Orthopaedic Department, University Hospital of Basel, Spitalstr. 21, 4031, Basel, Switzerland,
Knee Surg Sports Traumatol Arthrosc. 2014 Jun;22(6):1304-10. doi: 10.1007/s00167-013-2604-y. Epub 2013 Jul 13.
This study reports first evidence of a modified procedure for osteochondral autologous transplantation where bony periosteum-covered plugs are harvested at the iliac crest and transplanted into the talar osteochondral lesion.
Thirteen out of 14 patients, average age 39.6 (SD 14.4) years, were followed clinically and radiographically for a median of 25 (24-28) months (minimal follow-up, 24 months).
For these 13 patients, the American Orthopaedic Foot and Ankle Society hindfoot score increased from 47 (SD 11) points pre-operatively, to 81 (SD 14) points postoperatively (p < 0.0001). The average pain score decreased from 6.6 (SD 1.3) points pre-operatively, to 1.4 (SD 1.9) points postoperatively (p < 0.0001). Seven patients returned to sports activity. Radiographically good plug osteointegration was observed in nine out of 11 ankles. Follow-up arthroscopy showed fibrous cartilage in four ankles, periosteum hypertrophy in five ankles, and partial or total missing of coverage of the bone in three ankles. Three revision surgeries had to be performed.
This modified mosaicplasty might be recommended for severe and recurrent osteochondral lesions of the talus and may lead to restoration of the subchondral bone stock, formation of fibro-cartilage, and stable joint function.
IV.
本研究报告了自体骨软骨移植改良术式的初步证据，即在髂嵴采集带骨膜的骨栓并移植到距骨骨软骨病变处。
14 例患者中的 13 例（平均年龄 39.6 岁，标准差 14.4 岁）平均随访 25 个月（中位数 25 个月，范围 24-28 个月），进行临床和影像学随访。
对于这 13 例患者，美国矫形足踝协会后足评分从术前的 47 分（标准差 11 分）增加到术后的 81 分（标准差 14 分）（p < 0.0001）。平均疼痛评分从术前的 6.6 分（标准差 1.3 分）降低至术后的 1.4 分（标准差 1.9 分）（p < 0.0001）。7 例患者恢复运动。11 例踝关节中有 9 例观察到移植骨栓良好的骨整合。随访关节镜检查显示 4 例踝关节存在纤维软骨，5 例踝关节存在骨膜肥厚，3 例踝关节存在部分或完全骨覆盖缺失。3 例患者进行了翻修手术。
这种改良马赛克plasty 可能适用于严重和复发性距骨骨软骨病变，并可能导致软骨下骨储备的恢复、纤维软骨的形成以及关节功能的稳定。
IV。
