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[1]張志偉,賴良鵬,李興華,等.聯(lián)合改良雙平面Chevron內(nèi)踝截骨自體骨軟骨移植術(shù)治療HeppleⅤ期距骨骨軟骨損傷的臨床研究[J].中醫(yī)正骨,2022,34(10):38-43.
　ZHANG Zhiwei,LAI Liangpeng,LI Xinghua,et al.A clinical study of intra-articular injection of platelet-rich plasma combined with modified dual-plane Chevron medial malleolar osteotomy and autologous osteochondral transplantation for treatment of Hepple stageⅤosteochondral lesion of the talus[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(10):38-43.
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聯(lián)合改良雙平面Chevron內(nèi)踝截骨自體骨軟骨移植術(shù)治療HeppleⅤ期距骨骨軟骨損傷的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年10期
頁碼:
38-43
欄目:
臨床研究
出版日期:
2022-10-20

文章信息/Info

Title:
A clinical study of intra-articular injection of platelet-rich plasma combined with modified dual-plane Chevron medial malleolar osteotomy and autologous osteochondral transplantation for treatment of Hepple stageⅤosteochondral lesion of the talus
作者:
張志偉1; 賴良鵬2; 李興華3; 劉濤1; 陳陽1; 郭宗澤1
(1.周口骨科醫(yī)院,河南 周口 466000; 2.北京積水潭醫(yī)院,北京 100035; 3.鄭州市骨科醫(yī)院,河南 鄭州 450052)
Author(s):
ZHANG Zhiwei1; LAI Liangpeng2; LI Xinghua3; LIU Tao1; CHEN Yang1; GUO Zongze1
1.Zhoukou Orthopaedic Hospital,Zhoukou 466000,Henan,China 2.Beijing Jishuitan Hospital,Beijing 100035,China 3.Zhengzhou Orthopedics Hospital,Zhengzhou 450052,Henan,China
關(guān)鍵詞:
踝損傷;  距骨;  軟骨;  骨囊腫;  骨移植;  截骨術(shù);  注射; 關(guān)節(jié)內(nèi);  富血小板血漿;  臨床試驗
Keywords:
transplantation;  osteotomy;  injections; intra-articular;  platelet-rich plasma;  clinical trial
摘要:
目的:觀察富血小板血漿(platelet rich plasma,PRP)關(guān)節(jié)腔注射聯(lián)合改良雙平面Chevron內(nèi)踝截骨自體骨軟骨移植術(shù)治療HeppleⅤ期距骨骨軟骨損傷(osteochondral lesion of the talus,OLT)的療效和安全性。方法:將符合要求的38例OLT患者隨機分為2組,每組19例。自體骨軟骨移植組采用改良雙平面Chevron內(nèi)踝截骨自體骨軟骨移植術(shù)治療; 聯(lián)合治療組在改良雙平面Chevron內(nèi)踝截骨自體骨軟骨移植術(shù)治療的基礎(chǔ)上,聯(lián)合PRP關(guān)節(jié)腔注射治療。比較2組患者的美國足與踝關(guān)節(jié)協(xié)會(American Orthopedic Foot and Ankle Society,AOFAS)踝與后足評分、踝關(guān)節(jié)Karlsson-Peterson評分、踝關(guān)節(jié)活動度、踝關(guān)節(jié)疼痛視覺模擬量表(visual analogue scale,VAS)評分及治療和隨訪期間的并發(fā)癥發(fā)生情況。結(jié)果:①AOFAS踝與后足評分。術(shù)前2組患者的AOFAS踝與后足評分比較,差異無統(tǒng)計學(xué)意義(t=0.081,P=0.936); 術(shù)后1年,2組患者的AOFAS踝與后足評分均較術(shù)前提高[(61.57±6.98)分,(82.36±7.85)分,t=8.627,P=0.000;(61.39±6.79)分,(89.24±8.12)分,t=11.469,P=0.000]; 自體骨軟骨移植組術(shù)后1年的AOFAS踝與后足評分低于聯(lián)合治療組(t=2.655,P=0.012)。②踝關(guān)節(jié)Karlsson-Peterson評分。術(shù)前2組患者的踝關(guān)節(jié)Karlsson-Peterson評分比較,差異無統(tǒng)計學(xué)意義(t=0.060,P=0.953); 術(shù)后1年,2組患者的踝關(guān)節(jié)Karlsson-Peterson評分均較術(shù)前提高[(59.14±6.24)分,(80.24±7.21)分,t=9.646,P=0.000;(59.02±6.11)分,(85.33±7.91)分,t=11.474,P=0.000]; 自體骨軟骨移植組術(shù)后1年的踝關(guān)節(jié)Karlsson-Peterson評分低于聯(lián)合治療組(t=2.073,P=0.045)。③踝關(guān)節(jié)活動度。術(shù)前2組患者的踝關(guān)節(jié)活動度比較,差異無統(tǒng)計學(xué)意義(t=0.093,P=0.926); 術(shù)后1年,2組患者的踝關(guān)節(jié)活動度均較術(shù)前增大(46.11°±4.23°,58.91°±6.22°,t=7.417,P=0.000; 45.98°±4.37°,65.03°±6.47°,t=10.635,P=0.000); 自體骨軟骨移植組術(shù)后1年的踝關(guān)節(jié)活動度小于聯(lián)合治療組(t=2.972,P=0.005)。④踝關(guān)節(jié)疼痛VAS評分。術(shù)前2組患者的踝關(guān)節(jié)疼痛VAS評分比較,差異無統(tǒng)計學(xué)意義(t=0.171,P=0.865); 術(shù)后1年,2組患者的踝關(guān)節(jié)疼痛VAS評分均較術(shù)前降低[(7.55±1.12)分,(3.02±0.34)分,t=16.870,P=0.000;(7.49±1.04)分,(2.13±0.22)分,t=21.979,P=0.000]; 自體骨軟骨移植組術(shù)后1年的踝關(guān)節(jié)疼痛VAS評分高于聯(lián)合治療組(t=9.580,P=0.000)。⑤并發(fā)癥。2組各有1例患者出現(xiàn)下肢深靜脈血栓,經(jīng)常規(guī)抗凝治療后癥狀均消失。2組患者的并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學(xué)意義(P=1.000)。結(jié)論:采用PRP關(guān)節(jié)腔注射聯(lián)合改良雙平面Chevron內(nèi)踝截骨自體骨軟骨移植術(shù)治療HeppleⅤ期OLT,可有效減輕患者的踝關(guān)節(jié)疼痛、增加踝關(guān)節(jié)活動度、改善踝關(guān)節(jié)功能,效果優(yōu)于單純改良雙平面Chevron內(nèi)踝截骨自體骨軟骨移植術(shù),而且安全性較好。
