PDF(Pubmed)
Abstract：
Large subchondral bone cysts in the medial talar body and dome are common and can cause persistent pain and swelling during axial loading. Open debridement and bone grafting are often necessary to treat these lesions but can require extensive soft-tissue dissection or malleolar osteotomies. A 40-year-old woman presented with ankle pain and swelling for 1 year, worsening with activity and no history of trauma. X-rays showed a cystic lesion in the medial talar dome with no joint line disruption. CT confirmed the cystic lesion without bone collapse or expansion. An anterior approach to the ankle joint was extended to access the talar neck. A window was created in the talar neck to debride and curette the medial talar dome, and the void was filled with allograft. The patient was non-weight-bearing for 6 weeks, followed by gradual weight-bearing and ankle range of motion exercises starting on postoperative day 1. The patient returned to her pre-injury status within 3 months and was asymptomatic at the 6-year follow-up, with good bone graft integration and no symptoms. This technical note presents a novel approach to lesions of the medial talar body and dome through the talar neck, avoiding the need for malleolar osteotomy or disruption to the tibiotalar joint, and resulting in good functional outcomes.
摘要：
距骨内侧和圆顶中的大软骨下骨囊肿是常见的，并且在轴向负荷期间会引起持续的疼痛和肿胀。开放性清创术和骨移植通常是治疗这些病变所必需的，但可能需要广泛的软组织解剖或踝骨切开术。一名40岁的女性出现脚踝疼痛和肿胀1年，随着活动而恶化，没有外伤史。X射线检查显示距骨内侧圆顶有囊性病变，无关节线中断。CT证实囊性病变无骨质塌陷或扩张。扩展了踝关节的前路以进入距骨颈。在距骨颈部创建了一个窗口，以清除和刮匙内侧距骨圆顶，用同种异体移植物填满了空隙.患者无负重6周，然后从术后第1天开始进行逐渐负重和踝关节活动范围锻炼。患者在3个月内恢复到受伤前的状态，在6年的随访中无症状。植骨融合良好，无症状。本技术说明提出了一种通过距骨颈的内侧距骨和圆顶病变的新颖方法，避免踝骨截骨术或胫骨关节中断的需要，并产生良好的功能结果。
