关节镜监视下液态人工骨治疗距骨坏死的临床报道

目的探讨关节镜下液态人工骨治疗距骨坏死的临床疗效。方法 2006年1月至2013年5月,本组收治了25例距骨坏死患者,均采用关节镜监视下行病灶清除,并注射液态人工骨的治疗方法。术前、术后分别评估患者的VAS评分、ROM、踝关节功能评分及MRI。结果所有患者均获得随访,平均随访时间23.3个月,其中男19例,女6例;年龄23-40岁,平均30.5岁;左踝13例,右踝12例。本组患者手术时间平均65 min（55-80 min）,术中出血平均2 ml（0-3 ml）,术后患者伤口均为一期愈合,术前VAS评分平均7.25分,术后平均2.73分;术前ROM为46.7°,术后为57.9°;术前AOFAS评分为21.9分,术后评分为81.4分;术前MRI提示距骨坏死面积为23.9 mm^2,术后随访时复查MRI提示距骨坏死面积为11.4 mm^2;以上每组差异均有统计学意义（P〈0.01）。结论关节镜监视下距骨坏死病灶清除、液态人工骨填充术,操作简单、创伤小、病灶清除彻底,能早期功能锻炼,是一种较好的选择。

Clinical report of talus osteonecrosis treated with liquid artificial bone by arthroscopy

Objective To investigate the clinical effects of the treatment with liquid artificial bone by arthroscopy on the talar osteonecrosis.Methods Twenty-five talar osteonecrosis cases were treated by the author from January,2006 to May,2013.Each talar necrosis case was injected the liquid artificial bone after the debridement by arthroscopy.The patients were all compared by pre-operative and post-operative visual analog scale（VAS）,range of motion（ROM）,ankle-hindfoot scale of the American Orthopaedic Ankle Society（AOFAS）,and the necrosis area in MRI.Results Nineteen males and six females were all followed up,with the mean age of 30.5 years（ranging from 23 to 40 years）.Thirteen of them were in the left talus,and 12 of them were in the right talus.The average operation time was 65 minutes,the intraoperative blood loss was 2 ml and all wounds healed by first intention.The VAS scores,ROM,AOFAS scores and the necrosis area were significantly reduced from 7.25,46.7°,21.9,23.9 mm^2 preoperatively to 2.73,57.9°,81.4,11.4 mm^2 postoperatively.The differences were statistically significant（P〈0.01）.Conclusion Talar osteonecrosis debridement and liquid bone injection by arthroscopy is a good choice for the treatment of talus osteonecrosis,with the advantages of less trauma,less bleeding,easy operating,and complete debridement.