摘要
目的:探讨改良双平面Chevron内踝截骨自体骨软骨移植(AOT)配合补肾活血汤治疗HeppleⅢ、Ⅳ型距骨骨软骨损伤(OLT)的临床效果。方法:将赣州市中医院2023年8月—2024年8月收治的80例OLT患者(HeppleⅢ、Ⅳ型)作为本次研究对象,按随机数字表法分为对照组(n=40,接受改良双平面Chevron内踝截骨AOT治疗)和联合组(n=40,在对照组的基础上予补肾活血汤配合治疗)。观察比较两组术后6个月的软骨组织修复磁共振观察(MOCART)评分、术前及术后6个月的美国足与踝关节协会(AOFAS)踝-后足评分、踝关节活动度,以及术前与术后2周的实验室指标[前列腺素E_(2)(PGE_(2))、降钙素原(PCT)]、并发症发生情况。结果:术后6个月,联合组MOCART评分比对照组高(P<0.05)。两组术前AOFAS踝-后足评分、踝关节活动度比较,差异无统计学意义(P>0.05);术后6个月,两组AOFAS踝-后足评分较术前升高,且联合组较对照组高,两组踝关节活动度较术前增大,且联合组较对照组大(P<0.05)。术前,两组PCT、PGE_(2)水平比较,差异无统计学意义(P>0.05);术后2周,两组PCT、PGE_(2)水平均较术前降低,且联合组较对照组低(P<0.05)。联合组并发症总发生率为5.00%,较对照组的20.00%低(P<0.05)。结论:改良双平面Chevron内踝截骨AOT与补肾活血汤联合治疗HeppleⅢ、Ⅳ型OLT,不仅能使患者的踝关节功能得到改善,踝关节活动度增加,还能减轻疼痛及炎症反应,降低并发症发生率。
Objective:To investigate the clinical effect of modified biplane Chevron medial malleolus osteotomy autologous osteochondral transplantation(AOT)combined with Bushen Huoxue Decoction in the treatment of Hepple typeⅢandⅣosteochondral lesions of talus(OLT).Method:Eighty patients with OLT(Hepple typeⅢandⅣ)admitted to Ganzhou Hospital of TCM from August 2023 to August 2024 were selected as the research subjects of this study.According to the random number table method,they were divided into the control group(n=40,treated with modified biplane Chevron medial malleolus osteotomy AOT)and the combined group(n=40,treated with Bushen Huoxue Decoction on the basis of control group).The magnetic resonance observation of cartilage repair tissue(MOCART)score 6 months after surgery,American orthopaedic foot and ankle society(AOFAS)ankle-hindfoot score and ankle joint mobility before surgery and 6 months after surgery,laboratory indicators[prostaglandin E_(2)(PGE_(2)),procalcitonin(PCT)]before surgery and 2 weeks after surgery and the occurrence of complications were observed and compared between the two groups.Result:Six months after surgery,the MOCART score in combined group was higher than that in control group(P<0.05).There were no statistically significant differences in the AOFAS ankle-hindfoot scores and ankle joint mobility between the two groups before surgery(P>0.05).Six months after surgery,the AOFAS ankle-hindfoot scores in the two groups were increased compared with those before surgery,and those in combined group were higher than those in control group,the ankle joint mobility in the two groups were increased compared with those before surgery,and those in combined group were larger than those in control group(P<0.05).There were no statistically significant differences in the levels of PCT and PGE_(2) between the two groups before surgery(P>0.05).The levels of PCT and PGE_(2) in the two groups 2 weeks after surgery were decreased than those before surgery,and those in combined group were lower than those in control group(P<0.05).The total incidence of complications in combined group was 5.00%,which was lower than 20.00%in control group(P<0.05).Conclusion:The combination of modified biplane Chevron medial malleolus osteotomy AOT and Bushen Huoxue Decoction for Hepple typeⅢandⅣOLT can not only improve the ankle function of patient and increase the ankle joint mobility,but also relieve the pain and inflammatory response,and reduces the incidence of complications.
作者
涂峰
高军忠
廖文霞
TU Feng;GAO Junzhong;LIAO Wenxia(Department of Joint Surgery,Ganzhou Hospital of TCM,Ganzhou 341000,China;不详)
出处
《中国医学创新》
2025年第23期1-5,共5页
Medical Innovation of China
基金
江西省中医药管理局科技计划项目(2023B0046)
赣州市重点研发计划项目(GZ2024YLJ172)。
