The Analysis of the Efficacy of Ankle Arthroscopic Microfracture in the Treatment of Osteochondral Lesions of the Talus in Different MRI Classifications.
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摘要:
目的 探讨踝关节镜下微骨折术对于不同MRI分期距骨骨软骨损伤患者的临床治疗效果。 方法 48例应用踝关节镜下微骨折术治疗距骨软骨损伤的患者，根据MRI表现分级分成4组，术后随访了解踝关节功能恢复与疼痛缓解情况，比较各分组间疗效差异。 结果 48例平均随访23.7月，对于MRI分级Ⅱ° ，Ⅲ° ，Ⅳ° ，Ⅴ° 损伤患者，微骨折术均能带来良好的功能结果（P < 0.05）；术后AOFAS功能评分总优良率达40例（83.33%），其中Ⅱ°13（100%），Ⅲ° 16（100%）远高于Ⅳ° 7（63.64%），Ⅴ° 4（50%）；AOFAS评分改善在各组之间差异不显著（P > 0.05），VAS评分改善在各组之间具有明显统计学差异（P < 0.05），并且Ⅱ° 和Ⅲ° 损伤患者VAS评分改善明显优于Ⅳ°和Ⅴ°损伤患者（P < 0.05）。 结论 踝关节镜下微骨折术对不同MRI分期距骨骨软骨损伤的临床治疗有差异，Ⅱ° 和Ⅲ° 损伤患者疼痛缓解与术后功能明显优于Ⅳ° 和Ⅴ° 损伤患者。 Abstract:Objective To explore the clinical effects of ankle arthroscopic microfracture used in different MRI classifications of osteochondral lesions of the talus. Methods 48 cases with osteochondral lesions of the talus and treated with microfracture under the ankle arthroscopy were divided into 4 groups according to MRI classification. The functional recovery and pain relief of ankle joint were observed after the follow-up, and the curative effects of each group were compared. Results The average follow-up of 48 cases was 23.7 months. For MRI grade Ⅱ° , Ⅲ° , Ⅳ° , Ⅴ° injury patients, microfracture could bring good functional results （P < 0.05）. The total excellent and good rate of postoperative AOFAS function score was 40 cases （83.33%）, of which Ⅱ° 13 （100%） and Ⅲ° 16（100%） were much higher than Ⅳ° 7（63.64%）, Ⅴ° 4（50%）. There was no significant difference in the improvement of AOFAS score among the four groups （P > 0.05）. And the improvement of VAS score in patients with Ⅱ° and Ⅲ° injuries was significantly better than that in patients with Ⅳ° and Ⅴ° injuries （P < 0.05）. Conclusion The clinical effects of ankle arthroscopic microfracture are different in different MRI classifications of osteochondral lesions of the talus. Pain relief and postoperative function in patients with Ⅱor Ⅲ grade are significantly better than those with Ⅳ or Ⅴ grade. -
Key words:
- Osteochondral lesions of the talus /
- Ankle sprain /
- Microfracture /
- Ankle arthroscopy
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表 1 各组患者一般情况比较
Table 1. Comparison of general conditions in each group
MRI分级 性别（n，%） 年龄（岁，$\bar x \pm s $） 随访时间（月，$\bar x \pm s $） 男 女 Ⅱ° 7（53.85） 6（46.15） 28.07 ± 8.21 28.31 ± 12.70 Ⅲ° 9（16.25） 7（43.75） 28.75 ± 7.73 25.31 ± 9.86 Ⅳ° 5（45.45） 6（54.55） 37.09 ± 12.13 18.00 ± 3.07 Ⅴ° 4（50.00） 4（50.00） 36.25 ± 10.46 27.38 ± 10.36 统计量 0.335 2.680 2.512 P 0.953 0.058 0.071 
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表 2 不同分级OLT术前术后AOFAS改变
Table 2. Preoperative and postoperative changes of AOFAS in different grades of OLT
MRI分级 术前AOFAS [M（P25，P75）] 术后AOFAS [M（P25，P75）] Z P Ⅱ° 51.00（42.50，78.00） 99.00（93.00，100.00） −3.186 0.001* Ⅲ° 44.00（35.00，60.50） 98.00（84.00，100.00） −3.412 0.001* Ⅳ° 37.00（33.00，43.00） 80.00（69.00，84.00） −2.812 0.005* Ⅴ° 39.50（31.50，45.25） 74.00（62.50，79.25） −2.366 0.018* 总体 43.00（37.00，60.50） 88.00（80.00，100.00） −5.907 0.000* χ2 11.535 30.190 P 0.009* 0.000* *P < 0.05。
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表 3 不同分级OLT术前术后VAS改变
Table 3. Preoperative and postoperative changes of VAS in different grades of OLT
MRI分级 术前VAS [M（P25，P75）] 术后VAS [M（P25，P75）] Z P Ⅱ° 7.00（6.00，8.00） 0.00（0.00，1.50） -3.197 0.001* Ⅲ° 8.00（6.00，9.75） 0.50（0.00，2.75） -3.527 0.000* Ⅳ° 9.00（8.00，9.00） 5.00（3.00，5.00） -2.947 0.003* Ⅴ° 9.00（8.00，10.00） 5.00（4.25，6.75） -2.401 0.016* 总体 8.00（6.00，9.00） 2.00（0.00，4.75） -5.982 0.000* χ2 9.528 33.467 P 0.023* 0.000* *P < 0.05。
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表 4 不同分级OLT微骨折术疗效的比较
Table 4. Comparison of the effect of microfracture surgery in different grades of OLT
MRI分级 n 功能改善情况（$\bar x \pm s $） 疼痛缓解情况（$\bar x \pm s $） 术后AOFAS评分优良率n（%） Ⅱ° 13 43.38 ± 14.51 6.31 ± 1.38 13（100） Ⅲ° 16 46.18 ± 13.12 6.88 ± 1.93 16（100） Ⅳ° 11 32.09 ± 15.21 3.55 ± 1.86 7（63.64） Ⅴ° 8 31.25 ± 14.65 3.25 ± 1.49 4（50） 总计 48 40（83.33） F 3.382 13.697 15.273 P 0.026* 0.000* 0.002* *P < 0.05。
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