Tol J L, Struijs P A, Bossuyt P M, Verhagen R A, van Dijk C N
Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands.
Foot Ankle Int. 2000 Feb;21(2):119-26. doi: 10.1177/107110070002100205.
The aim of this study was to investigate the results of different treatment strategies for osteochondral defects (OCD) of the talus. Electronic databases from 1966 to July 1998 were systematically screened. Based on our inclusion criteria 32 studies describing the results of treatment strategies for OCD of the talus were included. No randomized clinical trials (RCT's) were identified. Fourteen studies described the results of excision alone, 11 the results of (EC), 14 the results of (ECD), 1 the results of cancellous bone grafting after EC, 1 the results of osteochondral transplantation and 3 the results of fixation. The average success rate of non-operative treatment (NT) was 45%. Comparison of different surgical procedures shows that the average highest success rate was reached by excision, curettage and drilling (ECD) (85%) followed by excision and curettage (EC) (78%) and excision alone (38%). Based on this systematic review we conclude that NT and excision alone are not to be recommended in treating talar OCD. Both EC and ECD have been shown to lead to a high percentage good/excellent results. However, due to great diversity in the articles and variability in treatment results, no definitive conclusions can be drawn. Further prospective randomized controlled trials are required to compare the outcome of these two surgical strategies for OCD of the talus.
本研究旨在调查距骨骨软骨损伤（OCD）不同治疗策略的结果。对1966年至1998年7月的电子数据库进行了系统筛选。根据纳入标准，纳入了32项描述距骨OCD治疗策略结果的研究。未发现随机临床试验（RCT）。14项研究描述了单纯切除的结果，11项描述了（EC）的结果，14项描述了（ECD）的结果，1项描述了EC后松质骨移植的结果，1项描述了骨软骨移植的结果，3项描述了固定的结果。非手术治疗（NT）的平均成功率为45%。不同手术方法的比较表明，切除、刮除和钻孔（ECD）的平均成功率最高（85%），其次是切除和刮除（EC）（78%），单纯切除（38%）。基于这项系统评价，我们得出结论，在治疗距骨OCD时，不推荐NT和单纯切除。EC和ECD均已显示可导致高比例的良好/优秀结果。然而，由于文章中存在很大差异且治疗结果存在变异性，无法得出明确结论。需要进一步进行前瞻性随机对照试验，以比较这两种距骨OCD手术策略的结果。
