Raikin Steven M, Elias Ilan, Zoga Adam C, Morrison William B, Besser Marcus P, Schweitzer Mark E
Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107,USA.
Foot Ankle Int. 2007 Feb;28(2):154-61. doi: 10.3113/FAI.2007.0154.
The primary aim of this study was to evaluate the true incidence of osteochondral lesions on the talar dome by location and by morphologic characteristics on MRI. Because no universally accepted localization system for talar dome osteochondral lesions currently exists, we established a novel, nine-zone anatomical grid system on the talar dome for an accurate depiction of lesion location.
We assigned nine zones to the talar dome articular surface in an equal 3 x 3 grid configuration. Zone 1 was the most anterior and medial, zone 3 was anterior and lateral, zone 7 was most posterior and medial, and zone 9 was the most posterior and lateral. The grid was designed with all nine zones being equal in surface area. Two observers reviewed MRI examinations of 428 ankles in 424 patients (211 males and 213 females; mean age 43 years; age range 6 to 85 years) with reported osteochondral talar lesions. We recorded the frequency of involvement and size of lesion for each zone. Statistical analyses were performed using ANOVA and Scheffe tests.
Four hundred and twenty-eight lesions were identified on MRI. The medial talar dome was more frequently involved (n = 269, 62%) than the lateral talar dome (n = 143, 34%). In the AP direction, the mid talar dome (equator) was much more frequently involved (n = 345, 80%) than the anterior (n = 25, 6%) or posterior (n = 58, 14%) thirds of the talar dome. Zone 4 (medial and mid) was most frequently involved (n = 227, 53%), and zone 6 (lateral and mid) was second most frequently involved (n=110, 26%). Lesions in the medial third of the talar dome were significantly larger in surface area involvement and deeper than those at the lateral talar dome.
Our established nine-grid scheme is a useful tool for localizing and characterizing osteochondral talar lesions, which are most frequently located in zone 4 at the medial talar dome, and second most in zone 6 at the lateral talar dome near its equator. Medial talar dome lesions are not only more common but are larger in surface area and in depth than lateral lesions. Posteromedial and anterolateral lesions rarely were found.
本研究的主要目的是通过位置和MRI上的形态学特征评估距骨穹窿骨软骨损伤的真实发生率。由于目前尚无普遍接受的距骨穹窿骨软骨损伤定位系统，我们在距骨穹窿上建立了一种新颖的九区解剖网格系统，以准确描述损伤位置。
我们以3×3的网格形式将九个区域分配到距骨穹窿关节面。1区位于最前内侧，3区位于前外侧，7区位于最后内侧，9区位于最后外侧。该网格设计为九个区域的表面积相等。两名观察者对424例患者（211例男性和213例女性；平均年龄43岁；年龄范围6至85岁）的428个踝关节的MRI检查进行了回顾，这些患者均报告有距骨骨软骨损伤。我们记录了每个区域的受累频率和损伤大小。使用方差分析和谢费检验进行统计分析。
MRI上共发现428处损伤。内侧距骨穹窿比外侧距骨穹窿更常受累（269处，62%）（外侧距骨穹窿143处，34%）。在前后方向上，距骨穹窿中部（赤道）比距骨穹窿前部（25处，6%）或后部（58处，14%）更常受累（345处，80%）。4区（内侧和中部）最常受累（227处，53%），6区（外侧和中部）其次（110处，26%）。距骨穹窿内侧三分之一的损伤在表面积累及和深度上均明显大于外侧距骨穹窿的损伤。
我们建立的九宫格方案是定位和描述距骨骨软骨损伤的有用工具，这些损伤最常位于内侧距骨穹窿的4区，其次是外侧距骨穹窿赤道附近的6区。内侧距骨穹窿损伤不仅更常见，而且表面积和深度均大于外侧损伤。后内侧和前外侧损伤很少见。
