关节镜下微骨折治疗距骨软骨损伤的临床疗效

目的 探究在踝关节镜下微骨折治疗距骨软骨损伤的临床疗效。方法 回顾性分析自2018年8月至2019年12月西安交通大学附属红会医院足踝外科行踝关节镜下微骨折治疗的20例距骨软骨损伤患者资料,其中男12例,女8例;左足14例,右足6例;年龄18～50岁,平均(28.3±10.8)岁;病程6～12个月,平均(8.3±3.2)个月。在踝关节镜下行清理术,显露距骨损伤部位,给予微骨折处理。采用美国骨科足与踝关节协会(American orthopedic foot and ankle society, AOFAS)踝-后足评分系统和疼痛视觉模拟评分(visual analogue scale, VAS)及影像学进行临床疗效评估。结果 患者均顺利完成手术,手术时间30～40 min。术中未出现血管、神经损伤等严重并发症。患者均获得有效随访,随访时间10～14个月,平均(12.1±1.1)个月。末次随访时AOFAS及VAS较术前均有显著性改善(P<0.05)。末次随访时MRI示距骨软骨损伤范围及程度较术前明显缩小。结论 踝关节镜下微骨折治疗距骨软骨损伤,改善关节功能及疼痛,疗效确切,且术后并...     

踝关节骨折并距骨骨软骨损伤的关节镜治疗

目的 探讨关节镜技术在踝关节骨折并距骨骨软骨损伤治疗中的应用及效果.方法 对23例踝关节骨折合并距骨骨软骨损伤的患者,在切开复位骨折内固定的同时行关节镜下取出软骨碎片、关节面修整及钻孔.结果 本组随访6～25个月,平均13.5个月.笔者按Must和Teipner评分标准:优18例,良3例,可1例,差1例.结论 关节镜下...     

关节镜下清创结合微骨折术治疗局灶性距骨软骨损伤

目的探讨关节镜下清创结合微骨折术治疗局灶性距骨软骨损伤的临床疗效。方法对43例局灶性距骨软骨损伤患者进行治疗与随访。应用AOFAS评分和VAS疼痛评分对最终随访结果和术前评分进行对比,并对关节活动度和并发症进行评估。结果术前AOFAS评分为(70.9±3.6)分,术后为(84.3±4.7)分,术后较术前显著提高(P<0.05);VAS疼痛评分术前为(7.6±1.2)分,术后为(2.7±1.6)分,术后较术前显著降低(P<0.05);术后关节活动度正常,无严重并发症出现。结论关节镜下清创结合微骨折技术治疗局灶性距骨软骨损伤短期疗效满意。     

距骨骨软骨损伤的诊断及关节镜治疗

目的 总结、分析距骨骨软骨损伤的症状、体征、影像学特点、关节镜下治疗方法及手术效果.方法 2000年至2005年共收治34例距骨骨软骨损伤患者,对其临床资料包括症状、体征、X线片、MRI表现、关节镜手术方法等进行回顾性分析,术后随访根据主观和客观评分判断疗效.术前美国足踝外科后足评分平均(71±8)分,术前主观疼痛程度评分(7.5±1.3)分.结果 34例患者MRI均有骨软骨损伤征象,其中21例通过X线片检查发现距骨骨软骨损伤.距骨骨软骨损伤的主要症状为负重疼痛以及运动后加重,MRI诊断准确率较X线片高(χ2=16.07,P＜0.001).31例患者获得随访,平均随访时间为28个月.术后美国足踝外科后足评分(91±9)分,显著高于术前(t=9.147,P＜0.001);术后主观疼痛程度评分(2.4±2.3)分,显著低于术前(t=10.853,P＜0.001);临床疗效优良率为87.1%.结论 MRI检查能够提高诊断的正确率,关节镜微创手术治疗距骨骨软骨损伤效果良好.     

