Gu Wenqi, Li Tanzhu, Shi Zhongmin, Mei Guohua, Xue Jianfeng, Zou Jian, Wang Xiaokang, Zhang Haotong, Xu Hongwei
Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
The People's Hospital of Shigatse City, Shigatse, Tibet 857000, China.
Biomed Res Int. 2017;2017:6525373. doi: 10.1155/2017/6525373. Epub 2017 Mar 16.
There has been no consensus on the treatment or prognosis of Hepple stage V osteochondral lesions of the talus (OLTs), especially for lesions greater than 1.5 cm in size. The objective of this study was to investigate the clinical outcomes achieved upon application of a platelet-rich plasma (PRP) scaffold with a cancellous bone autograft for Hepple stage V OLTs. Fourteen patients (mean age, 39 years) were treated with a cancellous bone graft and a PRP scaffold between 2013 and 2015. The mean time to surgical treatment was 23.5 months. Ankle X-ray and magnetic resonance imaging were performed at the final follow-up. Functional outcomes were evaluated according to the Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Short Form 36 (SF-36) score. The range of motion (ROM) of the ankle joint and complications also were recorded. Thirteen patients completed the full follow-up, with a mean follow-up duration of 18 months. MRI demonstrated the complete regeneration of subchondral bone and cartilage in all patients. The postoperative VAS, AOFAS ankle and hindfoot, and SF-36 scores were improved significantly (all < 0.001) without obvious complications. We suggest that, for the Hepple stage V OLTs, management with cancellous bone graft and PRP scaffold may be a safe and effective treatment.
对于距骨Hepple V期骨软骨损伤（OLTs）的治疗或预后，目前尚无共识，尤其是对于尺寸大于1.5厘米的损伤。本研究的目的是调查应用富含血小板血浆（PRP）支架联合松质骨自体移植治疗Hepple V期OLTs的临床效果。2013年至2015年期间，14例患者（平均年龄39岁）接受了松质骨移植和PRP支架治疗。手术治疗的平均时间为23.5个月。在末次随访时进行了踝关节X线和磁共振成像检查。根据视觉模拟量表（VAS）评分、美国矫形足踝协会（AOFAS）评分和简明健康状况调查量表（SF-36）评分评估功能结果。还记录了踝关节的活动范围（ROM）和并发症情况。13例患者完成了完整的随访，平均随访时间为18个月。MRI显示所有患者的软骨下骨和软骨均完全再生。术后VAS、AOFAS踝关节和后足评分以及SF-36评分均显著改善（均P<0.001），且无明显并发症。我们认为，对于Hepple V期OLTs，采用松质骨移植和PRP支架治疗可能是一种安全有效的治疗方法。
