Saxena Amol, Eakin Colin
Department of Sports Medicine, Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA 94301, USA.
Am J Sports Med. 2007 Oct;35(10):1680-7. doi: 10.1177/0363546507303561. Epub 2007 Jul 26.
The treatment options of talar osteochondral lesions are numerous. Although studies show these treatments have been used with varying success, the ability to return to activity (RTA), including sports after treatment of talar dome injuries, have not been well documented.
A treatment plan that uses microfracture for Hepple stage 2 through 4 lesions and autogenous bone grafting for Hepple stage 5 lesions for athletes with articular lesions of the talus will produce a high rate of return to athletic activity.
Case series; Level of evidence, 4.
Preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and RTA were assessed prospectively 2 to 8 years after surgery in high-demand (athletic) patients with articular injuries to the talar dome treated according to the above protocol over a 6-year period.
There were 26 microfracture procedures and 20 bone grafts to the talus. The AOFAS scores for both microfracture (pre-operative, 54.6; postoperative, 94.4) and bone graft (preoperative, 46.1; postoperative, 93.4) patients improved significantly. The RTA for the entire group was 17.0 +/- 5.3 weeks; for those undergoing microfracture, RTA was 15.1 +/- 4.0 weeks; and for bone grafting, it was 19.6 +/- 5.9 weeks. The RTA for the bone graft group was significantly slower than that of the microfracture group. Anterolateral lesions had significantly faster RTA and higher postoperative scores compared with other lesion locations. Arthroscopically treated lesions had similar postoperative AOFAS scores to those who had arthrotomy and did not have significantly faster RTA. Forty-four (96%) "excellent/good" AOFAS scores were achieved overall for talar lesions, with the same percentage of return to sport.
Talar bone grafting required a longer time to return to activity than microfracture in high-demand patients, but both groups had similar postoperative AOFAS scores. When applied to appropriate lesions, both techniques allow athletic patients to return to sports.
距骨骨软骨损伤的治疗选择众多。尽管研究表明这些治疗方法的成功率各不相同，但对于距骨穹窿损伤治疗后恢复活动（包括运动）的能力，相关记录并不完善。
对于患有距骨关节损伤的运动员，采用微骨折技术治疗Hepple 2至4期损伤、自体骨移植治疗Hepple 5期损伤的治疗方案，将产生较高的恢复运动活动率。
病例系列；证据等级，4级。
对在6年期间按照上述方案接受治疗的高需求（运动员）距骨穹窿关节损伤患者，在术后2至8年对其术前和术后的美国矫形足踝协会（AOFAS）评分及恢复活动情况进行前瞻性评估。
共进行了26例距骨微骨折手术和20例距骨骨移植手术。微骨折组（术前54.6分；术后94.4分）和骨移植组（术前46.1分；术后93.4分）患者的AOFAS评分均显著提高。整个组的恢复活动时间为17.0±5.3周；接受微骨折手术的患者恢复活动时间为15.1±4.0周；接受骨移植手术的患者为19.6±5.9周。骨移植组的恢复活动时间明显慢于微骨折组。与其他损伤部位相比，前外侧损伤的恢复活动时间明显更快，术后评分更高。关节镜治疗的损伤术后AOFAS评分与切开手术的患者相似，恢复活动时间也没有明显更快。距骨损伤总体上有44例（96%）获得“优秀/良好”的AOFAS评分，恢复运动的比例相同。
在高需求患者中，距骨骨移植恢复活动所需时间比微骨折长，但两组术后AOFAS评分相似。当应用于合适的损伤时，两种技术都能让运动员患者恢复运动。
