关节镜手术治疗后足骨样骨瘤疗效分析

目的探讨关节镜手术治疗后足骨样骨瘤临床疗效。方法2013年2月至2014年7月,采用关节镜手术治疗后足骨样骨瘤患者8例,其中男性5例,女性3例,平均年龄21.25岁。受累部位为跟骨5例,距骨3例。采用疼痛视觉模拟评分(VAS)、美国足踝骨科学会(AOFAS)踝-后足评分综合评估临床疗效。结果术后随访4~22个月,平均16个月。所有患者术后均无伤口感染、肿瘤复发等并发症发生。末次随访时VAS评分由术前平均8.375分改善至术后平均0.375分,差异有统计学意义;AOFAS踝-后足评分由术前平均40.375分改善至术后平均92.500分,差异有统计学意义。结论关节镜手术治疗后足骨样骨瘤在完整切除肿瘤的同时,可减少软组织并发症,是一种安全、可靠的治疗技术。     

自体骨-骨膜移植治疗Hepple Ⅴ型距骨骨软骨损伤的近期疗效

目的 探讨采用自体骨-骨膜移植治疗Hepple Ⅴ型距骨骨软骨损伤的近期疗效.方法 回顾性分析2007年10月至2011年9月治疗27例合并软骨下骨囊肿(平均直径＞8 mm)的距骨骨软骨损伤患者资料,男26例,女1例;年龄22～53岁,平均35.8岁.经踝关节镜探查明确发生距骨骨软骨损伤后,从自体髂骨取骨-骨膜移植物填充距骨骨软骨缺损区.采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分、视觉模拟(visual analogue score,VAS)评分及软骨修复MR评分(MOCART)对手术疗效进行评估;分析术后距骨X线和MRI改变,以及术后二次关节镜探查结果.结果 26例患者获得随访,随访时间为12～59个月,平均22.4个月.术后AOFAS踩与后足评分[(93.0±6.5)分]显著高于术前[(73.9±3.1)分];术后VAS评分[(0.8±0.8)分]显著低于术前[(5.4±1.0)分];术后患者非常满意16例,满意8例,一般2例,满意率为92.3％ (24/26).术后患者X线片均示软骨下囊肿低密度区消失,未见关节间隙狭窄;MRI均示原病灶缺损区被移植物填充.MOCART评分平均为(57.2±9.1)分,其中3例软骨下骨内有直径＜5mm的囊肿.18例行二次关节镜探查示原软骨缺损区被再生类软骨组织覆盖.结论 自体骨-骨膜移植可同时修复Hepple Ⅴ型距骨骨软骨损伤及软骨下囊肿,近期疗效满意,是安全、有效的治疗方法.     

自体骨－骨膜移植治疗Hepple V型距骨骨软骨损伤的近期疗效

 目的 探讨采用自体骨－骨膜移植治疗Hepple V型距骨骨软骨损伤的近期疗效。方法回顾性分析2007年10月至2011年9月治疗27例合并软骨下骨囊肿(平均直径 >8 mm)的距骨骨软骨损伤患者资料,男26例,女1例;年龄22~53岁,平均35.8岁。经踝关节镜探查明确发生距骨骨软骨损伤后,从自体髂骨取骨－骨膜移植物填充距骨骨软骨缺损区。采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分、视觉模拟(visual analogue score,VAS)评分及软骨修复MR评分(MOCART)对手术疗效进行评估;分析术后距骨X线和MRI改变,以及术后二次关节镜探查结果。结果 26例患者获得随访,随访时间为12~59个月,平均22.4个月。术后AOFAS踝与后足评分［(93.0±6.5)分］显著高于术前［(73.9±3.1)分］;术后VAS评分［(0.8±0.8)分］显著低于术前［(5.4±1.0)分］;术后患者非常满意16例,满意8例,一般2例,满意率为92.3%(24/26)。术后患者X线片均示软骨下囊肿低密度区消失,未见关节间隙狭窄;MRI均示原病灶缺损区被移植物填充。MOCART评分平均为(57.2±9.1)分,其中3例软骨下骨内有直径＜ 5 mm的囊肿。18例行二次关节镜探查示原软骨缺损区被再生类软骨组织覆盖。结论 自体骨－骨膜移植可同时修复Hepple V型距骨骨软骨损伤及软骨下囊肿,近期疗效满意,是安全、有效的治疗方法。     

