[目的]探讨内踝“V”形截骨自体骨软骨移植治疗距骨软骨损伤(osteochondral lesions of the talus,OLT)的临床疗效。[方法]回顾分析2018年1月—2020年6月,采用内踝“V”形截骨联合自体同侧股骨髁非负重区骨软骨移植术治疗OLT的24例患者...[目的]探讨内踝“V”形截骨自体骨软骨移植治疗距骨软骨损伤(osteochondral lesions of the talus,OLT)的临床疗效。[方法]回顾分析2018年1月—2020年6月,采用内踝“V”形截骨联合自体同侧股骨髁非负重区骨软骨移植术治疗OLT的24例患者,评价临床及影像资料。[结果]所有患者均顺利完成手术,无神经、血管损伤,手术时间平均(71.4±12.0)min,术中失血量平均(39.2±11.2)ml。随访时间平均(24.2±6.6)个月,与术前相比,术后1年及末次随访时疼痛VAS评分[(6.1±0.7),(1.0±0.9),(0.9±0.6),P<0.001]、AOFAS踝及后足评分[(66.8±4.8),(89.5±5.4),(93.0±5.1),P<0.001]均显著改善,而膝关节Lysholm评分无显著变化(P>0.05)。影像方面,磁共振软骨修复组织观察(magnetic resonance observation of cartilage repair tissue,MOCART)评分[(43.3±7.0),(66.5±7.1),(69.2±6.5),P<0.001]显著增加,所有截骨均骨性愈合,OLT病灶修复良好,Takaku踝关节退变分级无显著变化(P>0.05)。[结论]内踝“V”形截骨联合自体骨软骨移植治疗距骨骨软骨损伤疗效安全可靠。展开更多
Osteochondral lesion of the talus(OLT)is a common cause of ankle pain that often occurs in the talar dome and leads to talar cartilage and subchondral bone damage.Osteochondral autograft transplantation is a logical t...Osteochondral lesion of the talus(OLT)is a common cause of ankle pain that often occurs in the talar dome and leads to talar cartilage and subchondral bone damage.Osteochondral autograft transplantation is a logical treatment option.It is known that if the cartilage does not heal properly after injury,it degenerates,and osteoarthritis worsens.A three dimensional(3D)-printed guide plate can be used to find the curved articular surface from the donor site which optimally fits the defect in the talus.Herein,we present the case of a 28-year-old man who had an open injury from the crash of a tricycle in the right ankle at the age of 5.Radiographs revealed a large defect in the medial talar dome that affected nearly half of the talar dome.We performed the debridement of the ankle lesion.An osteochondral autograft was harvested from the medial femoral condyle(MFC)with the help of a personalised 3D-printed guide plate.This 3D-printed guide plate simulated the contour of a specific area in the talar dome,which involved the site of the defect.The autograft was then transplanted into the talus defect.The efficacy of this technique was evaluated at 2,4,and 7 months after surgery and proven to be reliable.展开更多
Osteochondral lesions of the talus(OLT) occur in up to 70% of acute ankle sprains and fractures. OLT have become increasingly recognized with the advancements in cartilage-sensitive diagnostic imaging modalities. Alth...Osteochondral lesions of the talus(OLT) occur in up to 70% of acute ankle sprains and fractures. OLT have become increasingly recognized with the advancements in cartilage-sensitive diagnostic imaging modalities. Although OLT may be treated nonoperatively, a number of surgical techniques have been described for patients whom surgery is indicated. Traditionally, treatment of symptomatic OLT have included either reparative procedures, such as bone marrow stimulation(BMS), or replacement procedures, such as autologous osteochondral transplantation(AOT). Reparative procedures are generally indicated for OLT < 150 mm^2 in area. Replacement strategies are used for large lesions or after failed primary repair procedures. Although shortand medium-term results have been reported, longterm studies on OLT treatment strategies are lacking. Biological augmentation including platelet-rich plasma and concentrated bone marrow aspirate is becoming increasingly popular for the treatment of OLT to enhance the biological environment during healing. In this review, we describe the most up-to-date clinical evidence of surgical outcomes, as well as both the mechanical and biological concerns associated with BMS and AOT. In addition, we will review the recent evidence for biological adjunct therapies that aim to improve outcomes and longevity of both BMS and AOT procedures.展开更多
[目的]研究微骨折术与骨软骨移植治疗小面积距骨骨软骨病变(osteochondral lesion of the talus,OLT)的疗效.[方法]回顾性分析本科2014年6月-2018年7月手术治疗小面积(0.80~1.20 cm^(2))OLT49例患者的临床资料,依据术前医患沟通结果,25...[目的]研究微骨折术与骨软骨移植治疗小面积距骨骨软骨病变(osteochondral lesion of the talus,OLT)的疗效.[方法]回顾性分析本科2014年6月-2018年7月手术治疗小面积(0.80~1.20 cm^(2))OLT49例患者的临床资料,依据术前医患沟通结果,25例采用微骨折治疗,24例采用骨软骨移植治疗.比较两组围手术期、随访与影像资料.[结果]所有患者均顺利完成手术,无神经血管损伤等严重并发症.微骨折组的手术时间、切口长度、术中失血量、住院时间、术中透视次数均优于移植组(P<0.05).两组患者均随访12个月以上,微骨折组恢复行走活动时间和完全负重时间均显著早于移植组(P<0.05).与术前相比,末次随访时两组患者VAS评分均显著下降(P<0.05),而AOFAS和AAS评分均显著增加(P<0.05).末次随访时移植组的上述评分均显著优于微骨折组(P<0.05).影像方面,与术前相比,末次随访时两组患者Bemdt分期均有显著改善(P<0.05).末次随访时,移植组的Bemdt分期显著优于微骨折组(P<0.05).至末次随访时,两组均未见严重踝关节退变.移植组所有患者术后均未出现截骨不愈合或延迟愈合、内固定脱落或断裂等并发症.[结论]对于小面积OLT,微骨折术与骨软骨移植术均能缓解疼痛,改善踝关节功能,骨软骨移植手术效果更显著.展开更多
