Moriwaki Dan, Nakasa Tomoyuki, Ikuta Yasunari, Kawabata Shingo, Ishibashi Saori, Sakurai Satoru, Adachi Nobuo
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Foot Ankle Int. 2025 Feb;46(2):175-181. doi: 10.1177/10711007241303757. Epub 2024 Dec 20.
Postoperative osteolysis may be observed around poly-l-lactic acid (PLLA) pins in osteochondral fragments fixation for an osteochondral lesion of the talus (OLT). Hydroxyapatite (HA) improves biocompatibility, osteoconductivity, and mechanical strength when added to PLLA. This study aimed to compare the characteristics of osteolysis and clinical outcomes of fixation for OLT with PLLA pins vs PLLA/HA pins.
Thirty-one ankles undergoing fixation with bioabsorbable pins for OLT were included. Fourteen ankles were fixed with PLLA/HA pins and 17 ankles with PLLA pins. Magnetic resonance imaging (MRI) was taken pre- and postoperatively at 1 year. Osteolysis around pins, bone marrow edema (BME) in the talus, and pin insertion angle on MRI, the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the visual analog scale (VAS) pain score were compared between the 2 groups pre- and postoperatively at 1 year. AOFAS score at the final follow-up was also compared between the 2 groups.
The osteolysis area was significantly smaller in the PLLA/HA group in both coronal and sagittal planes on MRIs obtained 1 year postoperatively. There were no significant differences in osteolysis frequency, BME area, AOFAS score, and VAS pain score. Lower pin insertion angles measured on either sagittal or coronal planes were generally associated with greater amounts of osteolysis.
We did not find superiority using PLLA/HA pins compared with PLLA pins to fixate talar osteochondral fragments. However, PLLA/HA pin use was associated with less osteolysis around pins compared with PLLA pins.
在距骨骨软骨损伤（OLT）的骨软骨碎片固定中，聚左旋乳酸（PLLA）钉周围可能会出现术后骨溶解。羟基磷灰石（HA）添加到PLLA中时可改善生物相容性、骨传导性和机械强度。本研究旨在比较PLLA钉与PLLA/HA钉固定OLT时骨溶解的特征和临床结果。
纳入31例行生物可吸收钉固定OLT的踝关节。14例踝关节用PLLA/HA钉固定，17例踝关节用PLLA钉固定。在术后1年进行术前和术后的磁共振成像（MRI）检查。比较两组术前和术后1年MRI上钉周围的骨溶解、距骨骨髓水肿（BME）、钉的插入角度、美国矫形足踝协会（AOFAS）评分和视觉模拟量表（VAS）疼痛评分。还比较两组最终随访时的AOFAS评分。
术后1年获得的MRI上，PLLA/HA组在冠状面和矢状面的骨溶解面积均显著较小。骨溶解频率、BME面积、AOFAS评分和VAS疼痛评分无显著差异。矢状面或冠状面上测量的较低钉插入角度通常与较多的骨溶解量相关。
我们未发现与PLLA钉相比，使用PLLA/HA钉固定距骨骨软骨碎片具有优越性。然而，与PLLA钉相比，使用PLLA/HA钉时钉周围的骨溶解较少。
