CAJ | 학술논문

目的对比研究自体骨软骨移植术和骨软骨折块摘除钻孔术治疗踝部骨折伴随的急性Ⅲ、Ⅳ型距骨骨软骨骨折的临床效果.方法 2002年5月至2007年8月,38例踝部骨折伴随的急性Ⅲ、Ⅳ型距骨骨软骨骨折,术中明确距骨骨软骨骨折的部位以及范围.20例折块摘除后,自同侧膝关节非负重区钻取骨软骨柱,采取打压固定技术将骨软骨柱植入受区的孔中,为移植组;18例骨软骨折块摘除后行钻孔术为钻孔组.对比观察研究两组患者踝关节的功能、X线以及MRI表现.结果移植组随访1.5～4.0年,平均(2.92±0.65)年,钻孔组随访2.5～5.0年,平均(3.02±0.83)年.7例行多柱移植,13例行单柱移植.根据Baird和Jackson踝关节评分系统进行功能评分:移植组平均(89.85±4.83)分,钻孔组平均(84.28±5.65)分,两组比较差异有统计学意义(t=3.277.P=0.002);X线片示移植组3例踝关节发生创伤性关节炎,发生率为15.0%(3/20),钻孔组8例踝关节发生创伤性关节炎,发生率为44.4%(8/18),两组比较差异有统计学意义(χ2=31.7,P<0.05);MRI显示移植组3例骨软骨柱松动吸收,发生距骨剥脱性骨软骨炎,占15.0%(3/20),其余修复的关节面平滑,骨软骨柱与周围组织结合良好;钻孔组6例发生距骨剥脱性骨软骨炎,发生率为33.3%(6/18),两组比较差异有统计学意义(χ2=39.6,P<0.05);两组膝关节均无远期供区并发症.结论自体骨软骨移植治疗踝部骨折伴随的急性Ⅲ、Ⅳ型距骨骨软骨骨折是一种有效的手术方法 ,降低了踝关节创伤性关节炎和距骨剥脱性骨软骨炎的发生率,提高了踝关节的功能.
목적 대비연구자체골연골이식술화골연골절괴적제찬공술치료과부골절반수적급성Ⅲ、Ⅳ형거골골연골골절적림상효과.방법 2002년5월지2007년8월,38례과부골절반수적급성Ⅲ、Ⅳ형거골골연골골절,술중명학거골골연골골절적부위이급범위.20례절괴적제후,자동측슬관절비부중구찬취골연골주,채취타압고정기술장골연골주식입수구적공중,위이식조;18례골연골절괴적제후행찬공술위찬공조.대비관찰연구량조환자과관절적공능、X선이급MRI표현.결과 이식조수방1.5～4.0년,평균(2.92±0.65)년,찬공조수방2.5～5.0년,평균(3.02±0.83)년.7례행다주이식,13례행단주이식.근거Baird화Jackson과관절평분계통진행공능평분:이식조평균(89.85±4.83)분,찬공조평균(84.28±5.65)분,량조비교차이유통계학의의(t=3.277.P=0.002);X선편시이식조3례과관절발생창상성관절염,발생솔위15.0%(3/20),찬공조8례과관절발생창상성관절염,발생솔위44.4%(8/18),량조비교차이유통계학의의(χ2=31.7,P<0.05);MRI현시이식조3례골연골주송동흡수,발생거골박탈성골연골염,점15.0%(3/20),기여수복적관절면평활,골연골주여주위조직결합량호;찬공조6례발생거골박탈성골연골염,발생솔위33.3%(6/18),량조비교차이유통계학의의(χ2=39.6,P<0.05);량조슬관절균무원기공구병발증.결론 자체골연골이식치료과부골절반수적급성Ⅲ、Ⅳ형거골골연골골절시일충유효적수술방법 ,강저료과관절창상성관절염화거골박탈성골연골염적발생솔,제고료과관절적공능.
Objective To compare autologous esteochondral transplantation and osteochondral drilling in treatment of osteochondral fracture lesions(types Ⅲ＆IV)on the talus dome associated with ankle fracture. Methods There were 38 patients with osteochondral fracture defects(types Ⅲ ＆IV)of the talar dome associated with ankle fracture.The position and size of the fracture deflects were defined during operation.The procedures involved removal of the fracture segments and drilling for 18 cases(Drilling Group) and transplantation with grafts harvested from the ipsilateral knee for 20 cases(Transplantation Group). Transplantation Was conducted by harvesting osteochondral cylinders from non-weight bearing surface of the ipsilateral knee and implanting the donor grafts into the recipient holes of talus to repair cartilaginous defects with press-fit technique.Single donor transplantation or mosaicplasty was adopted.The outcomes were as- sessed on the basis of ankle functional rating Scores.radiographic findings and MRI findings.Results The patients were followed up for 1.5 to 4.0(mean,2.92±0.65)years in Transplantation Group,and 2.5 to 5[mean,3.02±0.83)years in Drilling Group.Ankle funetions were rated by the Baird and Jackson e- valuation system.The average score was 89.85±4.83 for Transplantation Group and 84.28.4±5.65 for Drilling Group(P=0.002).Three patients in Transplantation Group(15.0%)and 8 patients in DriHi Group(44.4%)had posttraumatic arthritis(x2=31.7,P<0.05).Six patients had osteochondritis dis-z secans in Drilling Group(33.3%).In Transplantation Group,the grafts showed excellent bony integration with surrounding tissues and congruity of the articular surface except in 3 patients who had osteochondritis dissecans(15.0%)(x2=39.6,P<0.05). Conclusion Autogenous osteochondral transplantation using ipsilateral knee osteochondral grafte is a better snrgical procedure for treating acute local osteoehondral fracture lesions of the talus associated with ankle fracture than osteochondral drilling.because it improves the functional recovery of the ankle and reduces postoperative complications.