[1]张志伟,赖良鹏,李兴华,等.联合改良双平面Chevron内踝截骨自体骨软骨移植术治疗HeppleⅤ期距骨骨软骨损伤的临床研究[J].中医正骨,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.
点击复制

联合改良双平面Chevron内踝截骨自体骨软骨移植术治疗HeppleⅤ期距骨骨软骨损伤的临床研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年10期
页码:
38-43
栏目:
临床研究
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:
张志伟1; 赖良鹏2; 李兴华3; 刘涛1; 陈阳1; 郭宗泽1
(1.周口骨科医院,河南 周口 466000; 2.北京积水潭医院,北京 100035; 3.郑州市骨科医院,河南 郑州 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
关键词:
踝损伤;  距骨;  软骨;  骨囊肿;  骨移植;  截骨术;  注射; 关节内;  富血小板血浆;  临床试验
Keywords:
transplantation;  osteotomy;  injections; intra-articular;  platelet-rich plasma;  clinical trial
摘要:
目的:观察富血小板血浆(platelet rich plasma,PRP)关节腔注射联合改良双平面Chevron内踝截骨自体骨软骨移植术治疗HeppleⅤ期距骨骨软骨损伤(osteochondral lesion of the talus,OLT)的疗效和安全性。方法:将符合要求的38例OLT患者随机分为2组,每组19例。自体骨软骨移植组采用改良双平面Chevron内踝截骨自体骨软骨移植术治疗; 联合治疗组在改良双平面Chevron内踝截骨自体骨软骨移植术治疗的基础上,联合PRP关节腔注射治疗。比较2组患者的美国足与踝关节协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足评分、踝关节Karlsson-Peterson评分、踝关节活动度、踝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分及治疗和随访期间的并发症发生情况。结果:①AOFAS踝与后足评分。术前2组患者的AOFAS踝与后足评分比较,差异无统计学意义(t=0.081,P=0.936); 术后1年,2组患者的AOFAS踝与后足评分均较术前提高[(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]; 自体骨软骨移植组术后1年的AOFAS踝与后足评分低于联合治疗组(t=2.655,P=0.012)。②踝关节Karlsson-Peterson评分。术前2组患者的踝关节Karlsson-Peterson评分比较,差异无统计学意义(t=0.060,P=0.953); 术后1年,2组患者的踝关节Karlsson-Peterson评分均较术前提高[(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]; 自体骨软骨移植组术后1年的踝关节Karlsson-Peterson评分低于联合治疗组(t=2.073,P=0.045)。③踝关节活动度。术前2组患者的踝关节活动度比较,差异无统计学意义(t=0.093,P=0.926); 术后1年,2组患者的踝关节活动度均较术前增大(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); 自体骨软骨移植组术后1年的踝关节活动度小于联合治疗组(t=2.972,P=0.005)。④踝关节疼痛VAS评分。术前2组患者的踝关节疼痛VAS评分比较,差异无统计学意义(t=0.171,P=0.865); 术后1年,2组患者的踝关节疼痛VAS评分均较术前降低[(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]; 自体骨软骨移植组术后1年的踝关节疼痛VAS评分高于联合治疗组(t=9.580,P=0.000)。⑤并发症。2组各有1例患者出现下肢深静脉血栓,经常规抗凝治疗后症状均消失。2组患者的并发症发生率比较,差异无统计学意义(P=1.000)。结论:采用PRP关节腔注射联合改良双平面Chevron内踝截骨自体骨软骨移植术治疗HeppleⅤ期OLT,可有效减轻患者的踝关节疼痛、增加踝关节活动度、改善踝关节功能,效果优于单纯改良双平面Chevron内踝截骨自体骨软骨移植术,而且安全性较好。
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.

参考文献/References:

