自体骨软骨移植治疗Hepple V型距骨损伤时内侧与前侧踝关节截骨术的回顾性研究

Medial vs. Anterior Malleolar Osteotomy in Osteochondral Autologous Transplantation for Hepple V Talar Lesions: A Retrospective Study.

作者信息

Bai Lu, Liu Sanbiao, Yan Yuxin, Lin Jianjing, Chen Sumeng, Zhang Xintao

机构信息

Department of Sports Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China.

Department of Orthopedics, Wuhan Fifth Hospital, Wuhan, Hubei Province, China.

出版信息

Orthop Traumatol Surg Res. 2025 Jul 10:104332. doi: 10.1016/j.otsr.2025.104332.

DOI:10.1016/j.otsr.2025.104332

PMID:40651604

Abstract

AIMS

To compare clinical outcomes in patients with talar Osteochondral lesions (OLTs) treated with medial malleolar osteotomy (MMO) or anterior malleolar osteotomy (AMO) combined with Osteochondral autologous transplantation (OAT).

METHODS

From May 2014 to May 2020, 39 patients with Hepple V OLTs underwent MMO (n = 22) or AMO (n = 19). Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (AOFAS) and Visual Analog Scale (VAS) pain scores. Magnetic Response Observation of Cartilage Repair Tissues (MOCART) score was used for radiological evaluation. Second-look arthroscopy and hardware removal were performed 2 years postoperatively. International Cartilage Repair Society (ICRS) scores were used to assess cartilage quality at the graft and osteotomy sites.

RESULTS

There was no significant difference in the occurrence of surgical complications (P = 0.581) between groups. AOFAS, VAS and ICRS scores were significantly improved during follow-up in patients who underwent MMO or AMO (P < 0.01). At the 1-year follow-up, the AOFAS score (92.5±3.3 vs. 89.2±4.9, t = 2.53 P = 0.02) and MOCART score (67.0±3.7 vs. 63.0±8.5, t = 2.14, P = 0.048) were significantly higher in patients who underwent MMO vs. AMO (t = 2.53 P = 0.02). There was no significant difference in AOFAS scores at the 2-year follow-up (MMO, 94.0±4.0 vs. AMO, 91.5±5.5, t = 1.63 P = 0.11); however, the VAS pain score (0.3±0.5 vs. 0.8±0.9, t = 2.53 P = 0.02) was significantly lower and MOCART score (69.3±5.0 vs. 64.1±7.5, t = 2.59 P = 0.013) was significantly higher in patients who underwent MMO vs. AMO. Second-look arthroscopy revealed superior cartilage quality at the osteotomy site in patients who underwent MMO vs. AMO (χ = 22.826 P < 0.05), but no significant difference at the graft site (χ = 6.049 P = 0.327).

CONCLUSION

Both MMO and AMO combined with OAT can achieve good clinical outcomes for Hepple V OLTs; however, better pain relief and cartilage repair at the osteotomy site at 2-years of follow-up indicate that MMO may be the best choice.

LEVEL OF EVIDENCE

III; Retrospective Comparative Study.

摘要

目的

比较采用内踝截骨术（MMO）或前踝截骨术（AMO）联合自体骨软骨移植术（OAT）治疗距骨骨软骨损伤（OLTs）患者的临床疗效。

方法

2014年5月至2020年5月，39例Hepple V型OLTs患者接受了MMO（n = 22）或AMO（n = 19）治疗。采用美国矫形足踝协会踝-后足评分（AOFAS）和视觉模拟量表（VAS）疼痛评分评估功能结局。采用软骨修复组织磁共振反应观察（MOCART）评分进行影像学评估。术后2年进行二次关节镜检查及内固定取出。采用国际软骨修复协会（ICRS）评分评估移植部位和截骨部位的软骨质量。

结果

两组手术并发症发生率无显著差异（P = 0.581）。接受MMO或AMO治疗的患者在随访期间AOFAS、VAS和ICRS评分均显著改善（P < 0.01）。在1年随访时，接受MMO治疗的患者AOFAS评分（92.5±3.3 vs. 89.2±4.9，t = 2.53，P = 0.02）和MOCART评分（67.0±3.7 vs. 63.0±8.5，t = 2.14，P = 0.048）显著高于接受AMO治疗的患者（t = 2.53，P = 0.02）。在2年随访时，AOFAS评分无显著差异（MMO，94.0±4.0 vs. AMO，91.5±5.5，t = 1.63，P = 0.11）；然而，接受MMO治疗的患者VAS疼痛评分（0.3±0.5 vs. 0.8±0.9，t = 2.53，P = 0.02）显著更低，MOCART评分（69.3±5.0 vs. 64.1±7.5，t = 2.59，P = 0.013）显著更高。二次关节镜检查显示，接受MMO治疗的患者截骨部位的软骨质量优于接受AMO治疗的患者（χ = 22.826，P < 0.05），但移植部位无显著差异（χ = 6.049，P = 0.327）。