摘要
目的探讨关节镜下髓心减压术联合富血小板血浆(PRP)治疗距骨骨髓水肿的疗效。方法采用回顾性病例系列研究分析2018年1月至2020年7月华中科技大学同济医学院附属协和医院收治的17例距骨骨髓水肿患者的临床资料, 其中男11例, 女6例;年龄15~56岁[(45.7±4.3)岁]。均采用关节镜下髓心减压术联合PRP治疗。记录手术时间, 观察伤口愈合情况。比较术前、术后6, 12个月使用MRI测量的距骨骨髓水肿最大面积, 踝关节活动度(ROM)。术前、术后6, 12个月采用视觉模拟评分(VAS)及美国足踝外科协会(AOFAS)踝-后足评分评估疼痛情况及踝关节功能。观察并发症情况。结果患者均获随访12~41个月[(16.7±2.1)个月]。手术时间为45.2~68.5 min[(53.4±12.4)min]。伤口均Ⅰ期愈合。骨髓水肿最大面积由术前(28.2±6.9)mm2减小至术后6, 12个月的(16.3±5.7)mm2、(7.1±1.7)mm2(P均<0.01);踝关节ROM由术前(52.2±8.9)°增加至术后6, 12个月的(72.3±3.1)°、(83.1±2.8)°(P均<0.01);VAS由术前(8.2±0.6)分减少至术后6, 12个月的(6.5±0.4)分、(3.1±0.8)分(P均<0.01);AOFAS踝-后足评分由术前(32.4±4.8)分增加至术后6, 12个月的(54.4±6.5)分、(88.7±4.3)分(P均<0.01)。与术后6个月比较, 术后12个月骨髓水肿最大面积、踝关节ROM、VAS及AOFAS踝-后足评分差异有统计学意义(P均<0.01)。1例患者术后出现局部皮肤麻木, 行营养神经治疗后好转。结论关节镜下髓心减压术联合PRP治疗距骨骨髓水肿能有效减少骨髓水肿范围、提升踝关节活动度、缓解疼痛、改善踝关节功能, 术后并发症较少, 具有良好的近期临床疗效。
Objective To report the efficacy of arthroscopic medullary decompression combined with platelet-rich plasma(PRP)in the treatment of bone marrow edema of the talus.Methods A retrospective case series study was used to analyze the clinical data of 17 patients with bone marrow edema of the talus admitted to Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2018 to July 2020.There were 11 males and 6 females,with the age range of 15-56 years[(45.7±4.3)years].All patients were subjected to arthroscopic medullary decompression combined with the administration of PRP.Operation time and wound healing were recorded.Maximum area of bone marrow edema was measured by MRI preoperatively and at 6 and 12 months postoperatively.Ankle range of motion(ROM),visual analog score(VAS)and American Association of Foot and Ankle Surgery(AOFAS)ankle-hindfoot score were measured preoperatively and at 6 and 12 months postoperatively.Complications were also detected.Results All patients were followed up for 12-41 months[(16.7±2.1)months].Operation time was 45.2-68.5 minutes[(53.4±12.4)minutes].All wounds were healed at stage I.The maximum area of bone marrow edema decreased from(28.2±6.9)mm2 preoperatively to(16.3±5.7)mm2 at 6 months postoperatively and to(7.1±1.7)mm2 at 12 months postoperatively(all P<0.01).Ankle ROM increased from(52.2±8.9)°preoperatively to(72.3±3.1)°at 6 months postoperatively and to(83.1±2.8)°at 12 months postoperatively(all P<0.01).VAS decreased from(8.2±0.6)points preoperatively to(6.5±0.4)points at 6 months postoperatively and to(3.1±0.8)points at 12 months postoperatively(all P<0.01).AOFAS ankle-hindfoot score increased from(32.4±4.8)points preoperatively to(54.4±6.5)points at 6 months postoperatively and to(88.7±4.3)points at 12 months postoperatively(all P<0.01).There were significant differences in maximum area of bone marrow edema of the talus,ankle ROM,VAS and AOFAS ankle-hindfoot score at 12 months postoperatively when compared with those at 6 months postoperatively(all P<0.01).One patient showed the symptom of localized skin numbness postoperatively,and improved with nerve nutrition therapy.Conclusion Arthroscopic medullary decompression combined with PRP therapy for bone marrow edema of the talus presents good short-term clinical benefits in terms of reduced extent of bone marrow edema,improved ankle ROM,attenuated pain,improved ankle joint function and few postoperative complications.
作者
许岩
贺磊
段德宇
刘国辉
王俊文
肖飞
欧阳柳
Yan Xu;Lei He;Deyu Duan;Guohui Liu;Junwen Wang;Fei Xiao;Liu Ouyang(Department of Orthopedics,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Orthopedics,Puai Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430033,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2022年第4期327-331,共5页
Chinese Journal of Trauma
基金
湖北省自然科学基金青年项目(2018CFB423)。
关键词
距骨
关节镜
富血小板血浆
踝关节
Talus
Arthroscopes
Platelet-rich plasma
Ankle joint
