負重時間對小面積距骨骨軟骨損傷微骨折術療效的影響_《中國修復重建外科雜志》

作者：

李淑媛 ^1,2 , 王俊良曲峰劉暢劉玉杰王志剛魏民 ¹

1解放軍總醫院骨科（北京，100853）;;
2山東大學附屬省立醫院手足外科;

關鍵詞：

距骨骨軟骨損傷微骨折術負重時間關節功能

DOI：

10.7507/1002-1892.20130146

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目的通過術后早期及延遲負重比較，探討小面積距骨骨軟骨損傷（osteochondral lesion of the talus，OLT）行微骨折術后負重時間對療效的影響，為指導術后康復鍛煉提供依據。方法選擇2010年3月－2011年9月收治的小面積OLT（ lt; 2 cm2）擬行微骨折術治療的患者43例，隨機分為術后早期負重組（n=22）和延遲負重組（n=21）。兩組患者性別、年齡、體重指數、病程、損傷原因、術前疼痛視覺模擬評分（VAS）及美國矯形足踝協會（AOFAS）評分比較，差異均無統計學意義（P gt; 0.05），具有可比性。兩組患者均于關節鏡下行關節面清理及微骨折術治療。早期負重組患者術后即在“8”字護踝保護下完全負重，延遲負重組患者6周后開始逐漸負重。結果術中關節鏡下測量，早期負重組軟骨損傷面積為（1.24 ± 0.35）cm2，延遲負重組為（1.25 ± 0.42）cm2，損傷面積比較差異無統計學意義（t=0.09，P=0.93）；兩組軟骨損傷分級比較差異亦無統計學意義（Z= —1.45，P=0.15）。術后兩組患者均獲隨訪，隨訪時間12～18個月，平均14.5個月。兩組術后各時間點VAS及AOFAS評分均較術前顯著改善（P lt; 0.05）；術后3、6、12個月兩組間比較，差異均無統計學意義（P gt; 0.05）。早期負重組回歸工作時間為（6.35 ± 1.93）個月，顯著早于延遲負重組的（8.75 ± 1.48）個月（t= —4.10，P=0.00）。結論對于小面積OLT，微骨折術后早期負重與延遲負重近期療效相似，但早期負重患者回歸工作時間顯著提前。

引用本文： 李淑媛,王俊良曲峰劉暢劉玉杰王志剛魏民. 負重時間對小面積距骨骨軟骨損傷微骨折術療效的影響. 中國修復重建外科雜志, 2013, 27(6): 657-661. doi: 10.7507/1002-1892.20130146 復制

1.	Orr JD, Dutton JR, Fowler JT. Anatomic location and morphology of symptomatic, operatively treated osteochondral lesions of the talus. Foot Ankle Int, 2012, 33(12): 1051-1057.
2.	Giannini S, Buda R, Battaglia M, et al. One-step repair in talar osteochondral lesions: 4-year clinical results and t2-mapping capability in outcome prediction. Am J Sports Med, 2013, 41(3): 511-518.
3.	Kim YS, Park EH, Kim YC, et al. Factors associated with the clinical outcomes of the osteochondral autograft transfer system inosteochondral lesions of the talus: second-look arthroscopic evaluation. Am J Sports Med, 2012, 40(12): 2709-2719.
4.	劉暢, 施新革, 劉玉杰, 等. 關節鏡手術與非手術治療踝關節退行性骨關節病的療效比較. 中國修復重建外科雜志, 2012, 26(11): 1315-1318.
5.	Kok AC, Dunnen SD, Tuijthof GJ, et al. Is technique performance a prognostic factor in bone marrow stimulation of the talus? J Foot Ankle Surg, 2012, 51(6): 777-782.
6.	Becher C, Thermann H. Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int, 2005, 26(8): 583-589.
7.	Ferkel RD, Zanotti RM, Komenda GA, et al. Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med, 2008, 36(9): 1750-1762.
8.	Kuni B, Schmitt H, Chloridis D, et al. Clinical and MRI results after microfracture of osteochondral lesions of the talus. Arch Orthop Trauma Surg, 2012, 132(12): 1765-1771.
9.	Bae DK, Yoon KH, Song SJ. Cartilage healing after microfracture in osteoarthritic knees. Arthroscopy, 2006, 22(4): 367-374.
10.	Gobbi A, Francisco RA, Lubowitz JH, et al. Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy, 2006, 22(10): 1085-1092.
11.	Chuckpaiwong B, Berkson EM, Theodore GH. Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy, 2008, 24(1): 106-112.
12.	Lee DH, Lee KB, Jung ST, et al. Comparison of early versus delayed weightbearing outcomes after microfracture for small to midsized osteochondral lesions of the talus. Am J Sports Med, 2012, 40(9): 2023-2028.
13.	Gobbi A, Nunag P, Malinowski K. Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc, 2005, 13(3): 213-221.
14.	Marder RA, Hopkins G Jr, Timmerman LA. Arthroscopic microfracture of chondral defects of the knee: a comparison of two postoperative treatments. Arthroscopy, 2005, 21(2): 152-158.
15.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
16.	Cheng MS, Ferkel RD, Applegate GR. Osteochondral lesions of the talus: a radiologic and surgical comparison. Proceeding of Annual Meeting of the American Academy of Orthopedic Surgeons. New Orleans: [S.n], 1995.
17.	Backus JD, Viens NA, Nunley JA. Arthroscopic treatment of osteochondral lesions of the talus: microfracture and drilling versus debridement. J Surg Orthop Adv, 2012, 21(4): 218-222.
18.	Lee KB, Bai LB, Chung JY, et al. Arthroscopic microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc, 2010, 18(2): 247-253.
19.	Becher C, Driessen A, Hess T, et al. Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up. Knee Surg Sports Traumatol Arthrosc, 2010, 18(5): 656-663.
20.	Mithoefer K, Williams RJ 3rd, Warren RF, et al. High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med, 2006, 34(9): 1413-1418.
21.	Hensley CP, Sum J. Physical therapy intervention for a former power lifter after arthroscopic microfracture procedure for grade iv glenohumeral chondral defects. Int J Sports Phys Ther, 2011, 6(1): 10-26.

