Duke University Medical Center, Durham, North Carolina 27710, USA.
J Bone Joint Surg Am. 2011 Apr 6;93(7):648-54. doi: 10.2106/JBJS.J.00141.
With osteochondral lesions of the talar shoulder, their size, the articular cartilage geometry, and the loss of the medial or lateral articular buttress often preclude treatment with traditional osteochondral autograft techniques. We hypothesized that fresh, large osteochondral allograft transplantation is a viable treatment option for patients with such lesions.
A retrospective review was conducted of patients who underwent fresh talar shoulder allograft transplantation between 2000 and 2007. All patients failed initial conservative management. Preoperatively, a visual analog pain scale of 0 to 10 (with 0 denoting no pain and 10 denoting the worst pain imaginable) and the Lower Extremity Functional Scale were administered. At the time of most recent follow-up, the visual analog pain scale, the Lower Extremity Functional Scale, the American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, and the Short Musculoskeletal Function Assessment questionnaire were administered. Radiographs were assessed for allograft incorporation and joint deterioration.
Eight patients with a mean age of thirty-one years and a mean follow-up of forty-eight months were included. There was a significant decrease (p < 0.05) in pain, from a mean of 6 points (range, 5 to 8 points) preoperatively to a mean of 1 point (range, 0 to 2 points) postoperatively. The mean Lower Extremity Functional Scale score improved from 37 points initially (range, 24 to 52 points) to 65 points (range, 31 to 75 points; p < 0.05) at the time of final follow-up. The mean postoperative American Orthopaedic Foot & Ankle Society ankle-hindfoot score was 84 points. The mean Short Musculoskeletal Function Assessment dysfunction index score was 13.3 points and the mean bother index score was 14.3 points. Radiographic lucencies at the graft-host interface were seen in five patients. Four patients required an additional surgical procedure. No patients needed to undergo subsequent arthrodesis or arthroplasty.
These midterm results in a small group of patients indicate that structural fresh allograft transplantation can be a successful surgical option in the treatment of large osteochondral defects of the talar shoulder [corrected].
对于距骨肩的骨软骨病变，其大小、关节软骨几何形状以及内侧或外侧关节突的丧失常常排除了传统的骨软骨自体移植物技术的治疗。我们假设新鲜的大骨软骨同种异体移植是此类病变患者的可行治疗选择。
对 2000 年至 2007 年间接受新鲜距骨肩同种异体移植的患者进行了回顾性研究。所有患者初次保守治疗均失败。术前，进行视觉模拟疼痛量表（0 到 10，0 表示无痛，10 表示可想象到的最严重疼痛）和下肢功能量表评分。在最近的随访时，进行视觉模拟疼痛量表、下肢功能量表、美国矫形足踝协会踝-后足量表和短肢肌肉骨骼功能评估问卷评分。拍摄 X 线片评估移植物融合和关节退变情况。
纳入 8 例患者，平均年龄 31 岁，平均随访 48 个月。疼痛明显减轻（p < 0.05），从术前平均 6 分（5 到 8 分）降至术后平均 1 分（0 到 2 分）。下肢功能量表评分从最初的 37 分（24 到 52 分）改善至末次随访时的 65 分（31 到 75 分；p < 0.05）。术后平均美国矫形足踝协会踝-后足量表评分为 84 分。短肢肌肉骨骼功能评估问卷的平均功能障碍指数评分为 13.3 分，平均困扰指数评分为 14.3 分。5 例患者在移植物-宿主界面可见透光区。4 例患者需要进一步手术。无患者需要行后续关节融合术或关节置换术。
在一小部分患者中，这些中期结果表明，结构性新鲜同种异体移植可作为治疗距骨肩大骨软骨缺损的一种成功手术选择[校正]。
