进行评估。结果术前AOFAS评分为(70.9±3.6)分,术后为(84.3±4.7)分,术后较术前显著提高(P<0.05);VAS疼痛评分术前为(7.6±1.2)分,术后为(2.7±1.6)分,术后较术前显著降低(P<0.05);术后关节活动度正常,无严重并发症出现。结论关节镜下清创结合微骨折技术治疗局灶性距骨软骨损伤短期疗效满意。     

踝关节骨折伴距骨软骨损伤的实验及临床研究

目的　探讨踝关节骨折伴距骨软骨损伤的规律及治疗。方法　通过应用踝关节骨骼标本及距骨模型 ,观察在模拟踝关节骨折各种外力作用下距骨模型受力及关节面压缩情况 ,并对 42例踝关节骨折在关节镜辅助下手术所见及关节镜图像进行分析。结果　踝部骨折伴距骨软骨损伤的部位、程度与损伤时足位置及外力、关节类型密切相关 ,有一定的规律可循。结论　此规律有利于踝关节镜入路的选择和手术步骤的制定 ,遵循其规律可做到踝关节镜手术操作准确 ,避免漏诊 ,减少意外损伤 ,并提高临床治疗效果     

踝关节骨折并距骨骨软骨损伤的关节镜治疗

目的 探讨关节镜技术在踝关节骨折并距骨骨软骨损伤治疗中的应用及效果.方法 对23例踝关节骨折合并距骨骨软骨损伤的患者,在切开复位骨折内固定的同时行关节镜下取出软骨碎片、关节面修整及钻孔.结果 本组随访6～25个月,平均13.5个月.笔者按Must和Teipner评分标准:优18例,良3例,可1例,差1例.结论 关节镜下...     

关节镜下微骨折治疗距骨软骨损伤的临床疗效

目的 探究在踝关节镜下微骨折治疗距骨软骨损伤的临床疗效。方法 回顾性分析自2018年8月至2019年12月西安交通大学附属红会医院足踝外科行踝关节镜下微骨折治疗的20例距骨软骨损伤患者资料,其中男12例,女8例;左足14例,右足6例;年龄18～50岁,平均(28.3±10.8)岁;病程6～12个月,平均(8.3±3.2)个月。在踝关节镜下行清理术,显露距骨损伤部位,给予微骨折处理。采用美国骨科足与踝关节协会(American orthopedic foot and ankle society, AOFAS)踝-后足评分系统和疼痛视觉模拟评分(visual analogue scale, VAS)及影像学进行临床疗效评估。结果 患者均顺利完成手术,手术时间30～40 min。术中未出现血管、神经损伤等严重并发症。患者均获得有效随访,随访时间10～14个月,平均(12.1±1.1)个月。末次随访时AOFAS及VAS较术前均有显著性改善(P<0.05)。末次随访时MRI示距骨软骨损伤范围及程度较术前明显缩小。结论 踝关节镜下微骨折治疗距骨软骨损伤,改善关节功能及疼痛,疗效确切,且术后并...     

骨软骨移植联合富血小板血浆治疗距骨软骨缺损

[目的]介绍骨软骨移植联合富血小板血浆治疗距骨软骨缺损的手术技术及初步结果。[方法]对8例距骨软骨缺损行自体骨软骨移植联合富血小板血浆治疗。术前制定植骨方案。踝关节前侧入路暴露胫骨及距骨磨损的软骨面并预制植骨圆形凹槽，于股骨外侧髁非负重软骨面取大小与预制植骨凹槽相同的柱状软骨，挤压置入预制凹槽内部，同时注入富血小板血浆。[结果] 8例患者均顺利完成手术，无严重并发症，术后平均随访时间为（24.5±4.4）个月，与术前相比，末次随访时踝关节VAS评分显著降低[(7.3±1.0),(1.0±0.3), P<0.05],AOFAS踝与后足评分显著增加[(43.3±4.4),(87.6±5.7), P<0.05]。术后24个月踝关节的生存率达到100%。[结论]骨软骨移植联合富血小板血浆治疗距骨软骨缺损技术可行，近期临床疗效良好。     

踝关节牵张术联合同种异体骨软骨移植治疗距骨骨软骨损伤一例

<正>1病例介绍患者男，38岁。因“扭伤致右踝关节疼痛3年余，加重3个月”入院。查体：右踝关节无明显肿胀，踝关节背伸、跖屈活动正常。局部无明显按压痛，抽屉试验（–）。CT、MRI检查示右踝距骨内侧关节面骨软骨损伤，关节面下骨内囊肿形成。诊断：右距骨骨软骨损伤（Hepple-Ⅴ型）。手术采用内踝截骨，暴露距骨内侧穹窿关节面，可见距骨骨软骨损伤，骨内囊肿形成，直径约1 cm；     

Vascularized osteochondral free flaps from the femoral trochlea as versatile procedure for reconstruction of osteochondral lesions of the talus

