Wei Min, Liu Yang
Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China;
Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China.
Zhongguo Gu Shang. 2019 Jan 25;32(1):43-47. doi: 10.3969/j.issn.1003-0034.2019.01.009.
To evaluate clinical effect of autogenous iliac bone graft in treating osteochondral lesion of the talus with subchondral cyst.
Twenty-two osteochondral lesion of talus patients with subchondral cyst were collected from January 2011 to December 2014, including 18 males and 4 females aged from 34 to 58 years old with an average of (46.4± 6.9) years old. All patients manifested pain and swelling of ankle joint, 7 patients manifested partially limited activity of ankle joint, 2 patients manifested unstable of ankle joint, and 2 patients manifested poor force line of foot. All lesions located on the medial side of talus dome. The area of cartilage injury ranged from 64 to 132(101.6±27.1) mm2, and diameter of subchondral cyst ranged from 9 to 15(10.5±1.8) mm. VAS score and AOFAS score were used to evaluate pain releases and recovery of ankle joint function before operation, 12 and 24 months after operation. Healing condition of autograft was assessed under arthroscopy after removal of internal fixation at 1 year after operation.
All patients were followed up from 24 to 60 months with an average of(42.5±9.9) months. Postoperative MRI at 12 months showed autograft healed well but little cyst still seen. Bone grafting and talus healed well, and formation of fibrocartilage well under arthroscopy. Postoperative MRI at 24 months showed combination of bone grafting and surrounding bone well, and small cyst could seen but less than before. VAS score at 12 months after operation 2.8±0.8 was less than that of before operation 6.2±1.5, but had no differences compared with 24 months after operation 2.6 ±0.8 (>0.05). AOFAS score at 12 months after operation 83.0±5.6 was less than that of before operation 55.3±13.7, but had no differences compared with 24 months after operation 83.7±6.6(>0.05).
Autogenous iliac bone graft in treating osteochondral lesion of the talus with subchondral cyst could have a good synosteosis and fibrous cartilage on surface, and relieve clinical symptoms.
评估自体髂骨移植治疗距骨骨软骨损伤合并软骨下囊肿的临床效果。
收集2011年1月至2014年12月收治的22例距骨骨软骨损伤合并软骨下囊肿患者，其中男18例，女4例，年龄34～58岁，平均（46.4±6.9）岁。所有患者均有踝关节疼痛、肿胀，7例踝关节活动部分受限，2例踝关节不稳，2例足部力线不良。所有病损均位于距骨穹隆内侧。软骨损伤面积64～132（101.6±27.1）mm²，软骨下囊肿直径9～15（10.5±1.8）mm。采用视觉模拟评分（VAS）和美国足踝外科协会（AOFAS）评分，分别于术前、术后12个月及24个月评估疼痛缓解情况及踝关节功能恢复情况。术后1年取出内固定后，在关节镜下评估自体骨移植的愈合情况。
所有患者随访24～6个月，平均（42.5±9.9）个月。术后12个月MRI显示自体骨移植愈合良好，但仍可见少许囊肿。关节镜下见植骨与距骨愈合良好，表面纤维软骨形成良好。术后24个月MRI显示植骨与周围骨结合良好，可见小囊肿，但较前减少。术后12个月VAS评分为2.8±0.8，低于术前的6.2±1.5，但与术后24个月的2.6±0.8比较，差异无统计学意义（>0.05）。术后12个月AOFAS评分为83.0±5.6，低于术前的55.3±13.7，但与术后24个月的83.7±6.6比较，差异无统计学意义（>0.05）。
自体髂骨移植治疗距骨骨软骨损伤合并软骨下囊肿可获得良好的骨愈合及表面纤维软骨形成，缓解临床症状。