Abstract:
Objective:To observe the efficacy and safety of intra-articular injection of platelet-rich plasma(PRP)combined with modified dual-plane Chevron medial malleolar osteotomy(MMO)and autologous osteochondral transplantation(AOT)in the treatment of Hepple stageⅤosteochondral lesion of the talus(OLT).Methods:Thirty-eight eligible OLT patients were enrolled in the study and were randomly divided into AOT group and combination treatment group,19 cases in each group.All patients in the 2 groups were treated with modified dual-plane Chevron MMO and AOT,while the ones in the combination treatment group were further treated with intra-articular injection of PRP.The American Orthopedic Foot and Ankle Society(AOFAS)ankle-hind score,Karlsson-Peterson ankle score,ankle range of motion(ROM),ankle pain visual analogue scale(VAS)score and complications during the treatment and follow-up period were compared between the 2 groups.Results:①There was no significant difference in AOFAS ankle-hind score between the 2 groups before the surgery(t=0.081,P=0.936).The AOFAS ankle-hind scores increased in the 2 groups at postsurgical month 12 compared to pre-surgery(61.57±6.98 vs 82.36±7.85 points,t=8.627,P=0.000; 61.39±6.79 vs 89.24±8.12 points,t=11.469,P=0.000),and it was lower in AOT group compared to combination treatment group(t=2.655,P=0.012)②There was no significant difference in Karlsson-Peterson ankle score between the 2 groups before the surgery(t=0.060,P=0.953).The Karlsson-Peterson ankle scores increased in the 2 groups at postsurgical month 12 compared to pre-surgery(59.14±6.24 vs 80.24±7.21 points,t=9.646,P=0.000; 59.02±6.11 vs 85.33±7.91 points,t=11.474,P=0.000),and it was lower in AOT group compared to combination treatment group(t=2.073,P=0.045).③There was no significant difference in ankle ROM between the 2 groups before the surgery(t=0.093,P=0.926).The ankle ROM increased in the 2 groups at postsurgical month 12 compared to pre-surgery(46.11±4.23 vs 58.91±6.22 degrees,t=7.417,P=0.000; 45.98±4.37 vs 65.03±6.47 degrees,t=10.635,P=0.000),and it was smaller in AOT group compared to combination treatment group(t=2.972,P=0.005).④There was no significant difference in ankle pain VAS score between the 2 groups before the surgery(t=0.171,P=0.865).The ankle pain VAS scores decreased in the 2 groups at postsurgical month 12 compared to pre-surgery(7.55±1.12 vs 3.02±0.34 points,t=16.870,P=0.000; 7.49±1.04 vs 2.13±0.22 points,t=21.979,P=0.000),and it was higher in AOT group compared to combination treatment group(t=9.580,P=0.000).⑤The lower-extremity deep venous thrombosis was found in 1 patient in each group,and the symptoms disappeared after treatment with conventional anticoagulation therapy.There was no significant difference in the incidence of complication between the 2 groups(P=1.000).Conclusion:Intra-articular injection of PRP combined with modified dual-plane Chevron MMO and AOT can effectively relieve ankle pain,increase ankle ROM and improve ankle function in the treatment of Hepple stage V OLT,and its clinical efficacy is better than that of modified dual-plane Chevron MMO and AOT with high safety.

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通訊作者:郭宗澤 E-mail:[email protected]
更新日期/Last Update: 1900-01-01