[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
距骨骨软骨损伤(osteochondral lesion of talus, OLT)是由创伤等原因造成距骨滑车局限性的软骨及软骨下骨损伤,包括距骨剥脱性骨软骨炎(osteochondritis dissecans of talus, OCD)和距骨骨软骨切线骨折;可从无症状发展为软骨下骨囊肿...距骨骨软骨损伤(osteochondral lesion of talus, OLT)是由创伤等原因造成距骨滑车局限性的软骨及软骨下骨损伤,包括距骨剥脱性骨软骨炎(osteochondritis dissecans of talus, OCD)和距骨骨软骨切线骨折;可从无症状发展为软骨下骨囊肿伴踝关节深部疼痛,多发生在距骨穹窿内侧和外侧,严重影响患者生活及工作,甚至导致残疾。本文对OLT的治疗进展及其优缺点进行综述。根据不同分型或临床症状,OLT可采取不同治疗方法,包括保守治疗和手术治疗等。保守治疗大多短时缓解症状,仅延缓病情。近年来发现单一的富血小板血浆注射、微骨折、带骨膜骨移植、距骨软骨移植、同种异体骨移植、机器人导航下逆行钻孔等方法,都可取得不错的疗效,后期在微骨折结合富血小板血浆注射、微骨折结合软骨移植及各种治疗方式结合距腓前韧带修复,均展现出良好疗效。展开更多
Background The time until weight-bearing after arthroscopic microfracture when treating osteochondral lesions of the talus （OLT） is very important to the clinical outcomes of the operation.However,there have been no...Background The time until weight-bearing after arthroscopic microfracture when treating osteochondral lesions of the talus （OLT） is very important to the clinical outcomes of the operation.However,there have been no consistent opinions regarding the optimal time to start weight-bearing postoperatively.Many opinions advocate that weight-bearing should begin not earlier than the sixth or eighth week postoperatively,whereas others point out that earlier weight-bearing could also obtain satisfactory outcomes.The purpose of our study was to evaluate the clinical outcomes of early weight-bearing after arthroscopic microfracture during the treatment of OLT.Methods Fifty-eight ankles in 58 patients with a single OLT ＜2 cm2 were retrospectively studied.All lesions were treated with arthroscopic debridement and microfracture under local anesthesia.After the operation,the patients were allowed to bear full weight under the protection of figure-8-shaped splints.The visual analog scale （VAS） for pain and the American Orthopaedic Foot and Ankle Society （AOFAS） ankle—hindfoot scale were evaluated preoperatively and at six postoperative timepoints （1st day,1st month,3rd month,6th month,12th month,and 24th month）.Patients were followed up for 24-52 months （mean （34.97±7.33） months）.Results All 58 patients achieved excellent recovery with significant relief of their symptoms.The VAS score decreased from 7.31±1.0 preoperatively to 0.95±0.76 at the 24th month follow-up （P=0.000）,whereas the AOFAS score improved from 53.53±8.57 preoperatively to 87.62±5.42 at the 24th month follow-up （P=0.000）.Conclusion The successful clinical outcomes of this study demonstrated that early weight-bearing after the treatment of OLT with arthroscopic microfracture can be allowed.展开更多
目的总结距骨骨软骨病损(osteochondral lesions of the talus,OLT)外科治疗的研究进展。方法通过查阅近年OLT相关文献,分析总结各种外科治疗方案的优缺点。结果 OLT的外科治疗方案较多,主要包括骨髓刺激术、骨软骨移植术、自体软骨细...目的总结距骨骨软骨病损(osteochondral lesions of the talus,OLT)外科治疗的研究进展。方法通过查阅近年OLT相关文献,分析总结各种外科治疗方案的优缺点。结果 OLT的外科治疗方案较多,主要包括骨髓刺激术、骨软骨移植术、自体软骨细胞移植、生物制剂辅助治疗等修复或重建技术。各种方案均有不同的适应证和局限性。随着各项技术的不断发展,其治疗OLT的临床疗效也会逐步改善。结论 OLT的治疗仍存在许多难点和争议,尚无统一治疗方案,建议根据患者具体情况制定个性化手术方案。展开更多