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。     

病灶清除自体骨髓细胞结合重组合异种骨移植治疗距骨缺血性坏死

目的应用病灶清除自体骨髓细胞结合重组合异种骨移植的方法治疗距骨缺血性坏死,探索距骨骨坏死的微创治疗方法。方法自2000年6月～2002年9月采用上述术式治疗距骨缺血性坏死17例,均为单侧发病。根据Ficat及Arlet分期标准Ⅱ期14例,Ⅲ期3例,术后随访24～51个月,平均37个月,根据手术前后美国足踝关节外科协会踝关节功能评分标准(AO—FAS)进行随访观察。结果术后17例踝关节功能均有不同程度的改善,AOFAS评分较术前平均提高29．9分,1例于术后25个月改行踝关节融合术。结论病灶清除自体骨髓细胞结合重组合异种骨移植治疗距骨骨坏死,手术操作简便、手术创伤小、疗效确切,是一种值得提倡的微创手术治疗方法。     

镜下微骨折治疗距骨骨软骨损伤

[目的]探讨关节镜下微骨折术治疗距骨骨软骨损伤(OLT)的核磁共振成像(MRI)随访结果。[方法]选取2016年1月～2019年5月本科关节镜下微骨折术治疗距骨骨软骨损伤的患者40例进行回顾性分析,术前均完善负重位踝关节正侧位X线片及MRI检查,影像学评估术前及末次随访MRI脂肪抑制序列矢状位下的距骨骨水肿面积,临床评估术前及末次随访VAS评分和AOFAS评分。[结果]所有患者均顺利完成手术,无血管、神经损伤等严重并发症。所有患者均获得随访,平均随访时间(29.52±11.84)个月;末次随访时VAS评分由术前(5.95±1.08)降至(1.15±1.08),AOFAS由术前(64.70±9.74)增至(92.33±5.89),MRI显示软骨损伤区骨水肿面积由术前(80.51±39.55) mm2缩小至(35.41±45.27) mm2,差异均有统计学意义(P0.05);治疗有效率达92.50%。[结论]关节镜下微骨折术治疗距骨骨软骨损伤具有较好的临床疗效;其MRI显示明显好转。     

关节镜跟腱360°清理并跟骨成形术治疗跟腱Haglund综合征

目的研究关节镜跟腱360°清理并跟骨成形术治疗跟腱Haglund综合征的临床疗效。方法 2013年12月至2015年3月24例跟腱Haglund综合征患者采用关节镜跟腱360°清理并跟骨成形术治疗。男17例,女7例;年龄18~59岁,平均42.5岁。术前摄全足负重侧位X线片及跟腱MRI,根据跟腱Haglund综合征MRI分级,Ⅰ级5例,Ⅱ级10例,Ⅲ级4例,Ⅳ级5例。术前、术后进行美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)踝-后足功能评分。结果 24例均获随访,随访时间5~16个月,平均9.3个月。术前AOFAS踝-后足功能评分平均50分,术后末次随访时平均88.2分,与术前相比AOFAS踝-后足功能评分明显提高。优18例,良4例,可2例,优良率为91.7%。结论关节镜跟腱360°清理并跟骨成形术治疗跟腱Haglund综合征可获得良好的临床疗效。     

