慢性外不稳定踝关节距骨骨软骨缺损的治疗：小面积外侧软骨病变有良好的临床疗效。
Treatment of talus osteochondral defects in chronic lateral unstable ankles: small-sized lateral chondral lesions had good clinical outcomes.
机构信息
Department of Sports Medicine, Huashan Hospital, No 12, Wulumuqi Zhong Road, Shanghai, 200040, People's Republic of China.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2018 Jul;26(7):2116-2122. doi: 10.1007/s00167-017-4591-x. Epub 2017 Jun 2.
PURPOSE
To assess and compare the clinical and MRI outcomes of patients with talus osteochondral defect (OCD) and patients without OCD in a cohort with chronic lateral ankle instability.
METHODS
All patients who underwent open or arthroscopic anterior talofibular ligament repair of the lateral ligament complex by a single surgeon were included in this study. Ankle arthroscopic surgery was initially performed to manage any intra-articular OCD, including debridement and microfracture. Functional scores (AOFAS, Karlsson score) and Tegner activity level scores were determined. An MRI scan was performed at follow-up to assess talus OCD after treatment. Spearman's correlation coefficients were calculated between functional scores and various factors.
RESULTS
A total of 104 patients with chronic ankle instability were included in this study. Among them, 33 patients had cartilage injury on the talus (OCD group), and the other 71 patients had no cartilage injury (control group). After surgery, there was a significant increase in the AOFAS scores (p < 0.001), the Karlsson scores (p < 0.001), and the Tegner activity scores (p < 0.001) in both the OCD group and the control group. However, there was no significant difference in the AOFAS scores (90.7 ± 6.6 vs. 92.5 ± 8.5; n.s.), the Karlsson scores (89.7 ± 9.3 vs. 91.2 ± 9.1; n.s.), or the Tegner activity scores (5 vs. 6; n.s.) between the OCD group and the control group postoperatively. In the OCD group, there was a significant negative association between the functional scores (AOFAS, Karlsson score, or Tegner score) and the number of intra-articular lesions. For the lateral OCD, the mean lesion area significantly decreased from 49.0 ± 10.7 mm preoperatively to 18.3 ± 13.1 mm at the final follow-up (p < 0.001).
CONCLUSION
No significant difference in functional outcomes was found between the OCD group and the control group postoperatively. Arthroscopic microfracture is a good option for the long-term treatment of lateral talus OCD.
LEVEL OF EVIDENCE
III.
目的
评估并比较慢性外侧踝关节不稳定患者中存在距骨骨软骨缺损（OCD）和不存在距骨 OCD 的患者的临床和 MRI 结果。
方法
本研究纳入了由同一位医生进行外侧韧带复合体切开或关节镜下前距腓韧带修复的所有患者。首先进行踝关节关节镜手术以处理任何关节内 OCD，包括清创和微骨折术。确定功能评分（AOFAS、Karlsson 评分）和 Tegner 活动水平评分。在随访时进行 MRI 扫描以评估治疗后距骨 OCD。计算功能评分与各种因素之间的 Spearman 相关系数。
结果
本研究共纳入 104 例慢性踝关节不稳定患者。其中 33 例患者距骨软骨损伤（OCD 组），其余 71 例患者无软骨损伤（对照组）。术后 AOFAS 评分（p<0.001）、Karlsson 评分（p<0.001）和 Tegner 活动评分（p<0.001）均显著增加，在 OCD 组和对照组中均如此。然而，术后 AOFAS 评分（90.7±6.6 与 92.5±8.5；n.s.）、Karlsson 评分（89.7±9.3 与 91.2±9.1；n.s.）或 Tegner 活动评分（5 与 6；n.s.）在 OCD 组和对照组之间无显著差异。在 OCD 组中，功能评分（AOFAS、Karlsson 评分或 Tegner 评分）与关节内病变数量呈显著负相关。对于外侧 OCD，平均病变面积从术前的 49.0±10.7mm 显著减少至末次随访时的 18.3±13.1mm（p<0.001）。
结论
术后 OCD 组和对照组的功能结果无显著差异。关节镜下微骨折术是治疗外侧距骨 OCD 的长期有效方法。
证据等级
III 级。
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