D'Ambrosi Riccardo, Maccario Camilla, Ursino Chiara, Serra Nicola, Usuelli Federico Giuseppe
1 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
2 IRCCS Istituto Ortopedico Galeazzi, U.O. C.A.S.C.O., Piede e Caviglia, Milan, Italy.
Foot Ankle Int. 2017 May;38(5):485-495. doi: 10.1177/1071100716687367. Epub 2017 Jan 11.
The purpose of this study was to evaluate the clinical and radiologic outcomes of patients younger than 20 years, treated with the arthroscopic-talus autologous matrix-induced chondrogenesis (AT-AMIC) technique and autologous bone graft for osteochondral lesion of the talus (OLT).
Eleven patients under 20 years (range 13.3-20.0) underwent the AT-AMIC procedure and autologous bone graft for OLTs. Patients were evaluated preoperatively (T) and at 6 (T), 12 (T), and 24 (T) months postoperatively, using the American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS) score, the visual analog scale and the SF-12 respectively in its Mental and Physical Component Scores. Radiologic assessment included computed tomographic (CT) scan, magnetic resonance imaging (MRI) and intraoperative measurement of the lesion. A multivariate statistical analysis was performed.
Mean lesion size measured during surgery was 1.1 cm ± 0.5 cm. We found a significant difference in clinical and radiologic parameters with analysis of variance for repeated measures ( P < .001). All clinical scores significantly improved ( P < .05) from T to T. Lesion area significantly reduced from 119.1 ± 29.1 mm preoperatively to 77.9 ± 15.8 mm ( P < .05) at final follow-up as assessed by CT, and from 132.2 ± 31.3 mm to 85.3 ± 14.5 mm ( P < .05) as assessed by MRI. Moreover, we noted an important correlation between intraoperative size of the lesion and body mass index (BMI) ( P = .011).
The technique can be considered safe and effective with early good results in young patients. Moreover, we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life.
Level IV, retrospective case series.
本研究旨在评估采用关节镜下距骨自体基质诱导软骨形成（AT - AMIC）技术及自体骨移植治疗距骨骨软骨损伤（OLT）的20岁以下患者的临床和影像学结果。
11例20岁以下（年龄范围13.3 - 20.0岁）患者接受了OLT的AT - AMIC手术及自体骨移植。术前（T0）以及术后6个月（T1）、12个月（T2）和24个月（T3）对患者进行评估，分别使用美国矫形足踝协会踝与后足（AOFAS）评分、视觉模拟量表以及SF - 12的心理和生理成分评分。影像学评估包括计算机断层扫描（CT）、磁共振成像（MRI）以及术中对损伤的测量。进行了多变量统计分析。
手术中测得的平均损伤大小为1.1 cm±0.5 cm。通过重复测量方差分析，我们发现临床和影像学参数存在显著差异（P <.001）。所有临床评分从T0到T3均显著改善（P <.05）。根据CT评估，最终随访时损伤面积从术前的119.1±29.1 mm²显著减小至77.9±15.8 mm²（P <.05），根据MRI评估，从132.2±31.3 mm²减小至85.3±14.5 mm²（P <.05）。此外，我们注意到损伤的术中大小与体重指数（BMI）之间存在重要相关性（P = 0.011）。
该技术在年轻患者中可被认为是安全有效的，早期效果良好。此外，我们证明了BMI与损伤大小之间存在显著相关性，以及OLT对生活质量有显著影响。
IV级，回顾性病例系列。