截骨复位治疗踝关节骨折畸形愈合的疗效分析

目的：探讨采用截骨复位治疗踝关节骨折畸形愈合的临床疗效。方法：回顾性分析2018年3月至2021年6月收治的30例采用截骨复位治疗踝关节骨折畸形愈合的患者资料。男9例,女21例;手术时年龄18～70岁,平均（40.5±15.5）岁;受伤或第一次手术到截骨手术间隔9(6.3,22.5)个月。比较患者术前及末次随访时的美国足踝外科协会（AOFAS）踝与后足评分、疼痛视觉模拟评分（VAS）、足部功能指数（FFI）、距骨倾斜角（TT）、距踝角（TCA）和踝关节活动范围（ROM）,记录患者满意度及并发症。结果：所有患者术后随访18～57个月,平均（40.5±12.0）个月。末次随访时AOFAS踝与后足评分为（86.5±7.6）分、VAS为1.0(1.0,2.0)分、FFI为18.5(9.2,23.8)分、TT为1.4°（1.0°,2.1°）、TCA为79.2°±3.3°,较术前均显著改善,差异有统计学意义（P<0.05）。踝关节ROM术前和末次随访比较,差异无统计学意义。1例踝关节炎发生了进展,总体满意度86.7%(26/30)。结论：采用截骨复位治疗踝关节骨折畸形愈合具有良好的临床疗效,...     

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。     

全踝关节镜下改良brostrom手术治疗踝关节慢性不稳定

目的探讨分析全踝关节镜下改良brostrom手术治疗踝关节慢性不稳定的临床效果。方法将2013年8月~2015年8月我院收治的82例踝关节慢性不稳定患者纳入课题分析中,治疗方式为全踝关节镜下改良brostrom手术,比较不同时间点踝关节慢性不稳定患者踝关节查体结果、AOFAS评分、疼痛视觉模拟评分(VAS)及并发症发生情况。结果患者术后踝关节距骨倾斜角、距骨前移距离、踝关节跖屈角度、踝关节背伸角度、踝关节内翻角度、踝关节外翻角度较手术前有显著的好转(P0.001);Davis-Weber A、B、C型患者术后疼痛、异常步态、踝部支撑与自主功能、踝关节屈伸情况、最大步行距离和踝关节的稳定性踝关节功能的改善情况以及AOFAS评分较术前显著改善(P0.001);Davis-Weber A、B、C型术后患者距骨倾斜角、距骨前移距离、踝关节跖屈角度、踝关节背伸角度、踝关节内翻角度、踝关节外翻角度较术前有了显著的好转(P0.001)。术后随访两年,患者踝关节查体结果与术后相比,能够得到较为良好的维持,各项查体结果与术后相比差异无统计学意义(P0.05)。患者术后及术后随访两年,均无显著的神经损伤、感染、皮缘坏死等术后并发症发生。结论对于踝关节慢性不稳定患者采取全踝关节镜下改良brostrom手术进行治疗后,患者踝关节查体情况良好,术后AOFAS评分及VAS评分显著降低,临床效果显著,预后患者疼痛、踝关节功能恢复等情况均得到了显著的改善。     

Free microvascular iliac crest flap for extensive talar necrosis—Case report with a 16‐year long‐term follow up

Atraumatic osteonecrosis of the talus can be extremely painful and lead to significant functional impairment. Although clinical, radiographic, and demographic characteristics of atraumatic osteonecrosis of the talus have been well documented, the diagnosis is frequently missed or delayed; the most common causes are use of corticosteroids and the presence of immune disorders. Operative treatment of large osteochondral lesions of the talus is difficult because the blood supply is poor in the talar dome. Microvascular reconstruction of the talar dome with iliac crest autografts is a complex but functionally excellent therapeutic option. We present a 48‐year‐old man, who developed an extensive atraumatic avascular necrosis of the talar dome without collapse. Except for insulin dependent diabetes mellitus no further comorbidities were known. A microvascular iliac crest bone flap was inserted into the talus. A follow‐up 16 years postoperatively showed a clinically as well as radiographically stable reconstruction of the talar dome and an excellent mobility of the ankle joint. The AOFAS hindfoot scale had improved from initially 33 points to 100 on the last follow‐up. Free microvascular bony reconstruction of the talar dome should not only be considered in younger patients but also for middle aged active patients, since our follow‐up shows an excellent long term result. Early reconstruction can prevent collapse of the talar bone. © 2009 Wiley‐Liss, Inc. Microsurgery 2009.     