BackgroundOsteochondral lesions of the talus (OLT) are defects affecting the articular cartilage as well as the subchondral bone, on the lateral shoulder possibly associated with trauma. This study presents the results of reconstructing OLT using vascularized osteochondral flaps from the femoral trochlea.MethodsWe treated 19 patients with osteochondral talar shoulder defects, using osteochondral flaps from the medial (MFT) or lateral (LFT) femoral trochlea. Functional outcome was evaluated by clinical investigation, visual analogue scale (VAS, 0–10), American Orthopaedic Foot and Ankle Society-Ankle and Hindfoot Scale (AOFAS, 0–100) and The Foot and Ankle Disability Index (FADI, 0–104). Radiographic postoperative follow-up was done by anterior-posterior and lateral X-rays and union of the transferred osteochondral flaps was documented by CT scans.ResultsThe osteochondral flaps fused in all of the 19 cases. After a median follow-up of 45.5 months, the patients showed an average FADI of 94.9 and AOFAS-Ankle and Hindfoot Scale of 91.2. All of them were walking free and normal. Subjective median satisfaction was 1.3 in a scale from 1 to 5.ConclusionVascularized transfer of osteochondral flaps from the femoral trochlea is a reliable treatment option for symptomatic OLT of the medial and lateral talar edge.Level of clinical evidence: Therapeutic IV     

体外冲击波疗法联合踝关节镜治疗距骨骨软骨损伤

[目的]应用体外冲击波疗法联合踝关节镜治疗距骨骨软骨损伤,分析其治疗效果,探索治疗该病新方法.[方法]选择2007年6月～2010年1月本院收治的距骨骨软骨损伤患者26例30距骨,先用体外冲击波治疗,根据MRI检查距骨骨软骨损伤部位准确标定治疗点,能流密度0.14～0.16 mJ/mm2(3～3.5 bar,8 Hz),冲击频率40～50次/min,冲击次数2 000次,隔日1次,共治疗5次,然后进行踝关节镜手术行病灶清理,微骨折或钻孔术.应用Mazur症状与功能评分系统对治疗前后10个月踝关节功能进行评价;踝关节MRI检查观察治疗前及治疗后6、12、18个月距骨损伤面积的变化.[结果]体外冲击波疗法联合踝关节镜治疗距骨骨软骨损伤后Mazur踝关节功能评分较治疗前增高(P＜0.05)、MRI示损伤面积较治疗前明显减小(P＜0.05).[结论]体外冲击波联合踝关节镜治疗距骨骨软骨损伤具有疗效显著、创伤小、患者易于接受等特点,是治疗该病的理想方法.     

距骨骨软骨损伤的诊断及关节镜治疗

目的 总结、分析距骨骨软骨损伤的症状、体征、影像学特点、关节镜下治疗方法及手术效果.方法 2000年至2005年共收治34例距骨骨软骨损伤患者,对其临床资料包括症状、体征、X线片、MRI表现、关节镜手术方法等进行回顾性分析,术后随访根据主观和客观评分判断疗效.术前美国足踝外科后足评分平均(71±8)分,术前主观疼痛程度评分(7.5±1.3)分.结果 34例患者MRI均有骨软骨损伤征象,其中21例通过X线片检查发现距骨骨软骨损伤.距骨骨软骨损伤的主要症状为负重疼痛以及运动后加重,MRI诊断准确率较X线片高(χ2=16.07,P＜0.001).31例患者获得随访,平均随访时间为28个月.术后美国足踝外科后足评分(91±9)分,显著高于术前(t=9.147,P＜0.001);术后主观疼痛程度评分(2.4±2.3)分,显著低于术前(t=10.853,P＜0.001);临床疗效优良率为87.1%.结论 MRI检查能够提高诊断的正确率,关节镜微创手术治疗距骨骨软骨损伤效果良好.     

Biphasic bioresorbable scaffold (TruFit Plug®) for the treatment of osteochondral lesions of talus: 6- to 8-year follow-up

BackgroundThe ideal treatment of osteochondral lesions of the talus (OLT) is debatable. The TruFit plug has been investigated as a potential treatment method for osteochondral defects. This is a biphasic scaffold designed to stimulate cartilage and subchondral bone formation. The purpose of this retrospective study was to investigate the long-term functional and MRI outcomes of the TruFit Plug for the treatment of OLT.MethodsTwelve consecutive patients treated from March 2007 to April 2009 for OLT were evaluated. Clinical examination included the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score and the visual analog scale (VAS) for pain. MRI scans were optained pre-treatment and at last follow-up. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to assess cartilage incorporation.ResultsMean follow-up was 7.5 years (range, 6.5–8.7 years). The average age was of 38.6 years (range, 22–57 years). The sex ratio between males and females was 3:1 (9 males, 3 females). The mean AOFAS score improved from a preoperative score of 47.2 ± 10.7 to 84.4 ± 8 (p < 0.05). According to the postoperative AOFAS scores 1 case obtained excellent results, 9 were classified as good, and 2 were fair. VAS score improved from a preoperative value of 6.9 ± 1.4 points to 1.2 ± 1.1 points at last follow-up (p < 0.05). The MOCART score for cartilage repair tissue on postoperative MRI averaged 61.1 points (range, 25–85 points).ConclusionsThe long-term results suggest that the technique of Trufit Plug for OLT is safe and demonstrates good post-operative scores including improvement of pain and function, with discordant MRI results. However, randomized controlled clinical trials comparing TruFit Plug with an established treatment method are needed to improve synthetic biphasic implants as therapy for osteochondral lesions.Level of evidence: Retrospective case series, Level IV.     

