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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 688 -692. doi: 10.3877/cma.j.issn.1674-134X.2019.06.007

所属专题： 文献；

临床论著

微骨折术与自体骨填充治疗距骨软骨缺损的对比研究
焦弘升1,†()   
  1. 1. 056200　邯郸，冀中能源峰峰集团总医院
  • 收稿日期:2018-08-13 出版日期:2019-12-01
  • 通信作者: 焦弘升

Comparison of arthroscopic microfracture and autologous bone filling and fixation in treatment of talar cartilage defects

Hongsheng Jiao1,†()   

  1. 1. Jizhong Fengfeng Energy Group General Hospital, Handan 056200, China
  • Received:2018-08-13 Published:2019-12-01
  • Corresponding author: Hongsheng Jiao
  • About author:
    Corresponding author: Jiao Hongsheng, Email:
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引用本文：

焦弘升. 微骨折术与自体骨填充治疗距骨软骨缺损的对比研究[J]. 中华关节外科杂志(电子版), 2019, 13(06): 688-692.

Hongsheng Jiao. Comparison of arthroscopic microfracture and autologous bone filling and fixation in treatment of talar cartilage defects[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(06): 688-692.

目的

评估关节镜下自体骨填充固定术与关节镜下微骨折术治疗距骨软骨缺损的临床疗效。

方法

选取2012年1月至2016年6月因距骨软骨缺损就诊翼中能源峰峰集团有限公司总医院待行关节镜手术的患者，选择缺损直径大于10 mm可经手术修复的年龄为18～70岁的患者，排除合并类风湿性关节炎、踝关节疾病等病史者。共纳入26例患者，根据随机数字法分为观察组(n ＝11)和对照组(n＝15)，分别行关节镜下自体骨填充固定术和关节镜下微骨折术。使用t检验和卡方检验分析对比两组患者的美国矫形外科足踝协会(AOFAS)评分和疼痛数字评分(NRS)和影像学评价等。

结果

两组患者术前一般资料差异无统计学意义(P>0.05)。两组均在术后1年完成随访及CT复查，部分完成MRI复查。术前和术后1年，观察组与对照组在休息和运动时，AOFAS评分和NRS评分无明显差异(P>0.05)。对比术前，同一组术后1年的NRS评分有明显改善(观察组t ＝14.65、7.99；对照组t ＝18.59、5.57；均为P <0.01)。两组MRI结果存在不同，两组患者软骨下骨的平整程度有显著差异(χ2＝7.23，P <0.01)。经关节镜下微骨折术后，12例患者见软骨面不平整，3例患者见软骨面平整，关节镜下自体骨填充固定后3例患者见软骨面不平整，8例患者见软骨面平整。

结论

两组手术方法可以得到满意的临床疗效，均适合在临床上进一步推广。

关键词: 关节镜检查, 软骨, 自体移植物
Objective

To evaluate the clinical efficacy of arthroscopic autogenous bone filling and arthroscopic microfracture in the treatment of talus cartilage defects.

Methods

The patients who underwent arthroscopic surgery at the General Hospital of Jizhong Fengfeng Energy Group from January 2012 to June 2016 due to talus cartilage defects were enrolled according to the inclusion-exclusion criteria. Inclusion criteria: age at 18-70 years, the defect greater than 10 mm in diameter which can be surgical repaired. Exclusion criteria: history of rheumatoid arthritis and ankle joint diseases. A total of 26 patients were enrolled and divided into the observation group (n=11) and the control group (n=15) by the random number method. Arthroscopic autogenous bone filling and arthroscopic microfracture were performed respectively. Chi-square test and t-test were used to analyze and compare the American Orthopaedic Foot and Ankle Association (AOFAS) score and numerical rating scale (NRS), as well as the imaging evaluation.

Results

There was no significant difference in preoperative data between the two groups (P > 0.05). Both groups completed follow-up and CT review one year after surgery, and partially completed MRI review. There was no significant difference in AOFAS scores and NRS scores between the observation group and the control group (P>0.05). Compared to pre-operation, NRS scores of both groups were significantly improved(the observation group t =14.65, 7.99; the control group t =18.59, 5.57; all P <0.01). MRI results showed a significant difference in the smooth level of the subchondral bone between the two groups (χ2=7.23, P <0.01). After arthroscopic microfracture, 12 patients showed uneven cartilage surface, three patients showed cartilage surface flattening, three patients under autologous bone filling under arthroscopy showed cartilage surface unevenness, and eight patients showed cartilage surface smoothing.

Conclusion

Both groups of surgical methods can obtain satisfactory clinical results, and are suitable for further clinical promotion.

Key words: Arthroscopy, Cartilage, Autografts
图1 踝关节关节镜手术过程示意图。图A为关节镜下示距骨软骨缺损位置；图B　为缺损位置清理及打磨；图C　为对照组以垂直角度在软骨缺损骨面打孔
表1 患者一般资料
分组 例数 平均年龄[年，(±s)] 性别(男/女) 缺损直径(mm) 缺损原因(例)
前后 左右 上下 完全骨折 部分骨折
观察组 11 50.6±10.2 6/5 12.3±3.1 9.2±1.0 6.4±0.9 2 9
对照组 15 53.3±12.2 10 /5 13.1±2.6 9.6±1.0 5.9±1.1 2 13
统计值 － t＝1.02 χ2＝0.24 t＝0.79 t＝1.37 t＝1.39 χ2＝0.11
P值 － >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
表2 患者手术前后NRS评分比较(±s)
分组 例数 NRS休息 NRS运动
术前 术后1年 t值 P值 术前 术后1年 t值 P值
观察组 11 3.05±0.51 0.92±0.21 14.65 <0.01 8.00±1.50 3.67±1.26 7.99 <0.01
对照组 15 2.77±0.35 0.90±0.15 18.59 <0.01 7.50±2.50 3.55±1.00 5.57 <0.01
t值 － 1.80 0.28 － － 0.82 0.27 － －
P值 － >0.05 >0.05 － － >0.05 >0.05 － －
表3 患者手术前后AOFAS评分比较(±s)
分组 例数 术前评分 术后评分 t值 P值
观察组 11 54±6 76±6 1.22 >0.05
对照组 15 57±7 73±8 1.01 >0.05
t值 － 1.53 1.01 － －
P值 － >0.05 >0.05 － －
图5 观察组踝关节术前及术后1年矢状位CT。图A为术前影像，示内侧骨软骨距骨缺损，箭头示软骨缺损部位；图B为关节镜下填充固定术后1年，示骨愈合良好，关节面平整完好
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