文摘[目的]探讨内踝“V”形截骨自体骨软骨移植治疗距骨软骨损伤(osteochondral lesions of the talus,OLT)的临床疗效。[方法]回顾分析2018年1月—2020年6月,采用内踝“V”形截骨联合自体同侧股骨髁非负重区骨软骨移植术治疗OLT的24例患者,评价临床及影像资料。[结果]所有患者均顺利完成手术,无神经、血管损伤,手术时间平均(71.4±12.0)min,术中失血量平均(39.2±11.2)ml。随访时间平均(24.2±6.6)个月,与术前相比,术后1年及末次随访时疼痛VAS评分[(6.1±0.7),(1.0±0.9),(0.9±0.6),P<0.001]、AOFAS踝及后足评分[(66.8±4.8),(89.5±5.4),(93.0±5.1),P<0.001]均显著改善,而膝关节Lysholm评分无显著变化(P>0.05)。影像方面,磁共振软骨修复组织观察(magnetic resonance observation of cartilage repair tissue,MOCART)评分[(43.3±7.0),(66.5±7.1),(69.2±6.5),P<0.001]显著增加,所有截骨均骨性愈合,OLT病灶修复良好,Takaku踝关节退变分级无显著变化(P>0.05)。[结论]内踝“V”形截骨联合自体骨软骨移植治疗距骨骨软骨损伤疗效安全可靠。
基金the Clinical Research Program of 9th People’s Hospital,Shanghai Jiao Tong University School of Medicine(No.JYLJ015)the Clinical Research Plan of SHDC(No.16CR3099B)+1 种基金the National Key Research and Development Program of China(No.2017YFC1103900)the Class IV Peak Subject Program of Shanghai Jiao Tong University School of Medicine(No.GXQ03)。
文摘Osteochondral lesion of the talus(OLT)is a common cause of ankle pain that often occurs in the talar dome and leads to talar cartilage and subchondral bone damage.Osteochondral autograft transplantation is a logical treatment option.It is known that if the cartilage does not heal properly after injury,it degenerates,and osteoarthritis worsens.A three dimensional(3D)-printed guide plate can be used to find the curved articular surface from the donor site which optimally fits the defect in the talus.Herein,we present the case of a 28-year-old man who had an open injury from the crash of a tricycle in the right ankle at the age of 5.Radiographs revealed a large defect in the medial talar dome that affected nearly half of the talar dome.We performed the debridement of the ankle lesion.An osteochondral autograft was harvested from the medial femoral condyle(MFC)with the help of a personalised 3D-printed guide plate.This 3D-printed guide plate simulated the contour of a specific area in the talar dome,which involved the site of the defect.The autograft was then transplanted into the talus defect.The efficacy of this technique was evaluated at 2,4,and 7 months after surgery and proven to be reliable.
文摘Osteochondral lesions of the talus(OLT) occur in up to 70% of acute ankle sprains and fractures. OLT have become increasingly recognized with the advancements in cartilage-sensitive diagnostic imaging modalities. Although OLT may be treated nonoperatively, a number of surgical techniques have been described for patients whom surgery is indicated. Traditionally, treatment of symptomatic OLT have included either reparative procedures, such as bone marrow stimulation(BMS), or replacement procedures, such as autologous osteochondral transplantation(AOT). Reparative procedures are generally indicated for OLT < 150 mm^2 in area. Replacement strategies are used for large lesions or after failed primary repair procedures. Although shortand medium-term results have been reported, longterm studies on OLT treatment strategies are lacking. Biological augmentation including platelet-rich plasma and concentrated bone marrow aspirate is becoming increasingly popular for the treatment of OLT to enhance the biological environment during healing. In this review, we describe the most up-to-date clinical evidence of surgical outcomes, as well as both the mechanical and biological concerns associated with BMS and AOT. In addition, we will review the recent evidence for biological adjunct therapies that aim to improve outcomes and longevity of both BMS and AOT procedures.
文摘[目的]研究微骨折术与骨软骨移植治疗小面积距骨骨软骨病变(osteochondral lesion of the talus,OLT)的疗效.[方法]回顾性分析本科2014年6月-2018年7月手术治疗小面积(0.80~1.20 cm^(2))OLT49例患者的临床资料,依据术前医患沟通结果,25例采用微骨折治疗,24例采用骨软骨移植治疗.比较两组围手术期、随访与影像资料.[结果]所有患者均顺利完成手术,无神经血管损伤等严重并发症.微骨折组的手术时间、切口长度、术中失血量、住院时间、术中透视次数均优于移植组(P<0.05).两组患者均随访12个月以上,微骨折组恢复行走活动时间和完全负重时间均显著早于移植组(P<0.05).与术前相比,末次随访时两组患者VAS评分均显著下降(P<0.05),而AOFAS和AAS评分均显著增加(P<0.05).末次随访时移植组的上述评分均显著优于微骨折组(P<0.05).影像方面,与术前相比,末次随访时两组患者Bemdt分期均有显著改善(P<0.05).末次随访时,移植组的Bemdt分期显著优于微骨折组(P<0.05).至末次随访时,两组均未见严重踝关节退变.移植组所有患者术后均未出现截骨不愈合或延迟愈合、内固定脱落或断裂等并发症.[结论]对于小面积OLT,微骨折术与骨软骨移植术均能缓解疼痛,改善踝关节功能,骨软骨移植手术效果更显著.
