One-Step Repair in Talar Osteochondral Lesions
One-Step Repair in Talar Osteochondral Lesions
复制标题
距骨骨软骨损伤的一步修复
DOI：
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发表时间：
2013
影响因子：
4.8
通讯作者：
F. Vannini
中科院分区：
文献类型：
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作者：
S. Giannini;R. Buda;M. Battaglia;M. Cavallo;A. Ruffilli;Laura Ramponi;G. Pagliazzi;F. Vannini
背景：最近一项基于骨髓源性细胞移植的一步关节镜技术在修复距骨软骨病变（OLTs）方面取得了良好的效果，克服了旧技术的一些缺点。目的：报道4年后一系列接受距骨穹骨软骨病变一步修复的患者的结果，以及使用t2定位序列的磁共振成像（MRI）预测临床结果的能力。研究设计：病例系列；证据等级，4级。方法：49例患者（年龄[mean±SD]， 28.08±9.51岁）行OLTs一步修复术。通过美国骨科足踝学会（AOFAS）评分和x线片对患者进行临床评估，并在术前和术后预定时间进行MRI随访。在所有患者中，细胞均从髂骨采集，浓缩，并装载在关节镜下植入的支架上。结果：患者AOFAS总分（mean±SD）由术前的63.73±14.13分改善至48±6.1个月时的82.19±17.04分（P < .0005），随访24个月时效果最佳。术后24 ~ 36个月和24 ~ 48个月的临床评分均有显著下降（P = 0.001）。T2定位分析显示，再生组织的T2值为35 ~ 45毫秒，与透明软骨相似，平均在修复损伤区域的78%±16%。在最近一次随访中发现创伤发生与手术之间的时间对临床结果有负面影响；患者的年龄和病变大小影响早期临床结果，但不影响最终随访的结果。在最后一次随访时，临床结果随时间的稳定性与MRI T2成像所证实的与透明软骨值相似的组织百分比呈相关性（r = 0.497, P = 0.06）。结论：一步修复olt具有良好的临床效果，并且随着时间的推移，即使在最近的随访中AOFAS评分略有下降。MRI T2定位检测到的再生组织质量与临床结果直接相关。
Background: A recent one-step arthroscopic technique based on bone marrow–derived cell transplantation has achieved good results in repairing osteochondral lesions of the talus (OLTs), overcoming some of the drawbacks of older techniques. Purpose: To report the results after 4 years of a series of patients who underwent a one-step repair of osteochondral lesions of the talar dome, as well as the capability of magnetic resonance imaging (MRI) using a T2-mapping sequence to predict the clinical outcome. Study Design: Case series; Level of evidence, 4. Methods: Forty-nine patients (age [mean ± SD], 28.08 ± 9.51 y) underwent a one-step repair of OLTs. Patients were evaluated clinically by American Orthopaedic Foot and Ankle Society (AOFAS) scores and radiographs and underwent MRI preoperatively and during postoperative follow-ups at predetermined times. In all patients, the cells were harvested from the iliac crest, concentrated, and loaded on a scaffold that was implanted arthroscopically. Results: The overall AOFAS score (mean ± SD) improved from 63.73 ± 14.13 preoperatively to 82.19 ± 17.04 at 48 ± 6.1 months (P < .0005), with best results at the 24-month follow-up. A significant decrease in the clinical score was observed between 24 and 36 months postoperatively (P = .001) and between 24 and 48 months (P < .005). The T2-mapping analysis showed regenerated tissue with T2 values of 35 to 45 milliseconds, similar to hyaline cartilage, in a mean of 78% ± 16% of the repaired lesion area. The time between the occurrence of trauma and surgery was found to negatively affect the clinical outcome at the latest follow-up; patient’s age and lesion size influenced the early clinical results but did not affect the outcome at final follow-up. The stability of clinical results over time and the percentage of tissue with values similar to hyaline cartilage evidenced by MRI T2 mapping showed a tendency to correlate at the last follow-up (r = 0.497, P = .06). Conclusion: One-step repair of OLTs had good clinical results that were durable over time, even though there was a slight decrease in AOFAS score at the latest follow-up. The quality of the regenerated tissue detected by MRI T2 mapping directly correlated with the clinical results.