The effect of platelet-rich plasma on osteochondral defects treated with mosaicplasty

Purpose

This study investigated the efficacy of platelet-rich plasma (PRP) on articular surfaces on which the mosaicplasty technique was performed. Our hypothesis was that PRP can accelerate the osseointegration process and enhance the quality of articular integrity after the mosaicplasty procedure.

Methods

Standard defects were created in the femoral groove of both patellofemoral joints of 12 New Zealand rabbits. PRP solution was placed inside the defect before fixation of the osteochondral autografts and injected inside the involved joint after capsular closure of the tested knees. The contralateral knees served as the control sides. The animals were euthanized three or six weeks after mosaicplasty, and both limbs were assessed according to Pineda’s histological grading scale. Significance level was set at p ≤ 0.05 a priori, and the Mann–Whitney U test was used for statistical analysis.

Results

Histologic findings at the interface between the transferred autograft and the original cartilage revealed better integration of the adjacent surfaces in the mosaicplasty with PRP group three weeks after the procedure; the difference was significant (p < 0.05). However, no significant difference in the transition zone was observed between the groups six weeks after the experiment (p = 0.59).

Conclusions

Our animal model showed that adjunctive use of PRP produced a better healing response and resulted in superior histological scores after three weeks compared with the mosaicplasty-only procedure. Interpretation of our results is important in terms of rapid return to previous activity levels. Thus, application of PRP can represent a valid therapeutic option for improving the efficacy of mosaicplasty by stimulating the local healing response.     

踝关节距骨骨软骨损伤的影像学及关节镜下表现

目的分析踝关节距骨骨软骨损伤的影像学特点,包括病灶位置、病灶大小等形态学数据及MRI分期,并根据关节镜下表现进行分级,分析MRI分期与关节镜分级之间的关系。方法 2006年7月至2008年6月,35例距骨骨软骨损伤患者术前进行踝关节正侧位X线检查及MRI检查,分别根据BerdntHarty标准及Hepple's标准进行分期,在PACS系统上应用测量软件工具分析MRI图像,确定病灶位置、测量其前后径、左右径及深度。所有患病的踝关节均进行关节镜探查,并进行病灶分级。分析MRI分期与关节镜下分级之间的相关性。结果 35例患者的平均年龄为29.1岁(16～44岁),其中男30例,女5例。通过X线发现13例距骨骨软骨损伤,根据BerdntHarty分期:6例为Ⅰ期,3例为Ⅱ期,3例为Ⅲ期,1例为Ⅳ期;6例病灶位于外侧,7例位于内侧。MRI检查共发现38处距骨骨软骨损伤(3例患者均有两处病灶),根据Hepple分期:Ⅰ期1例,Ⅱ期17例,Ⅲ期7例,Ⅳ期2例,Ⅴ期11例。14例病灶位于外侧,24例位于内侧;按照9宫格分区法,55.3%的病灶位于4区(内侧中部),23.7%位于6区(外侧中部)。内侧组病灶大小为:前后径(9.0±2.5)mm、左右径(11.2±2.9)mm、深度(8.4±4.0)mm;外侧组病灶大小为:前后径(7.8±3.2)mm、左右径(10.9±3.2)mm、深度(7.9±4.2)mm。两组病灶大小的差异无统计学意义。关节镜探查共发现38处距骨骨软骨损伤(A级1例、B级1例、C级4例、D级27例、E级3例、F级2例)。MRI分期与关节镜下分级之间无相关性(r=0.12,P=0.474)。结论距骨骨软骨损伤主要位于距骨内侧中部及外侧中部,内侧病损以Hepple's Ⅱ期和Ⅴ期为主,外侧病变以Ⅲ期为主;内外侧病灶的大小差异无统计学意义。内外侧病变的关节镜下表现均以D级为主。Hepple'sMRI影像学分期与关节镜下分级无对应关系。     

自体脂肪移植联合富血小板血浆在面部年轻化中的应用

目的:探讨自体脂肪颗粒移植联合富血小板血浆在面部年轻化中的应用。方法:回顾性分析笔者科室2010年1月~2014年1月收治的43例行面部自体脂肪移植的求美者。选择大腿前外侧部、下腹部、臀部作为脂肪供区,采用肿胀吸脂术抽吸脂肪,再经提纯等处理后,联合适量自体富血小板血浆注射于面部凹陷处。结果:术后随诊6~12个月,无1例发生感染、血肿、不对称等并发症。术后,面部填充部位外观饱满、自然,皱纹明显减轻或消退,求美者对外形满意。结论:自体脂肪联合富血小板血浆注射移植操作简便,求美者痛苦少、安全有效,术后移植脂肪存活率得到提高,适合于面部凹陷的美容治疗,值得临床推广。