目的调查分析188例住院踝关节距骨骨软骨损伤(osteochondral lesions of the talus,OLT)患者的病例资料临床特点及流行病学,为OLT的临床防治提供参考依据。方法回顾性分析首都医科大学附属北京积水潭医院足踝外科2018年3月至2021年3月...目的调查分析188例住院踝关节距骨骨软骨损伤(osteochondral lesions of the talus,OLT)患者的病例资料临床特点及流行病学,为OLT的临床防治提供参考依据。方法回顾性分析首都医科大学附属北京积水潭医院足踝外科2018年3月至2021年3月收治住院的OLT患者的临床病例资料,统计患者基本信息、损伤原因、病灶位置,分析其大小、病程、手术方式及结果随访资料等。按手术方式分组比较,进行统计分析。结果本研究共纳入188例住院OLT患者,男130例(69.1%),女58例(30.9%)。其中,18~40岁为发病高峰,达138例(73.4%);144例(76.6%)患者的BMI大于25 kg/m^(2);病程平均(29.1±7.8)个月;创伤性损伤160例(85.1%),退变性损伤28例(14.9%);内侧软骨损伤142例(75.5%),外侧软骨损伤46例(24.5%);左踝84例(44.7%),右踝104例(55.3%);HeppleⅠ、Ⅱ型75例(39.9%),HeppleⅢ、Ⅴ型113例(60.1%);115例(61.2%)患者的病灶大于1.5 cm^(2)。67例(35.6%)患者采用微骨折手术治疗(关节镜微骨折组),84例(44.7%)患者采用自体骨软骨移植术治疗(自体骨软骨移植组),37例(19.7%)患者采用带骨膜髂骨移植术治疗(带骨膜髂骨移植组)。术后18个月自体骨软骨移植组和带骨膜髂骨移植组患者的AOFAS评分均明显高于关节镜微骨折组,且VAS评分低于关节镜微骨折组,差异均具有统计学意义(P<0.05)。结论OLT患者以创伤性损伤占多数,中青年好发,男性多于女性,内侧损伤多于外侧,HeppleⅢ、Ⅴ型损伤建议手术治疗。展开更多
Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may aris...Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the <i><span>Lauge-Hansen </span></i><span>fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, </span><b><i><span>versus</span></i></b><i><span> </span></i><span>ORIF </span><i><span>plus</span></i><span> arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/</span><span>-</span><span> arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the </span><i><span>Lauge-Hansen</span></i><span> ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination-external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with a</span><span>n</span><span> SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes</span><span>.</span>展开更多
文摘目的调查分析188例住院踝关节距骨骨软骨损伤(osteochondral lesions of the talus,OLT)患者的病例资料临床特点及流行病学,为OLT的临床防治提供参考依据。方法回顾性分析首都医科大学附属北京积水潭医院足踝外科2018年3月至2021年3月收治住院的OLT患者的临床病例资料,统计患者基本信息、损伤原因、病灶位置,分析其大小、病程、手术方式及结果随访资料等。按手术方式分组比较,进行统计分析。结果本研究共纳入188例住院OLT患者,男130例(69.1%),女58例(30.9%)。其中,18~40岁为发病高峰,达138例(73.4%);144例(76.6%)患者的BMI大于25 kg/m^(2);病程平均(29.1±7.8)个月;创伤性损伤160例(85.1%),退变性损伤28例(14.9%);内侧软骨损伤142例(75.5%),外侧软骨损伤46例(24.5%);左踝84例(44.7%),右踝104例(55.3%);HeppleⅠ、Ⅱ型75例(39.9%),HeppleⅢ、Ⅴ型113例(60.1%);115例(61.2%)患者的病灶大于1.5 cm^(2)。67例(35.6%)患者采用微骨折手术治疗(关节镜微骨折组),84例(44.7%)患者采用自体骨软骨移植术治疗(自体骨软骨移植组),37例(19.7%)患者采用带骨膜髂骨移植术治疗(带骨膜髂骨移植组)。术后18个月自体骨软骨移植组和带骨膜髂骨移植组患者的AOFAS评分均明显高于关节镜微骨折组,且VAS评分低于关节镜微骨折组,差异均具有统计学意义(P<0.05)。结论OLT患者以创伤性损伤占多数,中青年好发,男性多于女性,内侧损伤多于外侧,HeppleⅢ、Ⅴ型损伤建议手术治疗。
文摘Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the <i><span>Lauge-Hansen </span></i><span>fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, </span><b><i><span>versus</span></i></b><i><span> </span></i><span>ORIF </span><i><span>plus</span></i><span> arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/</span><span>-</span><span> arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the </span><i><span>Lauge-Hansen</span></i><span> ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination-external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with a</span><span>n</span><span> SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes</span><span>.</span>
