PDF(Pubmed)
Abstract：
UNASSIGNED: Malalignment has been suggested as a predisposing factor for the development of osteochondral lesions of the talus (OLTs).
UNASSIGNED: To evaluate the clinical and radiographic outcomes of realignment surgery in patients with a large cystic OLT of the talar shoulder and concurrent malalignment of the foot and ankle.
UNASSIGNED: Case series; Level of evidence, 4.
UNASSIGNED: The authors reviewed consecutive patients with large cystic OLTs (diameter, >10 mm) of the talar shoulder and concurrent malalignment of the foot and ankle who underwent realignment surgery between September 2013 and April 2021. The type of realignment procedure was determined based on patient symptoms and findings on plain radiographs and weightbearing computed tomography. Clinical improvement was assessed using pre- and postoperative Foot Function Index (FFI) scores and the visual analog scale (VAS) for pain. The OLT location was categorized according to Raikin zone, and the OLT area and volume were measured and compared pre- and postoperatively. The comparative analysis was performed using the Wilcoxon signed-rank test.
UNASSIGNED: In total, 27 ankles in 27 patients (mean age, 34.4 ± 11.9 years) were included in the analysis. There were 25 patients with a medial lesion (zone 4 [n = 19], zone 7 [n = 5], and zone 1 [n = 1]), and 2 patients with a lateral lesion (zone 6). Despite OLT location, patients\' symptoms varied; 15 (55.6%) patients reported both medial- and lateral-sided pain, 10 (37%) reported lateral-sided pain, and 2 (7%) reported medial-sided pain. Supramalleolar osteotomy was performed in 18 patients, while foot and hindfoot correction without supramalleolar osteotomy was performed in 9 patients. Postoperatively, both the median FFI (from 44.4 [interquartile range (IQR), 35.7-52.2] to 9.1 [IQR, 5.2-13.9]) and median VAS pain score (from 6 [IQR, 5-6] to 1 [IQR, 1-2]) improved significantly (P < .0001 for both), and the median lesion size (from 25.8 mm2 [IQR, 19.3-45.2 mm2] to 13.8 mm2 [IQR, 6.8-26.5 mm2]) and median volume (from 2226.8 mm3 [IQR, 1311-3104 mm3] to 1326.5 mm3 [IQR, 714-2100 mm3]) decreased significantly (P < .0001 for both). During the mean follow-up of 4.1 ± 2.1 years, no subsequent surgery for OLT was necessary.
UNASSIGNED: The results suggest that realignment procedures can improve the symptoms and radiographic profile of OLTs in patients with large cystic OLTs of the talar shoulder and malalignment of the foot and ankle.
UNASSIGNED: To evaluate the clinical and radiographic outcomes of realignment surgery in patients with a large cystic OLT of the talar shoulder and concurrent malalignment of the foot and ankle.
UNASSIGNED: Case series; Level of evidence, 4.
UNASSIGNED: The authors reviewed consecutive patients with large cystic OLTs (diameter, >10 mm) of the talar shoulder and concurrent malalignment of the foot and ankle who underwent realignment surgery between September 2013 and April 2021. The type of realignment procedure was determined based on patient symptoms and findings on plain radiographs and weightbearing computed tomography. Clinical improvement was assessed using pre- and postoperative Foot Function Index (FFI) scores and the visual analog scale (VAS) for pain. The OLT location was categorized according to Raikin zone, and the OLT area and volume were measured and compared pre- and postoperatively. The comparative analysis was performed using the Wilcoxon signed-rank test.
UNASSIGNED: In total, 27 ankles in 27 patients (mean age, 34.4 ± 11.9 years) were included in the analysis. There were 25 patients with a medial lesion (zone 4 [n = 19], zone 7 [n = 5], and zone 1 [n = 1]), and 2 patients with a lateral lesion (zone 6). Despite OLT location, patients\' symptoms varied; 15 (55.6%) patients reported both medial- and lateral-sided pain, 10 (37%) reported lateral-sided pain, and 2 (7%) reported medial-sided pain. Supramalleolar osteotomy was performed in 18 patients, while foot and hindfoot correction without supramalleolar osteotomy was performed in 9 patients. Postoperatively, both the median FFI (from 44.4 [interquartile range (IQR), 35.7-52.2] to 9.1 [IQR, 5.2-13.9]) and median VAS pain score (from 6 [IQR, 5-6] to 1 [IQR, 1-2]) improved significantly (P < .0001 for both), and the median lesion size (from 25.8 mm2 [IQR, 19.3-45.2 mm2] to 13.8 mm2 [IQR, 6.8-26.5 mm2]) and median volume (from 2226.8 mm3 [IQR, 1311-3104 mm3] to 1326.5 mm3 [IQR, 714-2100 mm3]) decreased significantly (P < .0001 for both). During the mean follow-up of 4.1 ± 2.1 years, no subsequent surgery for OLT was necessary.
