Cugat Ramón, Cuscó Xavier, García Montserrat, Samitier Gonzalo, Seijas Roberto
Artroscopia G.C. Clínica del Pilar, Barcelona, Spain.
Arthroscopy. 2007 Sep;23(9):1025.e1-4. doi: 10.1016/j.arthro.2006.07.010. Epub 2006 Nov 27.
Osteochondritis of the posterosuperior area of the talocalcaneal surface is a relatively uncommon injury, and only 1 case has been described in the literature. We present a 37-year-old man who complained of pain in the tarsal canal area during walking and when standing up. The magnetic resonance imaging study showed an osteochondral signal in the posterosuperior medial area of the calcaneus on the talocalcaneal surface. The persistence of pain and lack of improvement with conservative treatment made arthroscopic debridement of the injury necessary. The arthroscopic procedure was performed through 2 medial portals, made under fluoroscopy, marked with needles, and dissected with mosquito clamps, and the affected surface could be fully visualized, showing a chondral lesion. Debridement of the osteonecrotic area was performed, and the Steadman technique was used on the injured bone surface. The patient was pain-free, and limited activity (i.e., standing up and walking without symptoms) was allowed. After 24 months, the patient remains asymptomatic with weight-bearing working activities and when standing. Arthroscopic curettage and scission of the injury have been shown to yield good or excellent outcomes in 75% to 80% of patients with regard to the talar surface.
距跟关节面后上方区域的骨软骨炎是一种相对罕见的损伤，文献中仅描述过1例。我们报告一名37岁男性，他在行走和站立时主诉跗管区域疼痛。磁共振成像研究显示，在距跟关节面跟骨后上方内侧区域有骨软骨信号。由于疼痛持续存在且保守治疗未见改善，因此有必要对该损伤进行关节镜下清创术。关节镜手术通过两个内侧入路进行，在透视下用针标记，用蚊式钳切开，可充分观察到患区表面，显示有软骨损伤。对骨坏死区域进行了清创，并在受伤的骨表面采用了斯特德曼技术。患者疼痛消失，并允许进行有限的活动（即站立和行走时无症状）。24个月后，患者在负重工作活动和站立时仍无症状。对于距骨表面损伤，关节镜下刮除术和切开术已被证明在75%至80%的患者中可产生良好或优异的效果。
