距骨穹隆外伤性局灶性骨软骨缺损的 AMIC 治疗：一项 5 年随访前瞻性队列研究。
AMIC for traumatic focal osteochondral defect of the talar shoulder: a 5 years follow-up prospective cohort study.
机构信息
Department of Orthopaedic Surgery, Auguste-Viktoria Clinic, Ruhr University Bochum, 32545, Bad Oeynhausen, Germany.
Department of Orthopaedics and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, 52064, Aachen, Germany.
出版信息
BMC Musculoskelet Disord. 2021 Jul 24;22(1):638. doi: 10.1186/s12891-021-04506-z.
BACKGROUND
Autologous Matrix-Induced Chondrogenesis (AMIC) is addressed to osteochondral defects of the talus. However, evidence concerning the midterm efficacy and safety of AMIC are limited. This study assessed reliability and feasibility of AMIC at 60 months follow-up. We hypothesize that AMIC leads to good clinical outcome at midterm follow-up.
METHODS
Surgeries were approached with an arthrotomy via malleolar osteotomy. A resorbable porcine I/III collagen membrane (Chondro-Gide®, Geistlich Pharma AG, Wolhusen, Switzerland) was used. Patients were followed at 24 and 60 months. The primary outcome of interest was to analyse the Foot Function Index (FFI), and the subscale hindfoot of the American Orthopaedic Foot and Ankle Score (AOFAS). Complications such as failure, revision surgeries, graft delamination, and hypertrophy were also recorded. The secondary outcome of interest was to investigate the association between the clinical outcome and patient characteristics at admission.
RESULTS
Data from 19 patients were included. The mean age at admission was 47.3 ± 13.2 years, and the mean BMI 24.1 ± 4.9 kg/m. 53% (10 of 19 patients) were female. At a mean of 66.2 ± 11.6 months, the FFI decreased at 24-months follow-up of 22.5% (P = 0.003) and of further 1.3% (P = 0.8) at 60-months follow-up. AOFAS increased at 24-months follow-up of 17.2% (P = 0.003) and of further 3.4 (P = 0.2) at 60-months follow-up. There were two symptomatic recurrences within the follow-up in two patients. There was evidence of a strong positive association between FFI and AOFAS at baseline and the same scores last follow-up (P = 0.001 and P = 0.0002, respectively).
CONCLUSION
AMIC enhanced with cancellous bone graft demonstrated efficacy and feasibility for osteochondral defects of the talus at five years follow-up. The greatest improvement was evidenced within the first two years. These results suggest that clinical outcome is influenced by the preoperative status of the ankle. High quality studies involving a larger sample size are required to detect seldom complications and identify prognostic factors leading to better clinical outcome.
LEVEL OF EVIDENCE
II, prospective cohort study.
背景
自体诱导软骨生成术（AMIC）适用于距骨的骨软骨缺损。然而，关于 AMIC 的中期疗效和安全性的证据有限。本研究评估了 AMIC 在 60 个月随访时的可靠性和可行性。我们假设 AMIC 在中期随访时会产生良好的临床效果。
方法
手术通过踝骨切开术入路进行关节切开。使用可吸收的猪 I/III 胶原膜（Chondro-Gide®，Geistlich Pharma AG，Wolhusen，瑞士）。患者在 24 个月和 60 个月时进行随访。主要研究结果是分析足部功能指数（FFI）和美国矫形足踝协会（AOFAS）后足亚量表。还记录了并发症，如失败、翻修手术、移植物分层和肥大。次要研究结果是研究临床结果与入院时患者特征之间的关系。
结果
纳入 19 例患者的数据。入院时的平均年龄为 47.3±13.2 岁，平均 BMI 为 24.1±4.9kg/m。53%（19 例患者中有 10 例）为女性。平均 66.2±11.6 个月时，FFI 在 24 个月随访时下降了 22.5%（P=0.003），在 60 个月随访时又下降了 1.3%（P=0.8）。AOFAS 在 24 个月随访时增加了 17.2%（P=0.003），在 60 个月随访时增加了 3.4%（P=0.2）。两名患者在随访过程中出现了两次症状性复发。在基线和最后一次随访时，FFI 和 AOFAS 之间存在强烈的正相关（P=0.001 和 P=0.0002）。
结论
在五年随访中，用松质骨移植物增强的 AMIC 对距骨的骨软骨缺损显示出疗效和可行性。最大的改善发生在最初的两年内。这些结果表明，临床结果受踝关节术前状态的影响。需要进行涉及更大样本量的高质量研究，以发现罕见的并发症，并确定导致更好临床结果的预后因素。
证据等级
II，前瞻性队列研究。
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