Jarde O, Trinquier-Lautard J L, Garate F, de Lestang M, Vives P
Service de Chirurgie Orthopédique, CHU Nord, place Victor-Pauchet, 80054 Amiens Cedex 1.
Rev Chir Orthop Reparatrice Appar Mot. 2000 Oct;86(6):608-15.
We reviewed 30 cases of osteochondral lesions of the astragalar vault treated surgically.
Among the 30 patients, 17 participated in sports activities and 24 had a history of trauma. Mean delay to surgery was 10 months. Treatment included osteochondritis curettage and Pridie perforations. Direct access was used in 11 cases, malleolar osteotomy in 13 and arthroscopy in 6. Cancellous bone grafts were used in 6 cases.
Mean follow-up was 3 years 7 months (minimum 2 years). All patients had an arthroscan at last follow-up. Evaluation of post-operative outcome was based on clinical assessment and arthroscan findings. Surgical treatment provided very good results in 75 p. 100 of cases with pain relief and improved walking distance.
Our cases pointed out the important contribution of the FOG (Fracture Osteonecrosis Geode) classification to pathogenic and prognostic analysis. The Berndt and Harty classifications were not found to be useful.
In case of localized necrosis, we propose arthroscopic perforation curettage. In case of bone loss, a direct cancellous graft may be used.
我们回顾了30例经手术治疗的距骨穹窿部骨软骨损伤病例。
30例患者中，17例参与体育活动，24例有外伤史。平均手术延迟时间为10个月。治疗方法包括骨软骨炎刮除术和普里迪钻孔术。11例采用直接入路，13例采用踝关节截骨术，6例采用关节镜检查。6例使用松质骨移植。
平均随访3年7个月（最短2年）。所有患者在最后一次随访时均进行了关节扫描。术后结果评估基于临床评估和关节扫描结果。手术治疗在75%的病例中取得了非常好的效果，疼痛缓解，步行距离增加。
我们的病例指出了FOG（骨折-骨坏死-假囊肿）分类对病因和预后分析的重要贡献。未发现伯恩特和哈蒂分类有用。
对于局限性坏死，我们建议采用关节镜下钻孔刮除术。对于骨质缺损，可使用直接松质骨移植。
