■距骨的症状性骨软骨损伤(OLTs)通常需要手术干预。有各种手术方法。一般有效的,阶段依赖的治疗算法不存在。我们研究的目的是展示一种结合逆行钻探的替代技术的长期结果,在关节镜可视化下进行清创,和自体骨移植。
■对24例内侧或外侧OLT患者进行了手术技术,并对数据进行回顾性分析。在我们的技术中,受影响的软骨下骨逆行过度钻孔,并在关节镜可视化(骨镜)下切除,而不侵犯软骨。所产生的缺损用来自胫骨内侧干phy端的自体骨填充。结果参数是数字评定量表(NRS),美国骨科足踝协会(AOFAS)踝足-后足评分,和运动范围(ROM)。评估软骨修复组织的磁共振观察(MOCART)评分,并计算与临床结果评分的可能相关性。还收集了有关并发症发生率的数据。
■OLT的平均表面尺寸为0.9±0.3cm2。平均随访时间为89个月。AOFAS评分从术前的57.7分显着提高到最终随访的88.8分(P<0.0001)。NRS测得的疼痛值从8下降到2。背屈患者的ROM改善了37.5%,and屈患者的ROM改善了29.2%。MOCART评分与AOFAS评分或NRS上的疼痛值之间没有显着相关性。
■逆行钻孔,骨镜检查,自体骨移植是一种具有良好长期效果的有前途的技术。患者满意率,特别是在OLT阶段2和3,表现优异。
■四级,案例系列。
Symptomatic osteochondral lesions of the talus (OLTs) often require surgical intervention. There are various surgical methods. A generally valid, stage-dependent therapeutic algorithm does not exist. The aim of our study is to show long- term results of an alternative technique that combines retrograde drilling, debridement performed under arthroscopic visualization, and autologous bone grafting.
The surgical technique was performed in 24 patients with medial or lateral OLTs, and the data were analyzed retrospectively. In our technique, the affected subchondral bone was overdrilled retrogradely and resected under arthroscopic visualization (
ossoscopy) without violating the cartilage. The resulting defect was filled with autologous bone from the medial tibia metaphysis. Outcome parameters were the numeric rating scale (NRS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and range of motion (ROM). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was assessed and a possible correlation with the clinical outcome scores was calculated. Data concerning complication rates were also collected.
The mean surface size of the OLTs was 0.9 ± 0.3 cm2. The mean follow-up was 89 months. The AOFAS score improved significantly from 57.7 points preoperatively to 88.8 points at the final follow-up (P < .0001). The pain value measured by the NRS decreased significantly from 8 to a pain level of 2. ROM improved in 37.5% of the patients for dorsiflexion and 29.2% for plantarflexion. There were no significant correlations between the MOCART score and the AOFAS score or the pain value on NRS.
Retrograde drilling,
ossoscopy, and autologous bone grafting for OLTs is a promising technique with good long-term results. The patients\' satisfaction rate, especially in OLT stages 2 and 3, was excellent.
Level IV, case series.