Schimmer R C, Dick W, Hintermann B
University of Basel, Clinic of Orthopaedic Surgery, Kantonsspital, Switzerland.
Foot Ankle Int. 2001 Nov;22(11):895-900. doi: 10.1177/107110070102201107.
Thirty-six cases of osteochondritis dissecans (OD) of the talus were diagnosed among 413 ankle arthroscopies performed within a period of six years. In 52.8% of the cases the OD was found on the medial and in 41.7% on the lateral talus. 53.3% of the lateral OD presented stage III and IV lesions while only 26.3% of the medial OD were to be graded stage III and IV. Patients with grade I and II lesions had mostly excellent outcome scores between 90 and 100. However, four patients with medial OD at less severe stages who were treated surgically, showed a particularly unfavorable outcome with scores between 11 and 36. All these patients needed either ankle arthrodesis or total ankle joint replacement. For stage II and III medial lesions, our experience has led to a more conservative approach due to the unfavorable outcome of surgical treatment observed in these patients. Despite the usefulness of MRI in the diagnosis of OD of the talus, arthroscopy has been proven to represent a very helpful diagnostic tool in assessing extent and in particular stability and integrity of the osteochondritic lesion. Apart from enabling the various minimally invasive surgical treatment options, ankle arthroscopy should be performed in all patients with OD of the talus in order to help define the treatment strategy and avoid unnecessary surgery on stable lesions.
在六年内进行的413例踝关节镜检查中，诊断出36例距骨剥脱性骨软骨炎（OD）。52.8%的病例中OD位于距骨内侧，41.7%位于距骨外侧。外侧OD的53.3%表现为III期和IV期病变，而内侧OD只有26.3%为III期和IV期。I级和II级病变的患者大多预后评分优异，在90至100分之间。然而，四名处于较轻阶段的内侧OD患者接受手术治疗后，结果特别不理想，评分在11至36分之间。所有这些患者都需要进行踝关节融合术或全踝关节置换术。对于II期和III期内侧病变，由于观察到这些患者手术治疗效果不佳，我们的经验导致采取更保守的方法。尽管MRI对距骨OD的诊断有用，但关节镜检查已被证明是评估骨软骨损伤范围，特别是稳定性和完整性的非常有用的诊断工具。除了能够进行各种微创手术治疗选择外，对于所有距骨OD患者都应进行踝关节镜检查，以帮助确定治疗策略并避免对稳定病变进行不必要的手术。
