Department of Orthopaedic Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
Foot Ankle Surg. 2010 Dec;16(4):e88-90. doi: 10.1016/j.fas.2009.10.009.
Osteonecrosis is a serious complication of acute lymphoblastic leukemia (ALL) therapy. The spontaneous regression or healing of osteonecrosis is rare. An unusual case of an osteochondral defect of the talus secondary to osteonecrosis is herein presented. We treated a 26-year-old female who presented with an osteochondral defect of the talus after necrosis. ALL had previously been diagnosed in 1994 and the patients had been treated with chemotherapy included corticosteroid. She was thereafter diagnosed to have bilateral osteonecrosis of the talus in 1996, and thus had been treated with weight-bearing restriction using a patellar tendon bearing brace. She felt pain in her right ankle in 2006. Magnetic resonance imaging (MRI) showed an osteochondral defect in the lateral aspect of the talus and normal bone marrow signal in the right ankle. We performed arthroscopic treatment by means of a bone marrow stimulation technique. At second-look arthroscopy, the aspect of the talus was completely covered by fibrocartilage like tissue. This procedure is therefore considered to be one option for the treatment of an osteochondral defect of the talus after necrosis in young patients.
骨坏死是急性淋巴细胞白血病（ALL）治疗的严重并发症。骨坏死的自发消退或愈合很少见。本文报告了一例由骨坏死引起的距骨骨软骨缺损的不寻常病例。我们治疗了一位 26 岁的女性患者，她在坏死后出现距骨骨软骨缺损。1994 年，该患者被诊断患有 ALL，并接受了包括皮质类固醇在内的化疗。1996 年，她被诊断为双侧距骨骨坏死，因此使用髌腱承重支具限制负重。2006 年，她感到右脚踝疼痛。磁共振成像（MRI）显示右踝关节外侧有骨软骨缺损，骨髓信号正常。我们通过骨髓刺激技术进行了关节镜治疗。在二次关节镜检查中，距骨的表面完全被纤维软骨样组织覆盖。因此，该手术被认为是治疗年轻患者坏死性距骨骨软骨缺损的一种选择。