Surgical Revascularization—An Innovative Approach to the Treatment of Talar Osteonecrosis Dissecans Stages II and III

Talar osteonecrosis dissecans is caused by osseous malperfusion, leading to destruction of the talar bone. The current reference standard for advanced stages lacking arthrosis is core decompression, followed by autologous cancellous bone grafting. However, talar revascularization has not been observed in a subset of patients after this procedure. Microsurgical vascularized bone grafting can improve outcomes by the induction of angiogenesis. We present the 1-year follow-up data from 3 patients with talar osteonecrosis dissecans, who had undergone free vascularized medial femoral condyle autotransplantation. The patients were evaluated preoperatively and 3, 6, and 12 months postoperatively. The active range of motion, pain (visual analog scale [VAS]), and American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, and lower extremity functional scale were used. Osteonecrosis dissecans stage II was seen in patient 1 (aged 27 years) and stage III in patients 2 (aged 18 years) and 3 (aged 41 years). Preoperative pain of the ankle was recorded as VAS score of 3 by patients 1 and 2 and VAS score of 6 by patient 3. At 12 months postoperatively, patients 1 and 2 recorded a VAS score of 2 and patient 3, a VAS score of 0. All patients showed improvement in the lower extremity functional scale and American Orthopaedic Foot and Ankle Society scale scores. After 6 and 12 months, magnetic resonance imaging showed a well-vascularized femoral condyle incorporated into the talus in all the patients. Autotransplantation of vascularized bone grafts from the medial femoral condyle is a promising technique for surgical revascularization of talar osteonecrosis dissecans stage II and III.     

The role of external fixation in the management of infected avascular necrosis after traumatic talus fractures

PurposeAvascular necrosis (AVN) after fractures of the talus is a distinct and challenging clinical entity that is associated with poor outcomes. Although several articles are published on the management of posttraumatic AVN of the talus, very little is known about the management of infected AVN after talus fractures. Therefore, three cases of infected AVN were treated successfully by extensive debridement, external fixation and arthrodesis.MethodsThree cases of infected AVN of the talus were encountered after a mean of 3 months (range 2–6 months) after initial reconstructive surgery. Suspected infection was confirmed by positron emission tomography scan (PET-CT). Management involved extensive debridement, PMMA cement if necessary and final fusion using medial external fixator, accompanied by culture guided antibiotics. Functional outcome was assessed using the Foot Function Index (FFI) and the American Orthopaedic Foot and Ankle Society hindfoot score (AOFAS). Quality of life (QOL) was measured by the EuroQol-5D (EQ-5D).ResultsAfter a mean follow up of 24 months (range 13–29), FFI index scores ranged from poor to good (23, 50, 56) with similar AOFAS scores indicating poor to fair functional outcome (38, 41, 71). The EQ-5D score was 0.78. Overall patient satisfaction was high with a mean VAS of 8.3 (range 8–9).ConclusionInfected talar AVN is a rare condition associated with severe long-term morbidity in term of joint function. The authors recommend extensive debridement and arthrodesis by means of external fixation, followed by post-operative culture-guided antibiotics for the treatment of infected avascular necrosis of traumatic talar fractures. Shared decision-making and expectation management are of crucial importance and may lead to high patient satisfaction despite low functional outcomes.Level of evidenceIV, Retrospective case series.     