目的探讨机器人导航辅助下逆向钻孔术治疗距骨软骨损伤(osteochondral lesions of talus,OCLT)的疗效。方法回顾性分析2021年10月至2023年4月在深圳市第二人民医院足踝外科采用机器人导航辅助下逆向钻孔术治疗的10例OCLT患者资料,男9例,...目的探讨机器人导航辅助下逆向钻孔术治疗距骨软骨损伤(osteochondral lesions of talus,OCLT)的疗效。方法回顾性分析2021年10月至2023年4月在深圳市第二人民医院足踝外科采用机器人导航辅助下逆向钻孔术治疗的10例OCLT患者资料,男9例,女1例,平均年龄32岁。分析比较患者术前和术后的CT及MRI下的OCLT病灶面积、视觉模拟评分法(visual analogue scale,VAS)评分、美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足评分。结果术后随访时间3~18个月,10例患者均获得平均8个月的随访,随访过程中无患者出现关节感染、神经损伤、活动性出血等并发症,术后3个月CT及MRI显示所有患者均未出现距骨骨质局部坏死、骨溶解或骨囊性变等严重征象,且病灶面积均显著小于术前,差异有统计学意义(P<0.01)。末次随访时VAS评分为3分,AOFAS评分为88.6分,较术前显著改善,差异有统计学意义(P<0.01)。结论采用机器人导航辅助下逆行钻孔术治疗距骨软骨损伤的疗效显著,且并发症少,软骨修复较常规微骨折恢复快,手术安全微创,手术时间显著减少。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。
文摘距骨骨软骨损伤(osteochondral lesion of talus, OLT)是由创伤等原因造成距骨滑车局限性的软骨及软骨下骨损伤,包括距骨剥脱性骨软骨炎(osteochondritis dissecans of talus, OCD)和距骨骨软骨切线骨折;可从无症状发展为软骨下骨囊肿伴踝关节深部疼痛,多发生在距骨穹窿内侧和外侧,严重影响患者生活及工作,甚至导致残疾。本文对OLT的治疗进展及其优缺点进行综述。根据不同分型或临床症状,OLT可采取不同治疗方法,包括保守治疗和手术治疗等。保守治疗大多短时缓解症状,仅延缓病情。近年来发现单一的富血小板血浆注射、微骨折、带骨膜骨移植、距骨软骨移植、同种异体骨移植、机器人导航下逆行钻孔等方法,都可取得不错的疗效,后期在微骨折结合富血小板血浆注射、微骨折结合软骨移植及各种治疗方式结合距腓前韧带修复,均展现出良好疗效。
文摘Background The time until weight-bearing after arthroscopic microfracture when treating osteochondral lesions of the talus （OLT） is very important to the clinical outcomes of the operation.However,there have been no consistent opinions regarding the optimal time to start weight-bearing postoperatively.Many opinions advocate that weight-bearing should begin not earlier than the sixth or eighth week postoperatively,whereas others point out that earlier weight-bearing could also obtain satisfactory outcomes.The purpose of our study was to evaluate the clinical outcomes of early weight-bearing after arthroscopic microfracture during the treatment of OLT.Methods Fifty-eight ankles in 58 patients with a single OLT ＜2 cm2 were retrospectively studied.All lesions were treated with arthroscopic debridement and microfracture under local anesthesia.After the operation,the patients were allowed to bear full weight under the protection of figure-8-shaped splints.The visual analog scale （VAS） for pain and the American Orthopaedic Foot and Ankle Society （AOFAS） ankle—hindfoot scale were evaluated preoperatively and at six postoperative timepoints （1st day,1st month,3rd month,6th month,12th month,and 24th month）.Patients were followed up for 24-52 months （mean （34.97±7.33） months）.Results All 58 patients achieved excellent recovery with significant relief of their symptoms.The VAS score decreased from 7.31±1.0 preoperatively to 0.95±0.76 at the 24th month follow-up （P=0.000）,whereas the AOFAS score improved from 53.53±8.57 preoperatively to 87.62±5.42 at the 24th month follow-up （P=0.000）.Conclusion The successful clinical outcomes of this study demonstrated that early weight-bearing after the treatment of OLT with arthroscopic microfracture can be allowed.
文摘目的总结距骨骨软骨病损(osteochondral lesions of the talus,OLT)外科治疗的研究进展。方法通过查阅近年OLT相关文献,分析总结各种外科治疗方案的优缺点。结果 OLT的外科治疗方案较多,主要包括骨髓刺激术、骨软骨移植术、自体软骨细胞移植、生物制剂辅助治疗等修复或重建技术。各种方案均有不同的适应证和局限性。随着各项技术的不断发展,其治疗OLT的临床疗效也会逐步改善。结论 OLT的治疗仍存在许多难点和争议,尚无统一治疗方案,建议根据患者具体情况制定个性化手术方案。
