Department of Anesthesiology and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea.
Korean J Pain. 2013 Apr;26(2):164-8. doi: 10.3344/kjp.2013.26.2.164. Epub 2013 Apr 3.
It is easy to overlook osteochondral lesions (OCLs) of the ankle in patients with chronic lower limb pain, such as complex regional pain syndrome (CRPS) or thromboangiitis obliterans (TAO, Buerger's disease). A 57-year-old woman diagnosed with type 1 CRPS, and a 58-year-old man, diagnosed with TAO, complained of tactile and cold allodynia in their lower legs. After neurolytic lumbar sympathethic ganglion block and titration of medications for neuropathic pain, each subject could walk without the aid of crutches. However, they both complained of constant pain on the left ankle during walking. Focal tenderness was noted; subsequent imaging studies revealed OCLs of her talus and his distal tibia, respectively. Immediately after percutaneous osteoplasties, the patients could walk without ankle pain. It is important to consider the presence of a hidden OCL in chronic pain patients that develop weight-bearing pain and complain of localized tenderness on the ankle.
在患有慢性下肢疼痛的患者中，如复杂性区域疼痛综合征（CRPS）或血栓闭塞性脉管炎（TAO，伯格氏病），很容易忽略踝关节的骨软骨病变（OCL）。一名 57 岁女性被诊断为 1 型 CRPS，一名 58 岁男性被诊断为 TAO，他们都抱怨小腿有触觉和冷过敏。在进行神经松解性腰椎交感神经节阻滞和调整治疗神经性疼痛的药物剂量后，每位患者都可以不借助拐杖行走。然而，他们都在行走时抱怨左踝关节持续疼痛。局部压痛；随后的影像学研究分别显示他们的距骨和胫骨远端有 OCL。经皮骨成形术后，患者可以无痛行走。在出现负重疼痛并抱怨踝关节局部压痛的慢性疼痛患者中，重要的是要考虑是否存在隐匿性 OCL。
