目标:与踝关节骨软骨损伤(OCL)相反,OCL在脚的其他关节,如距下关节,距骨关节,跟骨关节,和中脚,是罕见的条件,但它们也会导致严重的发病率。本系统综述的目的是总结治疗距下OCLs的临床证据,距骨,跟骨,和其他中足关节。
方法:对MEDLINE的系统搜索,EMBASE,和CochraneLibrary数据库于2021年1月根据PRISMA(系统审查和荟萃分析的首选报告项目)指南由2名独立审查者进行。对纳入的研究进行了LOE(证据水平)和QOE(证据质量)评估。变量报告结果数据,临床结果,并对并发症进行了评估。
结果:纳入了21例患者的17项研究,所有病例均为病例报告(5级),没有任何病例系列报告超过3例患者.距下关节OCL患者5例,15例患者在距骨关节,跟骨关节1例。13例病例报告(4个距下关节,8距骨关节,和1个跟眼关节)报告了手术治疗。外科手术主要包括清创,骨髓刺激,固定,和骨移植,通过开放或关节镜检查,所有这些都导致了成功的结果。4例报告(1个距下关节,3个距骨关节)报告保守治疗成功。其他13例报告保守治疗失败后手术成功。未报告并发症和再次手术。
结论:目前的系统评价显示,没有可用的证据来确定保守和手术治疗距骨关节软骨损伤的临床结果,距下关节,和中足关节,由于文学的极度匮乏。非手术和手术治疗都可以考虑,但尚未建立治疗策略。
OBJECTIVE: In contrast to osteochondral lesion (OCL) of the ankle, OCLs in other joints of the foot, such as subtalar joint, talonavicular joint, calcaneocuboid joint, and the midfoot, are rare conditions, but they can also lead to significant morbidity. The objective of this systematic
review was to summarize the clinical evidence for the treatment of OCLs of the subtalar, talonavicular, calcaneocuboid, and the other midfoot joints.
METHODS: A systematic search of the MEDLINE, EMBASE, and Cochrane Library databases was performed in January 2021 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by 2 independent reviewers. Included studies were evaluated with regard to LOE (level of evidence) and QOE (quality of evidence). Variable reporting outcome data, clinical outcomes, and complications were evaluated.
RESULTS: Seventeen studies with 21 patients were included, all of which were case reports (level 5) without any case series reporting greater than 3 patients. There were 5 patients with OCL in the subtalar joint, 15 patients in the talonavicular joint, and 1 patient in the calcaneocuboid joint. Thirteen case reports (4 subtalar joint, 8 talonavicular joint, and 1 calcaneocuboid joint) reported surgical treatment. Surgical procedures mainly included debridement, bone marrow stimulation, fixation, and bone grafting, through open or arthroscopy, all of which resulted in successful outcomes. Four case reports (1 subtalar joint, 3 talonavicular joint) reported successful conservative treatment. Other 13 case reports reported successful surgery after failed conservative treatment. No complications and reoperations were reported.
CONCLUSIONS: The current systematic
review revealed that there is no available evidence to ascertain clinical outcomes of both conservative and surgical treatments for cartilage lesions in the talonavicular joint, subtalar joint, and the midfoot joints, owing to the extreme paucity of literature. Both nonoperative and operative treatments can be considered, but no treatment strategies have been established.