Surgical Outcomes of Articular Surface Crush Injury of Hawkins Ⅲ Talus Neck and Medial Malleolus Fracture

The present study was performed to evaluate the effects of the medial and anterolateral approach combined with internal fixation by double head compression screws and countersunk K-wires for Hawkins Ⅲ talus neck and medial malleolus fracture. Eleven patients with articular surface crush injury resulting in Hawkins Ⅲ talus neck fractures accompanied by medial malleolus fractures were reviewed. All patients underwent emergency operations. The fractures were fixed using double head compression screws and countersunk K-wires through combined medial and anterolateral approaches. FAOS, AOFAS ankle-hindfoot scale, and VAS questionnaire scores were recorded. In addition, ROM of the ankle and postoperative complications were assessed. All patients were followed up for a median of 52.45 ± 5.15 months. The multiple scales data of FAOS on the affected side were: pain score 89.14 ± 7.08; activities of daily living score 89.57 ± 8.88; quality-of-life score 89.20 ± 7.44; sports score 75.00 ± 15.49; and other symptoms score 84.74 ± 7.51. The mean overall AOFAS ankle-hindfoot score was 88.36 ± 6.39. The VAS score was 0.72 ± 0.65. Ankle motion included dorsiflexion (13.18° ± 9.02°) and plantar flexion (32.27° ± 12.34°). Subtalar joint motion included eversion (10.91° ± 7.01°) and inversion (11.36° ± 7.45°). All scores of the healthy side were higher than those of the affected side (p < .05). In addition to ROM of the ankle and subtalar joint and sports score, various indicators of recovery rate had scores > 80%. One patient developed skin necrosis, which healed after debridement and wound dressing. Late complications included subtalar and/or ankle traumatic arthritis in six patients, four of whom showed no obvious clinical symptoms. In conclusion, the method of emergency surgery and medial and anterolateral approach combined with countersunk K-wires to fix small bone fragments to restore the integrity of the articular surface is acceptable for Hawkins Ⅲ talus neck with medial malleolus fracture.     

关节镜微创治疗距骨颈骨折的临床疗效

目的评价关节镜监视下微创治疗距骨颈骨折的临床疗效。方法回顾性研究2005—2013年于我院住院治疗的距骨颈骨折患者27例,根据治疗方法分为关节镜组和切开复位内固定组。关节镜组常规采用前内侧和前外侧入路,必要时加用距下关节入路;切开复位内固定组均采用相同的前内侧切口。两组术中均达到骨折的解剖复位,终末随访时进行美国足踝外科协会（AOFAS）的踝一后足评分（AHS评分）。结果两组患者术后均无感染刀口不愈合的情况。关节镜组2例患者发生了距骨缺血性坏死（AVN）,其中Ⅱ型患者1例、Ⅲ型患者1例,发生率为18．2％;切开复位内固定组4例发生了距骨缺血性坏死,其中Ⅱ型患者3例、Ⅲ型患者1例,发生率为25％（x2=7．143,P=0．008）。最终随访时,关节镜组AHS评分为（86.3±9．2）分,切开复位内固定组为（78．5±7．8）分,组间差异具有统计学意义（t=1．303,P=0．205）。结论关节镜监视下复位经皮内固定距骨颈骨折创伤小,降低术后距骨缺血性坏死发生率,临床疗效满意,是治疗距骨颈骨折患者的良好选择。     

Extracorporeal Shock Wave Therapy for Pain Relief After Arthroscopic Treatment of Osteochondral Lesions of Talus

Arthroscopic treatment is an effective technique for osteochondral lesion of talus (OLT); however, some patients still suffer pain and limitation of activities after surgery. The purpose of this study was to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) after ankle arthroscopy for OLT. We reviewed the clinical history of a series of 78 patients with OLT who underwent arthroscopic microfracture. ESWT was prescribed for 15 patients who complained of ankle pain and restriction of weightbearing activities 3 months postoperatively. The parameters assessed were visual analog scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale scores (before ESWT, at 6 and 12 weeks, and at last follow-up after ESWT) and magnetic resonance imaging (MRI) before and 1 year after ESWT. Follow-up was 27.8 ± 15.2 months. VAS and AOFAS scores showed a significant improvement at 12 weeks after ESWT and a progressive trend at last follow-up. Areas of lesions in sagittal plane in MRI were distinctly reduced at last follow-up. ESWT for osteochondral lesions of talus after arthroscopy results in good clinical outcomes.     

