摘要
目的对距骨缺血性坏死手术治疗研究进展进行综述。方法广泛查阅近年来国内外距骨缺血性坏死相关文献,从发病机制、手术治疗方式及预后等方面进行总结。结果距骨缺血性坏死早期临床症状不明显,患者就诊时大多已进展至Ficat-ArletⅢ~Ⅳ期,需要手术治疗。目前,该病手术治疗方法主要包括髓芯减压、带血管蒂骨瓣移植、关节置换术及关节融合术等。早期距骨缺血性坏死可保守治疗,如治疗失败可以考虑髓芯减压。关节融合术应作为终末期骨关节炎和塌陷患者的补救手术,存在严重骨丢失时需行胫距跟融合术和植骨。带血管蒂骨瓣移植效果良好,对各期距骨缺血性坏死均有一定治疗效果,但合适骨瓣供区仍需进一步研究。结论距骨缺血性坏死手术方法以及不同分期治疗体系均有待完善。
Objective To summarize the surgical treatment methods for avascular necrosis of the talus.Methods The recent domestic and international literature related to avascular necrosis of the talus was extensively conducted.The pathogenesis,surgical treatment methods,and prognosis were summarized.Results The clinical symptoms of avascular necrosis of the talus at early stage are not obvious,and most patients have progressed to Ficat-Arlet stagesⅢ-Ⅳand require surgical treatment.Currently,surgical treatments for this disease include core decompression,vascularized bone flap transplantation,arthroplasty,and arthrodesis,etc.Early avascular necrosis of the talus can be treated conservatively,and if treatment fails,core decompression can be considered.Arthrodesis is a remedial surgery for patients with end-stage arthritis and collapse,and in cases of severe bone loss,tibiotalocalcaneal arthrodesis and bone grafting are required.Vascularized bone flap transplantation is effective and plays a role in all stages of avascular necrosis of the talus,but the appropriate donor area for the flap still needs further to be studied.Conclusion The surgical treatment and the system of treatment for different stages of avascular necrosis of the talus still need to be refined.
作者
张涛
李振豪
崔焱
熊婉琦
王泽文
何挺
刘家河
许静宜
刘保一
杨帆
ZHANG Tao;LI Zhenhao;CUI Yan;XIONG Wanqi;WANG Zewen;HE Ting;LIU Jiahe;XU Jingyi;LIU Baoyi;YANG Fan(Department of Orthopedics,Affiliated Zhongshan Hospital of Dalian University,Dalian Liaoning,116001,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2024年第4期493-497,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
大连市博士后科学基金(285395)
大连医学科学研究项目(2111038)
辽宁省教育厅重点攻关项目(LJKZZ20220148)
大连市科技人才创新支持政策项目(2023RQ034)
大连市科技局科技惠民项目(2023JJ13SN056)。
关键词
距骨缺血性坏死
手术
带血管蒂骨瓣移植
关节置换
关节融合
Avascular necrosis of talus
surgery
vascularized bone flap transplantation
arthroplasty
arthrodesis
