D'Ambrosi Riccardo, Maccario Camilla, Ursino Chiara, Serra Nicola, Usuelli Federico Giuseppe
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Istituto Ortopedico Galeazzi, U.O. C.A.S.C.O. - Piede e Caviglia, Milan, Italy.
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Istituto Ortopedico Galeazzi, U.O. C.A.S.C.O. - Piede e Caviglia, Milan, Italy.
Foot Ankle Surg. 2018 Jun;24(3):229-235. doi: 10.1016/j.fas.2017.02.010. Epub 2017 Mar 6.
To assess the functional and radiological outcomes after arthroscopic talus autologous matrix-induced chondrogenesis (AT-AMIC) in 2 groups: patients with and without bone marrow edema (BME).
Thirty-seven patients of which 24 without edema (GNE) and 13 with edema (GE) were evaluated. All patients were treated with AT-AMIC repair for symptomatic osteochondral talar lesion. Clinical and radiological parameters were evaluated with VAS score for pain, AOFAS and SF-12 at T (preoperatively), T (6 months), T (12 months), T (24 months) and MRI and CT-scan at T, T, T and T.
No patients were lost to the final follow-up. In both groups we found a significant difference for clinical and radiological parameters with ANOVA for repeated measures through four time points (p<0.001). In GNE, AOFAS improved significantly at each follow-up (p<0.05); while CT and MRI showed a significant reduction in lesion size between T and T and T and T (p<0.05). In GE, AOFAS improved significantly between T and T and T and T (p<0.05); lesion size, measured with CT, decreased between T and T (p<0.05), while with MRI the lesion showed a reduction at each follow-up (p<0.05). Lesion size was significantly higher both in MRI and CT in GE compared to GNE (p<0.05). In GNE no patients presented edema at T while in GE only 23.08% of the patients presented edema at T CONCLUSIONS: The study revealed that osteochondral lesions of the talus were characterized by bigger size both in MRI and CT in patients with edema. We conclude that AT-AMIC can be considered a safe and reliable procedure that allows effective healing, regardless of edema and more than half of patients did not present edema six months after surgery.
评估两组患者（有或无骨髓水肿（BME））在关节镜下距骨自体基质诱导软骨形成术（AT-AMIC）后的功能和影像学结果。
评估了37例患者，其中24例无水肿（GNE组），13例有水肿（GE组）。所有患者均接受AT-AMIC修复有症状的距骨骨软骨损伤。在术前（T0）、术后6个月（T1）、12个月（T2）、24个月（T3）通过视觉模拟评分法（VAS）评估疼痛、美国足踝外科协会（AOFAS）评分和SF-12健康调查简表评估临床和影像学参数，并在T0、T1、T2和T3进行MRI和CT扫描。
无患者失访至最终随访。通过重复测量方差分析，在四个时间点两组患者的临床和影像学参数均存在显著差异（p<0.001）。在GNE组，每次随访时AOFAS均显著改善（p<0.05）；而CT和MRI显示T0和T1以及T1和T2之间病变大小显著减小（p<0.05）。在GE组，T0和T1以及T1和T2之间AOFAS显著改善（p<0.05）；CT测量的病变大小在T0和T1之间减小（p<0.05），而MRI显示每次随访时病变均减小（p<0.05）。与GNE组相比，GE组MRI和CT的病变大小均显著更高（p<0.05）。在GNE组，T3时无患者出现水肿，而在GE组，T3时仅23.08%的患者出现水肿。结论：研究表明，有水肿患者的距骨骨软骨损伤在MRI和CT上的特征是病变更大。我们得出结论，AT-AMIC可被认为是一种安全可靠的手术方法，无论有无水肿均可实现有效愈合，且超过一半的患者术后6个月未出现水肿。