关节镜下微骨折技术治疗距骨骨软骨损伤60例疗效观察

目的探讨关节镜下微骨折技术治疗距骨骨软骨损伤的疗效。方法采用关节镜下微骨折技术治疗距骨骨软骨损伤60例,观察踝关节功能评分及疼痛评分变化。结果 60例患者术后踝关节功能评分较术前平均提高20.1分,差异具有统计学意义(P<0.05);术后疼痛评分较术前平均降低5.1分,差异具有统计学意义(P<0.05)。结论关节镜下微骨折技术治疗距骨骨软骨损伤,具有显著的临床疗效,值得推广应用。     

距骨骨软骨损伤的诊断及关节镜治疗分析

目的 探讨距骨骨软骨损伤的诊断方法及使用关节镜治疗的临床效果.方法 选取36例距骨骨软骨损伤的患者,均采取踝关节镜手术治疗,观察其治疗效果.结果 36例距骨骨软骨损伤患者的优良率为88.9%,治疗前后踝关节功能及症状比较差异有统计学意义（P ＜0.05）.治疗前后中度疼痛以上比例比较差异有统计学意义（P ＜0.05）.结论 负重疼痛是距骨骨软骨损伤的主要症状,及时发现、及早治疗是治愈的关键.采用关节镜治疗效果显著、微创、安全可靠,值得在临床上合理推广.     

踝关节骨折合并距骨软骨损伤的手术治疗

2010年1月～2012年8月,我科共收治踝关节骨折患者36例,术中发现有15例合并距骨软骨损伤,经治疗疗效满意,报道如下。1材料与方法1.1病例资料本组15例,男13例,女2例,年龄25～52岁。踝关节骨折按Lauge-Hansen分类:旋后内收型2例,旋后外旋型6例,旋前外展型3例,旋前外旋型4例。距骨软骨损伤按Berndt-Har-ty分类[1]:Ⅰ型3例,Ⅱ型5例,Ⅲ型3例,Ⅳ型4例。     

踝关节距骨骨软骨损伤的影像学及关节镜下表现

目的分析踝关节距骨骨软骨损伤的影像学特点,包括病灶位置、病灶大小等形态学数据及MRI分期,并根据关节镜下表现进行分级,分析MRI分期与关节镜分级之间的关系。方法 2006年7月至2008年6月,35例距骨骨软骨损伤患者术前进行踝关节正侧位X线检查及MRI检查,分别根据BerdntHarty标准及Hepple's标准进行分期,在PACS系统上应用测量软件工具分析MRI图像,确定病灶位置、测量其前后径、左右径及深度。所有患病的踝关节均进行关节镜探查,并进行病灶分级。分析MRI分期与关节镜下分级之间的相关性。结果 35例患者的平均年龄为29.1岁(16～44岁),其中男30例,女5例。通过X线发现13例距骨骨软骨损伤,根据BerdntHarty分期:6例为Ⅰ期,3例为Ⅱ期,3例为Ⅲ期,1例为Ⅳ期;6例病灶位于外侧,7例位于内侧。MRI检查共发现38处距骨骨软骨损伤(3例患者均有两处病灶),根据Hepple分期:Ⅰ期1例,Ⅱ期17例,Ⅲ期7例,Ⅳ期2例,Ⅴ期11例。14例病灶位于外侧,24例位于内侧;按照9宫格分区法,55.3%的病灶位于4区(内侧中部),23.7%位于6区(外侧中部)。内侧组病灶大小为:前后径(9.0±2.5)mm、左右径(11.2±2.9)mm、深度(8.4±4.0)mm;外侧组病灶大小为:前后径(7.8±3.2)mm、左右径(10.9±3.2)mm、深度(7.9±4.2)mm。两组病灶大小的差异无统计学意义。关节镜探查共发现38处距骨骨软骨损伤(A级1例、B级1例、C级4例、D级27例、E级3例、F级2例)。MRI分期与关节镜下分级之间无相关性(r=0.12,P=0.474)。结论距骨骨软骨损伤主要位于距骨内侧中部及外侧中部,内侧病损以Hepple's Ⅱ期和Ⅴ期为主,外侧病变以Ⅲ期为主;内外侧病灶的大小差异无统计学意义。内外侧病变的关节镜下表现均以D级为主。Hepple'sMRI影像学分期与关节镜下分级无对应关系。     

