负重时间对小面积距骨骨软骨损伤微骨折术疗效的影响_《中国修复重建外科杂志》

作者：

李淑媛 ^1,2 , 王俊良曲峰刘畅刘玉杰王志刚魏民 ¹

1解放军总医院骨科（北京，100853）;;
2山东大学附属省立医院手足外科;

关键词：

距骨骨软骨损伤微骨折术负重时间关节功能

DOI：

10.7507/1002-1892.20130146

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的通过术后早期及延迟负重比较，探讨小面积距骨骨软骨损伤（osteochondral lesion of the talus，OLT）行微骨折术后负重时间对疗效的影响，为指导术后康复锻炼提供依据。方法选择2010年3月－2011年9月收治的小面积OLT（ lt; 2 cm2）拟行微骨折术治疗的患者43例，随机分为术后早期负重组（n=22）和延迟负重组（n=21）。两组患者性别、年龄、体重指数、病程、损伤原因、术前疼痛视觉模拟评分（VAS）及美国矫形足踝协会（AOFAS）评分比较，差异均无统计学意义（P gt; 0.05），具有可比性。两组患者均于关节镜下行关节面清理及微骨折术治疗。早期负重组患者术后即在“8”字护踝保护下完全负重，延迟负重组患者6周后开始逐渐负重。结果术中关节镜下测量，早期负重组软骨损伤面积为（1.24 ± 0.35）cm2，延迟负重组为（1.25 ± 0.42）cm2，损伤面积比较差异无统计学意义（t=0.09，P=0.93）；两组软骨损伤分级比较差异亦无统计学意义（Z= —1.45，P=0.15）。术后两组患者均获随访，随访时间12～18个月，平均14.5个月。两组术后各时间点VAS及AOFAS评分均较术前显著改善（P lt; 0.05）；术后3、6、12个月两组间比较，差异均无统计学意义（P gt; 0.05）。早期负重组回归工作时间为（6.35 ± 1.93）个月，显著早于延迟负重组的（8.75 ± 1.48）个月（t= —4.10，P=0.00）。结论对于小面积OLT，微骨折术后早期负重与延迟负重近期疗效相似，但早期负重患者回归工作时间显著提前。

引用本文： 李淑媛,王俊良曲峰刘畅刘玉杰王志刚魏民. 负重时间对小面积距骨骨软骨损伤微骨折术疗效的影响. 中国修复重建外科杂志, 2013, 27(6): 657-661. doi: 10.7507/1002-1892.20130146 复制

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.	刘畅, 施新革, 刘玉杰, 等. 关节镜手术与非手术治疗踝关节退行性骨关节病的疗效比较. 中国修复重建外科杂志, 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. 刘畅, 施新革, 刘玉杰, 等. 关节镜手术与非手术治疗踝关节退行性骨关节病的疗效比较. 中国修复重建外科杂志, 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.

《中国修复重建外科杂志》

负重时间对小面积距骨骨软骨损伤微骨折术疗效的影响

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《中国修复重建外科杂志》

负重时间对小面积距骨骨软骨损伤微骨折术疗效的影响

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