Vascularized bone graft from the medial calcaneus for treatment of large osteochondral lesions of the medial talus

BACKGROUND: Operative treatment of large osteochondral lesions of the talus is difficult because the blood supply is poor in the talar dome. The purpose of this study was to evaluate the results of a vascularized bone graft transfer from the medial calcaneus to the large osteochondral lesion. METHODS: Four ankles in four patients with medial osteochondral lesions were treated through a medial transmalleolar approach. Vascularized bone graft was harvested from the medial calcaneus using the calcaneal branch of the posterior tibial artery and was placed through a fenestration of the medial aspect of the talar dome. The mean duration of postoperative followup was 34 (range 24 to 48) months. Clinical and radiographic evaluations were made before surgery and at final followup. RESULTS: According to the AOFAS ankle-hindfoot scale, mean pain and function scores improved from 20 to 33 points and 30 to 43 points, respectively. The mean total score improved from 60 to 83 points. Plain radiography at followup showed slight osteosclerosis in all patients, but joint space narrowing was not seen in any patient. Cysts seen preoperatively on MRI or CT resolved after 12 months postoperatively, and MRI or CT did not reveal any findings indicative of osteonecrosis. CONCLUSIONS: Clinical and radiographic results were satisfactory. Vascularized bone grafts harvested from the calcaneus were successful for the treatment of large osteochondral lesions of the medial talus.     

开放性距骨脱位的手术治疗

目的：探讨手术治疗开放性距骨脱位的临床疗效。方法：收集2001年6月至2008年7月资料完整的开放性距骨脱位患者11例,男8例,女3例;年龄19～52岁,平均39.5岁。按照Gustilo分型：Ⅰ型2例,Ⅱ型6例,ⅢA型2例,ⅢB型1例。胫距关节脱位5例（其中合并距下关节脱位3例）,距下关节脱位4例,距骨完全脱位2例。8例合并距骨不同部位骨折。所有患者均在伤后8h内接受清创、复位内固定加石膏或外固定支架固定。术后6周去除外固定。X线提示骨折愈合后负重。随访时摄踝关节正侧位、足部正位X线片,并按照美国足踝外科协会（AOFAS）对后足功能评分标准从疼痛、功能、力线等方面进行评分。结果：11例患者随访时间为10～15个月,平均13.8个月。8例合并不同部位骨折的患者均获得愈合,愈合时间4～7个月,平均4.3个月,无伤口及深部感染。距骨坏死2例,创伤性关节炎2例。末次随访时AOFAS评分为（71.3±8.6）分,其中疼痛（32.4±7.1）分,功能（31.0±15.7）分,力线（7.6±2.3）分。结论：对于开放性距骨脱位,通过积极彻底清创可以避免感染的发生;早期复位和固定是治疗的关键。     

Osteochondral lesions of the talus: results of repeat arthroscopic debridement

BACKGROUND: Repeat arthroscopic debridement of osteochondral lesions of the talus has a poor reputation despite a paucity of evidence in the literature. METHODS: We reviewed all patients who had repeat arthroscopic debridement of an osteochondral lesion performed by the senior author. They were scored using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, and lesions were graded using the system described by Berndt and Harty. RESULTS: Between 1993 and 2002, 808 consecutive ankle arthroscopies were performed by the senior author, of which 215 were to treat osteochondral lesions of the talus. Of these, 12 had repeat arthroscopies because of unresolved symptoms. AOFAS scores improved from a mean of 34.8 prior to arthroscopy to 80.5 after repeat arthroscopy at a mean followup of 5.9 years (18 months to 11 years). Two patients returned to professional sports after the second procedure. Six patients returned to their preinjury levels of sporting activity and three returned to the same sports but played to a lesser standard or less frequently. One patient had already had a cartilage transplantation procedure. CONCLUSIONS: This is the first series specifically assessing patients who have had repeat arthroscopic debridement of osteochondral lesions of the talus, using the same debridement technique by a single surgeon. Our results question the assumption that repeat arthroscopic debridement yields poor results. They also provide a baseline for the newer chondral and osteochondral transplantation techniques to compare to at the medium term.