Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan.
Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan.
Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):291-297. doi: 10.1007/s00167-019-05716-8. Epub 2019 Sep 21.
Osteochondral talar lesions, regardless of their size and/or chronicity, are, at our hospital, now treated by fixation of the fragment if the talar dome cartilage is judged to be healthy. The retrospective study described herein was conducted to assess clinical outcomes of this treatment strategy.
The study group comprised 44 patients (18 men and 26 women) with 45 such talar lesions. In all cases, the osteochondral fragment was reduced and fixed with bone harvested from the osteotomy site and shaped into peg(s) (one to four pegs per lesion). Median follow-up was 2.1 years (1-9 years). The lesion area was measured on computed tomography arthrographs, and the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale was used to evaluate postoperative outcomes. Clinical failure was defined as a JSSF score < 80 points.
The mean JSSF score improved significantly from 63.5 points preoperatively to 93.0 postoperatively (p < 0.001). Treatment failure occurred in only one ankle (0.02%). The mean lesion area was 51.2 mm (range 5-147 mm). Correlation between lesion areas and the postoperative JSSF scores was weak (r = - 0.133). Correlation between the time of the trauma to the time of fixation surgery and the postoperative JSSF scores was also weak (r = 0.042). Radiographic outcomes were good for 28 ankles, fair for 10, and poor for 7.
Fixation of the lesion fragment, regardless of size and/or chronicity, appears to be appropriate in cases of an osteochondral talar lesion.
IV.
无论距骨软骨损伤的大小和/或慢性程度如何，如果距骨穹窿软骨被判断为健康，我们医院现在都会采用对骨块进行固定的方法来治疗此类损伤。本回顾性研究旨在评估这种治疗策略的临床效果。
研究组包括 44 名患者（18 名男性和 26 名女性），共 45 个距骨软骨损伤部位。所有病例均采用取自骨切开部位的骨块对骨软骨碎片进行复位和固定，并将其塑造成（每个损伤部位 1 至 4 个）栓钉。中位随访时间为 2.1 年（1 至 9 年）。采用 CT 关节造影术测量损伤面积，并采用日本足踝外科协会（JSSF）踝关节/后足评分评估术后结果。临床失败定义为 JSSF 评分<80 分。
JSSF 评分从术前的 63.5 分显著提高到术后的 93.0 分（p<0.001）。只有 1 例踝关节（0.02%）治疗失败。平均损伤面积为 51.2mm（5-147mm）。病变面积与术后 JSSF 评分之间的相关性较弱（r=-0.133）。创伤至固定手术时间与术后 JSSF 评分之间的相关性也较弱（r=0.042）。28 个踝关节的影像学结果良好，10 个踝关节的结果尚可，7 个踝关节的结果较差。
对于距骨软骨损伤，无论损伤的大小和/或慢性程度如何，采用固定骨块的方法似乎都是合适的。
IV 级。
