Periosteum-covered iliac crest autografts for treatment of severe osteochondral lesions of talus
10.3760/cma.j.cn501098-20210329-00206
- VernacularTitle:自体带骨膜髂骨移植治疗重度距骨软骨损伤
- Author:
Yuhai MA
1
;
Yu LIU
;
Changsong CHEN
;
Xiaohua HU
;
Huadong YIN
;
Jianxin HE
;
Xiaofeng ZHU
;
Chunhu WU
Author Information
1. 武警浙江省总队医院骨科，杭州 310012
- Keywords:
Ilium;
Fractures，cartilage;
Periosteum;
Bone transplantation
- From:
Chinese Journal of Trauma
2021;37(7):635-640
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical efficacy of periosteum-covered iliac crest autografts for treatment of severe osteochondral lesions of talus （OCLTs）.Methods:A retrospective case series study was used to analyze the clinical data of 26 patients with severe OCLTs treated at Zhejiang Armed Police Corps Hospital from January 2013 to October 2019. There were 21 males and 5 females，aged 17-49 years ［（36.3 ± 10.9）years］. All patients were treated using periosteum-covered iliac crest autografts. The visual analogue scale （VAS），American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot score and ankle joint range of motion （ROM） were assessed before operation，6 months after operation and at the last follow-up （≥ 12 months）. The area of talus injury with MRI at the same level was recorded before operation and at the last follow-up. The healing of talus and joint surface was detected with CT at the last follow-up. The healing of the incision and osteotomy site and complications were observed.Results:All patients were followed for 12 to 22 months［（15.1 ± 3.2）months］. The VAS was （2.4 ± 0.9）points and （1.7 ± 0.6）points at postoperative 6 months and at the last follow-up，significantly lower than the preoperative （5.4 ± 1.2）points （ P < 0.01）. Meanwhile，the VAS at the last follow-up was significantly lower than that at postoperative 6 months （ P < 0.01）. The AOFAS ankle-hindfoot score was （71.7 ± 7.8）points and （87.8 ± 6.2） points at postoperative 6 months and at the last follow-up，significantly lower than the preoperative （66.5 ± 7.5） points （ P < 0.01）. Meanwhile，the AOFAS ankle-hindfoot at the last follow-up was significantly lower than that at postoperative 6 months （ P < 0.01）. The ankle ROM was （58.4 ± 5.5）° and （70.0 ± 4.9）° at postoperative 6 months and at the last follow-up，significantly improved when compared to the preoperative （42.3 ± 8.1）° （ P < 0.01）. Meanwhile，the ankle ROM at the last follow-up was significantly improved when compared to that at postoperative 6 months （ P < 0.01）. The area of talus injury with MRI at the same level was 0.67（0.55，0.89）cm 2 at the last follow-up，significantly improved when compared to preoperative 2.64（1.98，3.68）cm 2 （ P < 0.01）. The transplantation had neither obvious defects nor joint surface steps based on CT findings. All surgical incisions were healed by first intention. There were no complications such as incision infection，skin necrosis，nonunion of osteotomy，malunion or severe ankle joint disorder except that 8 patients had residual local subchondral bone?marrow?edema-like?signal?and 2 patients showed delayed healing of medial malleolus osteotomy. Conclusion:For patients with severe OCLTs，periosteum-covered iliac crest autografts can effectively relieve ankle pain，improve ankle function，and reduce the area of injury.
