| Objective Analyze the surgical treatment of Hepple ?-? talus cartilage injury and its clinical treatment effect retrospectively to provide reference for the clinical prevention and treatment of Hepple ?-? talus cartilage injury.Methods A total of 57 patients(57 feet)who underwent surgical treatment with the type of Hepple ?-? talus cartilage injury were enrolled in North China University of science and technology affiliate Tangshan Orthopedic Hospital(Tangshan Second Hospital)from October 2009 to August 2016.There were 31 males(31 feet)and 26 females(26 feet)aged from 16 to 65 years(mean age 43.65 years);left foot in 29 cases,right foot in 28 cases;ankle medial talus cartilage injury in 53 cases,ankle lateral talus cartilage injury in 4 cases;all cases were closed injury.According to Hepple who proposed MRI classification of talus cartilage injury: 16 cases is the type of ?,27 cases is the type of ? and 14 cases is the type of ?.Fifty-seven patients according to the classification and severity of talus cartilage injury were respectively treated with autologous cancellous bone grafting,autologous iliac bone periosteum or microinjection of calcium sulfate implantation.In this group of 16 cases of type ? talar cartilage injury cases,of which 7 cases of autologous cancellous bone grafting,5 cases of autologous iliac bone periosteum bone grafting,4cases of micro-injectable calcium sulfate implantation;There were 8 cases of autologous cancellous bone grafting,15 cases of autologous iliac bone periosteal grafting,4 cases of microinjection of calcium sulfate implantation;14 cases of type ? Talus cartilage injury,5 cases of autologous cancellous bone grafting,6 cases of autologous iliac bone periosteum bone grafting,3 cases of microinjection of calcium sulfate implantation.All patients used conventional posterior lateral fixation ankle in the neutral position after the surgery.Nonweight bearing ankle exercise is begin at about 1 week after the incision healed.Absolute free weight exercise about 6-8 weeks after the surgery.Preoperative and postoperative follow-up were performed on the lateral side of the ankle joint X-ray and CT,MRI examination;the same time using the American foot and ankle ankle and hind foot score(AOFAS)and visual pain scale(VAS)to assess ankle function and pain.So it can determine the treatment effect.Efficacy rating is divided into excellent,good,medium and Poor.Results Fifty-seven patients with talus cartilage injury were followed up for 6 months to54 months.The average follow-up was 22.49 months.The ankle and hind foot score(AOFAS)was 54.68 ± 17.66 and the average score was 87.19 ± 10.57.Visual surgery scale(VAS)preoperative average score was 7.81 ± 1.26 Points,the average postoperative score was 3.23 ± 2.71 points.The difference between preoperative and postoperative was statistically significant(P <0.05).According to the type of Hepple,the mean score of preoperative type ? AOFAS was 53.50 ± 13.99,the average score of grade ? was 61.19± 17.80,the average score of type ? was 43.50 ± 16.12.The average score of type ?AOFAS was 87.06 ± 8.71,The average score was 88.74 ± 10.48 Points,the type of ?average score is 84.35 ± 12.64 points;preoperative and postoperative differences were statistically significant(P <0.05).The mean score of type ? VAS before operation was7.81 ± 1.47,the mean score of type IV was 7.41 ± 1.15,the average score of type V was8.57 ± 0.85;the mean score of type ? VAS was 2.31 ± 1.74,the mean score of type ?was 2.58± 0.85 points,the mean score of type ? was 4.93 ± 3.25 points;preoperative and postoperative differences were statistically significant(P <0.05).According to the different types of talus cartilage injury,the AOFAS and VAS scores of patients with preoperative and postoperative patients were analyzed by one-way anova.The AOFAS scores and VAS scores of preoperative and postoperative talus cartilage injury was statistically meaningless(P> 0.05).The variance of VAS score was statistically significant(P <0.05).Univariate analysis of variance was performed according to the different types of talar cartilage injury.The difference was statistically significant for Hepple ?-? type osteosomal cartilage injury(P <0.05).The group of 57 cases,AOFAS score excellent in 41 cases,good in 6 cases,medium in 7 cases,Poor in 3 cases,the total excellent and good rate was 82.46%.VAS score was excellent in 37 cases,good in 8 cases,medium in 7 cases and poor in 5 cases.The overall excellent and good rate was 61.40%.Conclusion Hepple type ? talus bone cartilage injury surgical approach for the choice of no significant difference.For Hepple?-? talus bone cartilage injury,the use of autologous iliac bone periosteal bone graft surgery is the best,autologous cancellous bone grafting is the second.Micro-injection of calcium sulfate injection surgery is the worst.The type of Hepple ? and ? type Talus cartilage injury underwent surgery to relieve pain and to reduce VAS score was significantly better than type ?. |
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