关节镜下微骨折联合自体富血小板血浆治疗Hepple Ⅲ～Ⅳ型距骨骨软骨损伤

目的探讨关节镜下微骨折联合自体富血小板血浆治疗HeppleⅢ~Ⅳ型距骨骨软骨损伤的临床效果。方法自2013年1月至2017年12月我院采用关节镜下微骨折联合自体富血小板血浆治疗的HeppleⅢ~Ⅳ型距骨软骨损伤患者15例,其中男11例,女4例;年龄15~48,平均(34.1±2.7)岁;右足10例,左足5例。根据Hepple分型,Ⅲ型9例,Ⅳ型6例。术前及术后12个月均采用疼痛视觉模拟评分(visual analogue scale,VAS)、美国美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)及MRI进行评估。结果15例患者均获得随访,随访时间12~23个月,平均(15.1±2.2)个月。术前AOFAS评分(54.3±8.9)分、VAS评分(7.1±2.3)分,术后12个月AOFAS评分(89.2±6.4)分、VAS评分(1.3±0.8)分,手术前后比较差异均有统计学意义(P<0.05)。术后12个月MRI检查见距骨软骨的损伤区域较平滑,周围水肿消失。结论采用关节镜下微骨折联合自体富血小板血浆治疗HeppleⅢ~Ⅳ型距骨骨软骨损伤可以有效缓解踝关节疼痛及改善功能,明显促进损伤软骨愈合,是一种较有效的治疗方式。     

踝关节骨折伴距骨软骨损伤的实验及临床研究

目的：探讨踝关节骨折伴距骨软骨损伤的规律及治疗。方法：通过应用踝关节骨骼标本及距骨模型，观察在模拟踝关节骨折各种外力应用下距骨模型受力及关节面压缩情况，并对42例踝关节骨折在关节镜辅助下手术所见及关节镜图像进行分析。结果：踝部骨折伴距骨软骨损伤的部位、程度与损伤时足位置及外力、关节类型密切相关，有一定的规律可循。结论：此规律有利于踝关节镜入路的选择和手术步骤的制定，遵循其规律可做到踝关节镜手术操作准确，避免漏诊，减少意外损伤，并提高临床治疗效果。     

No mid-term difference in mosaicplasty in previously treated versus previously untreated patients with osteochondral lesions of the talus

Introduction Osteochondral transplantations, albeit technically challenging, appear promising not only in knee joint lesions, but also in the treatment of talus lesions. We hypothesized that in patients suffering osteochondral lesions of the talus, favorable outcomes are obtained in patients undergoing primary mosaicplasty as compared to patients undergoing secondary mosaicplasty. Materials and methods Over a 3-year period (1998–2001), 14 patients (six male, eight female, median age 22 years) were treated with an autologous osteochondral transplantation of the talus. Eight patients were previously untreated (group I). Six patients had previous ankle procedures, such as microfracturing (group II). The median follow-up was 24 months and 100% complete at 12 months. The functional outcome was evaluated at least at 6 weeks, 12 weeks, and 1 year after surgery using pain on a visual analog scale (VAS) and sports activity was recorded at 1 year after surgery. In ten patients, magnetic resonance imaging (MRI) of the ankle was performed at 1 year after surgery (group I/II: 7/3). Results Overall ankle pain was decreased from 6.9 ± 2.1 to 4.0 ± 2.8 postoperatively. The mean knee pain for the donor knee was 2.6 ± 2.4. We found no significant difference between the primary mosaicplasty group and the secondary mosaicplasty group with regard to pain. MRI scans of ten patients showed a complete incorporation of the osteochondral cylinders at 1 year after surgery. Conclusion Favorable outcomes were obtained in patients undergoing primary mosaicplasty as compared to patients undergoing secondary mosaicplasty. We found no significant difference among patients with previous ankle surgery in contrast to those without, with a median 24-months follow-up.     