[1] TOTLIS T,MARÍN FERMÍN T,KALIFIS G,et al.Arthroscopic debridement for focal articular cartilage lesions of the knee:a systematic review[J].Surgeon,2021,19(6):356-364.
[2] HEPPLE S,WINSON I G,GLEW D.Osteochondral lesions of the talus:a revised classification[J].Foot Ankle Int,1999,20(12):789-793.
[3] 刘林,杨宗宇,刘核达,等.自体带骨膜髂骨移植联合PRP治疗HeppleⅤ期距骨骨软骨损伤[J].中国矫形外科杂志,2021,29(2):154-157.
[4] 赵良军,许放,缪季峰,等.改良双平面Chevron内踝截骨自体骨软骨移植治疗距骨软骨损伤合并骨囊肿的疗效分析[J].中华创伤骨科杂志,2021,23(4):306-311.
[5] FUGGLE N R,COOPER C,OREFFO R,et al.Alternative and complementary therapies in osteoarthritis and cartilage repair[J].Aging Clin Exp Res,2020,32(4):547-560.
[6] 潘跃,陈波,陈旭辉,等.关节镜微骨折术与自体富血小板血浆治疗距骨软骨损伤的临床观察[J].浙江创伤外科,2020,25(4):732-734.
[7] 王正义.足踝外科学[M].北京:人民卫生出版社,2006:98-99.
[8] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:231-232.
[9] KARLSSON J,PETERSON L.Evaluation of ankle joint function:the use of a scoring scale[J].Foot,1991,1(1):15-19.
[10] WANG C C,YANG K C,CHEN I H.Current treatment concepts for osteochondral lesions of the talus[J].Tzu Chi Med J,2021,33(3):243-249.
[11] 李琦,尚林,贾光辉,等.自体骨软骨移植结合中药薰洗治疗HeppleⅤ型距骨骨软骨损伤[J].中医正骨,2021,33(1):63-66.
[12] 娄磊,俞光荣,倘艳锋,等.纯富血小板血浆关节腔注射联合手术治疗HeppleⅤ型距骨骨软骨损伤[J].中医正骨,2020,32(12):25-30.
[13] 康健,付志厚,王冰,等.自体骨软骨移植治疗HeppleⅤ型距骨骨软骨损伤的临床疗效评价[J].生物骨科材料与临床研究,2021,18(1):85-88.
[14] 陈忠益,王雪松,张晋,等.自体骨软骨移植术治疗HeppleⅤ型距骨骨软骨损伤[J].中国运动医学杂志,2020,39(11):858-862.
[15] 尼加提·阿不力米提,周开磊,李纲,等.双平面截骨加自体骨软骨移植治疗距骨骨软骨损伤合并距骨囊肿的临床效果[J].中华外科杂志,2020,58(3):220-224.
[16] 王勇,张宇,刘英,等.富血小板血浆关节腔注射在关节镜下微骨折术治疗距骨骨软骨损伤中的应用[J].中医正骨,2022,34(5):6-12.
[17] 陆锋艺,庄汝杰.富血小板血浆治疗距骨骨软骨损伤的研究进展[J].中医正骨,2021,33(9):52-53.
[18] LE A,ENWEZE L,DEBAUN M R,et al.Current clinical recommendations for use of platelet-rich plasma[J].Curr Rev Musculoskelet Med,2018,11(4):624-634.
[19] 李嘉晖,罗明辉,潘建科,等.关节腔注射富血小板血浆辅助关节镜下微骨折术治疗距骨骨软骨损伤疗效、安全性的Meta分析[J].山东医药,2022,62(11):66-69.
[20] PAGET L,REURINK G,DE VOS R J,et al.Effect of platelet-rich plasma injections vs placebo on ankle symptoms and function in patients with ankle osteoarthritis:a rando-mized clinical trial[J].JAMA,2021,326(16):1595-1605.
[21] HENNING P R,GREAR B J.Platelet-rich plasma in the foot and ankle[J].Curr Rev Musculoskelet Med,2018,11(4):616-623.
[22] PAGET L,BIERMA-ZEINSTRA S,GOEDEGEBUURE S,et al.Platelet-rich plasma injection management for ankle osteoarthritis study(PRIMA):protocol of a dutch multicentre,stratified,block-randomised,double-blind,placebo-controlled trial[J].BMJ Open,2019,9(10):e030961.
[23] VANNINI F,DI MATTEO B,FILARDO G,et al.Platelet-rich plasma for foot and ankle pathologies:a systematic review[J].Foot Ankle Surg,2014,20(1):2-9.
[24] 方亮,董睿,金红婷,等.富血小板血浆关节腔注射联合补肾活血方口服治疗膝骨关节炎肝肾亏虚证的临床研究[J].中医正骨,2018,30(11):1-5.
[25] 邱元洲,高彦军,王士波,等.关节镜下微骨折联合自体富血小板血浆治疗HeppleⅢ～Ⅳ型距骨骨软骨损伤[J].实用骨科杂志,2020,26(2):182-184.
[26] 魏芳远,曲峰,王显军,等.富含血小板血浆通过抑制基质细胞衍生因子-1/CxC趋化因子受体4通路治疗距骨软骨损伤的作用机制[J].中国临床医生杂志,2019,47(7):834-837.
[27] 连伟飞,廖明新,黄杰鑫,等.自体松质骨移植联合富血小板血浆治疗距骨骨软骨损伤近期疗效分析[J].中国骨与关节损伤杂志,2021,36(4):434-436.

相似文献/References:

[1]韦健,容安,周建飞,等.腓骨延长术治疗外踝开放性骨缺损[J].中医正骨,2016,28(10):62.
[2]蒋巧玲,郭水洁,叶艳君,等.应用SPECT-CT图像融合技术评价锝〖99Tc〗-亚甲基二膦酸盐治疗距骨缺血性坏死的临床疗效[J].中医正骨,2017,29(02):31.
[3]董秀珍.腓骨头复合组织瓣移植治疗儿童内踝骨及皮肤软组织缺损[J].中医正骨,2017,29(06):59.
[4]杨宗宇,刘非,崔亮,等.踝关节镜手术联合改良Bromstrm术治疗慢性踝关节不稳合并骨软骨损伤[J].中医正骨,2017,29(08):72.
[5]张鑫,刘辉,刘波.郑氏形意拳配合中药薰洗治疗慢性踝关节不稳[J].中医正骨,2018,30(12):50.
[6]俞益火,谢嫚花,周文军,等.中医理筋正骨手法治疗慢性踝关节损伤的临床研究[J].中医正骨,2019,31(03):20.
　YU Yihuo,XIE Manhua,ZHOU Wenjun,et al.A clinical study of TCM sinew-adjusting and bone-setting manipulation for treatment of chronic ankle injury[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(10):20.
[7]康永奇,李豪,李华兵.切开复位钢板内固定治疗Pilon骨折[J].中医正骨,2019,31(06):60.
[8]王建超,胡秀良,苗旭东,等.自体带骨膜髂骨植骨联合螺钉内固定治疗距骨软骨损伤[J].中医正骨,2019,31(09):71.
[9]邓刚,蔡幸健,王一海,等.踝关节镜下清理联合自体肌腱移植治疗慢性踝关节外侧不稳[J].中医正骨,2020,32(06):69.
[10]赵洪洲,范桐顺,刘丽民.非单纯性下胫腓联合损伤评估的研究进展[J].中医正骨,2020,32(09):54.

备注/Memo

备注/Memo:
通讯作者:郭宗泽 E-mail:guozz67826@163.com
更新日期/Last Update: 1900-01-01