自体骨－骨膜移植治疗Hepple V型距骨骨软骨损伤的近期疗效

 目的 探讨采用自体骨－骨膜移植治疗Hepple V型距骨骨软骨损伤的近期疗效。方法回顾性分析2007年10月至2011年9月治疗27例合并软骨下骨囊肿(平均直径 >8 mm)的距骨骨软骨损伤患者资料，男26例，女1例；年龄22~53岁，平均35.8岁。经踝关节镜探查明确发生距骨骨软骨损伤后，从自体髂骨取骨－骨膜移植物填充距骨骨软骨缺损区。采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society，AOFAS)踝与后足评分、视觉模拟(visual analogue score，VAS)评分及软骨修复MR评分(MOCART)对手术疗效进行评估；分析术后距骨X线和MRI改变，以及术后二次关节镜探查结果。结果 26例患者获得随访，随访时间为12~59个月，平均22.4个月。术后AOFAS踝与后足评分［(93.0±6.5)分］显著高于术前［(73.9±3.1)分］；术后VAS评分［(0.8±0.8)分］显著低于术前［(5.4±1.0)分］；术后患者非常满意16例，满意8例，一般2例，满意率为92.3%(24/26)。术后患者X线片均示软骨下囊肿低密度区消失，未见关节间隙狭窄；MRI均示原病灶缺损区被移植物填充。MOCART评分平均为(57.2±9.1)分，其中3例软骨下骨内有直径＜ 5 mm的囊肿。18例行二次关节镜探查示原软骨缺损区被再生类软骨组织覆盖。结论 自体骨－骨膜移植可同时修复Hepple V型距骨骨软骨损伤及软骨下囊肿，近期疗效满意，是安全、有效的治疗方法。

Outcomes of autologous osteo-periosteal cylinder graft transplantation for Hepple V osteochondral lesions of the talus

Objective To study the outcomes of autologous osteo-periosteal cylinder graft transplantation for Hepple V osteochondral lesions of the talus (OLT) with large subchondral cyst. Methods The data of 27 consecutive patients of OLT with subchondral cyst was retrospectively analyzed who were treated by autologous osteo-periosteal cylinder graft transplantation from October 2007 to September 2011. There were 26 males and 1 female with an average age of 35.8 years (range, 22-53 years). Visual analogue score (VAS) for pain during daily activities, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, and subjective satisfaction were investigated. The plain radiographs, magnetic resonance imaging (MRI) of the ankle, and second look arthroscopy were analyzed. Results All the 26 patients were followed up for 22.4 months. At the last follow-up, the VAS score decreased from 5.4±1.0 points preoperatively to 0.8±0.8 points postoperatively, and the mean (50%) AOFAS score improved from 73.9±3.1 points preoperatively to 93.0±6.5 points postoperatively. In 26 cases, the radiolucent area of cysts disappeared on plain radiographs. The mean magnetic resonance observation of cartilage repair tissue (MOCART) score was 57.2, though small subchondral bone cyst was still found in 3 cases on postoperative MRI. The mean (50%) ICRS arthroscopic score of cartilage repair was 9.2 points according to second look arthroscopy of 18 cases. There were 16 cases receiving excellent effect, 8 good and 2 fair. The excellent and good rate was 92.3%(24/26). There were no major complications. Conclusion Autologous osteo-periosteal cylinder graft transplantation could repair the osteochondral defects. It yields satisfactory results, and is suitable for treating OLT with large subchondral cyst.