One step treatment of talus osteochondral lesions with microfracture and cell free hyaluronic acid based scaffold combination

ObjectiveThe aim of this study was to assess the effectiveness of microfracture and cell free hyaluronic acid (HA) based scaffold combination in the treatment of talus osteochondral defects (OCD).MethodsThis study retrospectively evaluated the clinical results of the 20 patients (14 males and 6 females, mean age at the time of surgery: 32.9 years (range: 16–52 years)) who were treated with MFx and cell-free HA-based scaffold combination for talus OCD smaller than 1.5 cm² and deeper than 7 mm. Results were evaluated with AOFAS and VAS scores. Also, patients' satisfaction was questioned.ResultsPatients were evaluated after an average follow-up of 20.3 months. Intraoperative measurements showed that mean depth of the lesions were 10.4 ± 1.9 mm after debridement. The mean preoperative AOFAS score was 57.45 ± 9.37, which increased to 92.45 ± 8.4 postoperatively (p < 0.05). VAS score was improved from 7.05 ± 2.45 to 1.65 ± 2.20 postoperatively (p < 0.05).ConclusionMFx and cell-free HA-based scaffold combination appear to be a safe and efficient technique that provide good clinical outcomes for lesions deeper than 7 mm.Level of evidenceLevel IV, Therapeutic Study.     

A prospective evaluation of bone marrow aspirate concentrate and microfracture in the treatment of osteochondral lesions of the talus

BackgroundThe term osteochondral lesion (OCL) refers to a defect involving the chondral surface and or subchondral bone. These lesions are associated with ankle injuries with bony and soft tissue and cause pain, decreased range of motion, swelling and impact adversely on quality of life. To date the standard treatment has been isolated microfracture (BMS). The aim of this study was to compare the outcomes of BMS alone to BMS augmented with bone marrow aspirate concentrate (BMAC) in the treatment of ankle OCLs.MethodsThis study was a prospective cohort study carried out from 2010–2015 in a single surgeon’s practice. Patients from 2010–2012 were treated with microfracture alone while patients from 2013–2015 were treated with micro fracture augmented with bone marrow aspirate concentrate and fibrin glue. Self-reported patient outcome measures were measured. Complications, revision rates, and visual analogue pain scores were compared.Results101 patients were included in the study. 52 patients were in the microfracture group while 49 patients were in the microfracture/BMAC group. The minimum follow-up for both groups was 36 months. Both groups had a statistically significant improvement in pain scores, quality of life scores, participation in sport and activities of daily living. The revision rate was 28.8% in the microfracture group versus 12.2% in the microfracture/BMAC group, which was statistically significant, p = 0.0145. The majority of the lesions were less than 1.5 cm² in diameter in both cohorts.ConclusionsMicrofracture and bone marrow aspirate concentrate appears to be a safe and effective treatment option for osteochondral lesions of the talus. The addition of bone marrow aspirate concentrate does not result in any increase in ankle or donor site morbidity. It is a well-tolerated therapy which decreases revision rates for treatment of the osteochondral lesions when compared to microfracture alone.Level of evidenceLevel III.     

Vascularized osteochondral free flaps from the femoral trochlea as versatile procedure for reconstruction of osteochondral lesions of the talus

BackgroundOsteochondral lesions of the talus (OLT) are defects affecting the articular cartilage as well as the subchondral bone, on the lateral shoulder possibly associated with trauma. This study presents the results of reconstructing OLT using vascularized osteochondral flaps from the femoral trochlea.MethodsWe treated 19 patients with osteochondral talar shoulder defects, using osteochondral flaps from the medial (MFT) or lateral (LFT) femoral trochlea. Functional outcome was evaluated by clinical investigation, visual analogue scale (VAS, 0–10), American Orthopaedic Foot and Ankle Society-Ankle and Hindfoot Scale (AOFAS, 0–100) and The Foot and Ankle Disability Index (FADI, 0–104). Radiographic postoperative follow-up was done by anterior-posterior and lateral X-rays and union of the transferred osteochondral flaps was documented by CT scans.ResultsThe osteochondral flaps fused in all of the 19 cases. After a median follow-up of 45.5 months, the patients showed an average FADI of 94.9 and AOFAS-Ankle and Hindfoot Scale of 91.2. All of them were walking free and normal. Subjective median satisfaction was 1.3 in a scale from 1 to 5.ConclusionVascularized transfer of osteochondral flaps from the femoral trochlea is a reliable treatment option for symptomatic OLT of the medial and lateral talar edge.Level of clinical evidence: Therapeutic IV     

