Yantaishan Hospital, Yantai China-France Friendship Hospital, Orthopaedics, 91 Jiefang Road, Yantai City, 264001, Shandong Province, China.
Foot Ankle Int. 2011 Apr;32(4):437-42. doi: 10.3113/FAI.2011.0437.
Osteochondral fractures of the talar dome (OCFT) are frequently associated with ankle fractures. Controversy exists regarding the treatment of acute Grade III and IV OCFT. Osteochondral autograft transplantation (OAT) is a possible operative solution.
We performed OAT in 16 patients with acute Grade III or IV OCFT. There were ten males and six females with the average age of 33.9 (range, 18 to 49) years. The average period of followup was 36.3 (range, 21 to 48) months. OCFT was identified, and clinically determined to be Grade III or IV using radiographs and intraoperative assessment. Seven patients were Grade III, nine patients were Grade IV OCFT. The OAT consisted of two sequential procedures: 1) harvesting of osteochondral autograft cylinder from the nonweightbearing surface of the ipsilateral knee, and 2) implanting the donor graft into the talar defect with press-fit technique. Single cylinder transplantation or a mosaicplasty was used. The outcome was determined by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, the simplified symptomatology evaluation, plain radiography and MRI.
The mean size of the osteochonral fracture defects was 84.1 (range, 50 to 125) mm(2), and the mean depth was 2.5 (range, 1 to 5) mm. The mean AOFAS score was 95.4 (range, 86 to 100) points postoperatively. At the latest followup, there was no radiographic evidence of post-traumatic arthritis. Based on the MRI of all patients, 93.7% of the osteochondral grafts showed bony integration and articular congruity of the talar dome.
OAT was shown to be an effective treatment with excellent clinical outcome and imaging evidence of graft integration.
距骨穹隆骨软骨骨折（OCFT）常与踝关节骨折相关。对于急性 III 级和 IV 级 OCFT 的治疗存在争议。骨软骨自体移植（OAT）是一种可行的手术解决方案。
我们对 16 例急性 III 级或 IV 级 OCFT 患者进行了 OAT。其中男性 10 例，女性 6 例，平均年龄 33.9 岁（18 至 49 岁）。平均随访时间为 36.3 个月（21 至 48 个月）。OCFT 通过影像学和术中评估确定，并根据临床分级为 III 级或 IV 级。7 例为 III 级，9 例为 IV 级 OCFT。OAT 包括两个连续的步骤：1）从同侧膝关节非负重面采集骨软骨自体移植物圆柱；2）将供体移植物压入距骨缺损处以达到压配效果。采用单个圆柱移植或马赛克plasty 技术。采用美国矫形足踝协会（AOFAS）踝关节后足评分、简化症状评估、X 线平片和 MRI 来评估结果。
骨软骨骨折缺损的平均大小为 84.1mm²（50 至 125mm²），平均深度为 2.5mm（1 至 5mm）。术后 AOFAS 平均评分为 95.4 分（86 至 100 分）。在末次随访时，无创伤性关节炎的放射学证据。根据所有患者的 MRI 结果，93.7%的骨软骨移植物显示出骨性整合和距骨穹隆的关节吻合。
OAT 是一种有效的治疗方法，具有良好的临床结果和影像学证据表明移植物的整合。