1. Orr JD, Dutton JR, Fowler JT. Anatomic location and morphology of symptomatic, operatively treated osteochondral lesions of the talus. Foot Ankle Int, 2012, 33(12): 1051-1057.
2. Giannini S, Buda R, Battaglia M, et al. One-step repair in talar osteochondral lesions: 4-year clinical results and t2-mapping capability in outcome prediction. Am J Sports Med, 2013, 41(3): 511-518.
3. Kim YS, Park EH, Kim YC, et al. Factors associated with the clinical outcomes of the osteochondral autograft transfer system inosteochondral lesions of the talus: second-look arthroscopic evaluation. Am J Sports Med, 2012, 40(12): 2709-2719.
4. 劉暢, 施新革, 劉玉杰, 等. 關節鏡手術與非手術治療踝關節退行性骨關節病的療效比較. 中國修復重建外科雜志, 2012, 26(11): 1315-1318.
5. Kok AC, Dunnen SD, Tuijthof GJ, et al. Is technique performance a prognostic factor in bone marrow stimulation of the talus? J Foot Ankle Surg, 2012, 51(6): 777-782.
6. Becher C, Thermann H. Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int, 2005, 26(8): 583-589.
7. Ferkel RD, Zanotti RM, Komenda GA, et al. Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med, 2008, 36(9): 1750-1762.
8. Kuni B, Schmitt H, Chloridis D, et al. Clinical and MRI results after microfracture of osteochondral lesions of the talus. Arch Orthop Trauma Surg, 2012, 132(12): 1765-1771.
9. Bae DK, Yoon KH, Song SJ. Cartilage healing after microfracture in osteoarthritic knees. Arthroscopy, 2006, 22(4): 367-374.
10. Gobbi A, Francisco RA, Lubowitz JH, et al. Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy, 2006, 22(10): 1085-1092.
11. Chuckpaiwong B, Berkson EM, Theodore GH. Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy, 2008, 24(1): 106-112.
12. Lee DH, Lee KB, Jung ST, et al. Comparison of early versus delayed weightbearing outcomes after microfracture for small to midsized osteochondral lesions of the talus. Am J Sports Med, 2012, 40(9): 2023-2028.
13. Gobbi A, Nunag P, Malinowski K. Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc, 2005, 13(3): 213-221.
14. Marder RA, Hopkins G Jr, Timmerman LA. Arthroscopic microfracture of chondral defects of the knee: a comparison of two postoperative treatments. Arthroscopy, 2005, 21(2): 152-158.
15. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
16. Cheng MS, Ferkel RD, Applegate GR. Osteochondral lesions of the talus: a radiologic and surgical comparison. Proceeding of Annual Meeting of the American Academy of Orthopedic Surgeons. New Orleans: [S.n], 1995.
17. Backus JD, Viens NA, Nunley JA. Arthroscopic treatment of osteochondral lesions of the talus: microfracture and drilling versus debridement. J Surg Orthop Adv, 2012, 21(4): 218-222.
18. Lee KB, Bai LB, Chung JY, et al. Arthroscopic microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc, 2010, 18(2): 247-253.
19. Becher C, Driessen A, Hess T, et al. Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up. Knee Surg Sports Traumatol Arthrosc, 2010, 18(5): 656-663.
20. Mithoefer K, Williams RJ 3rd, Warren RF, et al. High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med, 2006, 34(9): 1413-1418.
21. Hensley CP, Sum J. Physical therapy intervention for a former power lifter after arthroscopic microfracture procedure for grade iv glenohumeral chondral defects. Int J Sports Phys Ther, 2011, 6(1): 10-26.

《中國修復重建外科雜志》

負重時間對小面積距骨骨軟骨損傷微骨折術療效的影響

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《中國修復重建外科雜志》

負重時間對小面積距骨骨軟骨損傷微骨折術療效的影響

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