Treatment strategies for osteochondral lesions of the talus: A review of the recent evidence

BackgroundThere has been no consensus regarding the treatment of osteochondral lesions of the talus, there has been many attempts to formulate a treatment pathway, with multiple proposed modalities and adjuncts used.ObjectivesThe aim of this paper was to investigate the evidence published in the recent history, identify the relevant papers, review and summarize the findings, to help clarify the available operative treatment options and their respective efficacies based on the level of evidence provided.Study design & methodsA literature search through electronic databases MEDLINE and EMBASE was done, these databases were screened for publications and papers form June 2004 to June 2019. Key words were utilised in the search ‘talus, talar, tibia, cartilage, osteochondral, ankle, osteochondritis dissecans, articular cartilage’. Studies on adults aged 18–60 years were included. Exclusion criteria were studies with less than 10 patients, or no clear outcome was recorded. Papers were reviewed by the authors and data extracted as per a pre-defined proforma.ResultsFollowing screening, 28 published articles were included and reviewed. Of these publications 5 were level I, 7 level II, 4 level III and 12 level IV. The total number of patients was 1061 patients. Treatment modalities included arthroscopic microfracture, drilling, hyaluronic acid injection, platelet rich plasma, osteochondral autologous transplantation (OAT), vascularised free bone graft among others. The most common functional measures used to assess efficacy were the Visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle (AOFAS) score. Follow up ranged from 26 weeks upto 4 years.ConclusionsDespite the abundance of treatment options, high level evidence (level I) remains limited and does not conclude a definitive treatment modality as superior to others. Further research, in the form highly organised randomised clinical trials, is needed to help improve the efficacy and develop new treatment modalities in the future.     

微骨折术联合关节腔内注射富血小板血浆治疗小面积距骨骨软骨损伤

目的探讨微骨折术联合关节腔内注射富血小板血浆(platelet-rich plasma,PRP)治疗小面积距骨骨软骨损伤(osteochondral lesion of the talus,OLT)的临床疗效。方法以2014年9月-2017年10月收治且符合选择标准的43例小面积OLT患者为研究对象,采用随机数字表法将其分为两组,微骨折组(21例)行单纯微骨折术治疗,联合组(22例)采用微骨折术联合关节腔内注射自体PRP治疗。两组患者性别、年龄、病程、侧别、损伤部位、病损面积、Mintz分型、术前疼痛视觉模拟评分(VAS)及美国矫形足踝协会(AOFAS)踝与后足评分比较,差异均无统计学意义(P>0.05)。治疗后采用MRI评价OLT恢复情况,VAS评分及AOFAS踝与后足评分评价踝关节疼痛及功能。结果术后两组切口均Ⅰ期愈合,无静脉血栓形成、踝关节内感染等并发症发生。两组患者均获随访,随访时间12~18个月,平均15.6个月。术后6、12个月两组患者VAS评分及AOFAS踝与后足评分均较术前显著改善,术后12个月较6个月时进一步改善,差异均有统计学意义(P<0.05)。术后6、12个月,联合组VAS评分及AOFAS踝与后足评分均显著优于微骨折组,差异有统计学意义(P<0.05)。MRI复查示术后12个月两组患者OLT处均填充良好。结论与单纯微骨折术相比,微骨折术联合关节腔内注射自体PRP治疗小面积OLT可有效减轻疼痛、改善踝关节功能,具有良好临床疗效。     

Arthroscopic treatment of ankle osteochondral lesions

Arthroscopic treatment of osteochondral lesions (OCLs) of the ankle is a popular first-line surgical option after conservative therapy has failed. MRI is the preferred imaging modality to evaluate OCLs and aid in surgical planning. Associated soft tissue pathology must be appreciated and addressed surgically, because associated synovitis and soft tissue impingement often contribute to symptoms. The diverse treatment modalities available via arthroscopy offer simplistic and straightforward solutions for biologically and mechanically complicated pathology. Marrow-stimulating techniques, particularly microfracture, have shown good to excellent results in most patients with small (<15 mm) acute lesions, and have a low complication rate.