UNASSIGNED: The results suggest that realignment procedures can improve the symptoms and radiographic profile of OLTs in patients with large cystic OLTs of the talar shoulder and malalignment of the foot and ankle.
摘要：
■错位已被认为是距骨软骨损伤（OLTs）发展的诱发因素。
■评估距骨肩大囊性OLT患者的重新对准手术的临床和影像学结果，并伴有足和踝关节对准不良。
■案例系列；证据级别，4.
■作者回顾了连续的大型囊性OLT患者（直径，>10毫米）的距骨肩和同时发生的脚和脚踝的不对齐，在2013年9月至2021年4月之间接受了重新对齐手术。重新对齐程序的类型是根据患者症状以及平片和负重计算机断层扫描的发现确定的。使用术前和术后足部功能指数（FFI）评分和疼痛的视觉模拟量表（VAS）评估临床改善情况。OLT位置根据Raikin区域分类，术前和术后测量并比较OLT面积和体积。使用Wilcoxon符号秩检验进行比较分析。
■总共，27例患者中的27例脚踝(平均年龄，34.4±11.9年）纳入分析。有25例患者有内侧病变（4区[n=19]，区域7[n=5]，和区域1[n=1])，和2例侧方病变（6区）。尽管OLT位置,患者的症状各不相同；15例（55.6%）患者报告了中侧和外侧疼痛，10例（37%）报告有外侧疼痛，2例（7％）报告了内侧疼痛。18例患者行上踝截骨术，9例患者进行了足和后足矫正，而没有进行踝上截骨术。术后,两者的FFI中位数(从44.4[四分位数间距(IQR)，35.7-52.2]至9.1[IQR，5.2-13.9])和中位VAS疼痛评分(从6[IQR，5-6]到1[IQR，1-2])显著改善(两者P<0.0001)，和中位病变大小(从25.8mm2[IQR，19.3-45.2mm2到13.8mm2[IQR,6.8-26.5mm2)和中值体积(从2226.8mm3[IQR，1311-3104mm3]to1326.5mm3[IQR,714-2100mm3])显著下降(两者P<0.0001)。在平均4.1±2.1年的随访期间，没有必要对OLT进行后续手术.
■结果表明，重新对齐程序可以改善距肩大囊性OLT和脚和脚踝对齐不良的患者的OLT症状和影像学特征。
■评估距骨肩大囊性OLT患者的重新对准手术的临床和影像学结果，并伴有足和踝关节对准不良。
■案例系列；证据级别，4.
■作者回顾了连续的大型囊性OLT患者（直径，>10毫米）的距骨肩和同时发生的脚和脚踝的不对齐，在2013年9月至2021年4月之间接受了重新对齐手术。重新对齐程序的类型是根据患者症状以及平片和负重计算机断层扫描的发现确定的。使用术前和术后足部功能指数（FFI）评分和疼痛的视觉模拟量表（VAS）评估临床改善情况。OLT位置根据Raikin区域分类，术前和术后测量并比较OLT面积和体积。使用Wilcoxon符号秩检验进行比较分析。
■总共，27例患者中的27例脚踝(平均年龄，34.4±11.9年）纳入分析。有25例患者有内侧病变（4区[n=19]，区域7[n=5]，和区域1[n=1])，和2例侧方病变（6区）。尽管OLT位置,患者的症状各不相同；15例（55.6%）患者报告了中侧和外侧疼痛，10例（37%）报告有外侧疼痛，2例（7％）报告了内侧疼痛。18例患者行上踝截骨术，9例患者进行了足和后足矫正，而没有进行踝上截骨术。术后,两者的FFI中位数(从44.4[四分位数间距(IQR)，35.7-52.2]至9.1[IQR，5.2-13.9])和中位VAS疼痛评分(从6[IQR，5-6]到1[IQR，1-2])显著改善(两者P<0.0001)，和中位病变大小(从25.8mm2[IQR，19.3-45.2mm2到13.8mm2[IQR,6.8-26.5mm2)和中值体积(从2226.8mm3[IQR，1311-3104mm3]to1326.5mm3[IQR,714-2100mm3])显著下降(两者P<0.0001)。在平均4.1±2.1年的随访期间，没有必要对OLT进行后续手术.
■结果表明，重新对齐程序可以改善距肩大囊性OLT和脚和脚踝对齐不良的患者的OLT症状和影像学特征。
