Shang Xi-Liang, Tao Hong-Yue, Chen Shi-Yi, Li Yun-Xia, Hua Ying-Hui
Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China.
Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China.
Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):1243-9. doi: 10.1007/s00167-015-3575-y. Epub 2015 Mar 13.
The purpose of this study was to compare the clinical and magnetic resonance imaging (MRI) outcomes of arthroscopic microfracture surgery alone or in combination with hyaluronic acid (HA) injection in the treatment of osteochondral lesions of the talus.
Thirty-five patients with osteochondral lesions of the talus who underwent arthroscopic microfracture were included and followed up for at least 9 months post-operatively. The patients were randomly divided into non-injection group (n = 17) who received treatment with microfracture surgery alone and injection group (n = 18) who also accepted intra-articular injection of HA post-operatively. Quantitative MRI was used to evaluate the cartilage repair after surgery. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hind foot Scale scores and Visual Analogue Scale (VAS) scores were used to evaluate clinical outcomes.
After operation, the MRI outcomes showed that the thickness index was higher (0.8 ± 0.1 vs. 0.7 ± 0.1) and the T2 index was lower (1.2 ± 0.1 vs. 1.4 ± 0.1) in the injection group than in the non-injection group (P < 0.01). As for the volumes of subchondral bone marrow oedema, there are no significant differences between groups (n.s.). Compared with the non-injection group, the AOFAS score and the VAS score yielded a higher level of improvement in injection group at final follow-up post-operatively (P < 0.05).
Arthroscopic microfracture is a safe and effective procedure for osteochondral lesions of the talus. Intra-articular HA injection as an adjunct to arthroscopic microfracture might offer better functional recovery than microfracture alone.
II.
本研究旨在比较单纯关节镜下微骨折手术与联合透明质酸（HA）注射治疗距骨骨软骨损伤的临床及磁共振成像（MRI）结果。
纳入35例行关节镜下微骨折手术治疗的距骨骨软骨损伤患者，术后至少随访9个月。患者被随机分为非注射组（n = 17），仅接受微骨折手术治疗；注射组（n = 18），术后还接受关节内HA注射。采用定量MRI评估术后软骨修复情况。采用美国矫形足踝协会（AOFAS）踝-后足评分量表和视觉模拟评分（VAS）评估临床结果。
术后MRI结果显示，注射组的厚度指数较高（0.8±0.1对0.7±0.1），T2指数较低（1.2±0.1对1.4±0.1），均优于非注射组（P < 0.01）。关于软骨下骨髓水肿的体积，两组之间无显著差异（无统计学意义）。与非注射组相比，术后末次随访时注射组的AOFAS评分和VAS评分改善程度更高（P < 0.05）。
关节镜下微骨折是治疗距骨骨软骨损伤的一种安全有效的方法。关节内HA注射作为关节镜下微骨折的辅助治疗可能比单纯微骨折提供更好的功能恢复。
II级。
