Palo Alto Medical Foundation, University of California, San Francisco, Burlingame, CA, USA.
Foot Ankle Int. 2020 May;41(5):549-555. doi: 10.1177/1071100720907313. Epub 2020 Feb 23.
While smaller talar dome osteochondral lesions (OCLs) are successfully treated with bone marrow stimulation techniques, the optimal treatment for large or cystic OCLs remains controversial. This study tested the hypothesis that transferring structural autograft bone from the distal tibia to the talus for large or cystic OCLs improves pain and function.
Thirty-two patients with large or cystic OCLs underwent structural bone grafting from the ipsilateral distal tibia to the talar dome. Patients were assessed with subjective patient-centered tools and objective clinical outcomes. Average age was 48.6 ± 14.9 years, and average follow-up was 19.5 ± 13.3 months. Average lesion area was 86.2 ± 23.5 mm, and average depth was 8.4 ± 3.0mm.
At final follow-up, improvement compared to preoperative scores was seen in American Orthopaedic Foot & Ankle Society (65.4 ± 21.2 to 86.9 ± 15.0, < .05), Foot Function Index (48.9 ± 20.8 to 21.1 ± 18.9, < .05), visual analog scale for pain (4.7 ± 3.0 to 1.4 ± 1.5, < .05), and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (40.4 ± 5.4 to 45.5 ± 7.4, < .05) scores. There was no improvement in PROMIS pain interference (54.7 ± 18.1 to 52.4 ± 7.3, > .05). Satisfaction with surgery was 8.4 ± 1.3/10, and 96% of patients would have the procedure again. Ninety-four percent of patients returned to work and/or play. One patient had a deep vein thrombosis 6 weeks postoperatively, and 1 patient underwent ankle fusion at 18 months postoperatively.
This study demonstrates that structural bone graft harvested from the distal tibia transferred to the talus was a safe and effective treatment for large and cystic OCLs. Outcomes compare favorably to other described techniques for treatment of these injuries.
Level IV, case series.
虽然较小的距骨穹隆骨软骨病变（OCL）可以通过骨髓刺激技术成功治疗，但对于大或囊性 OCL 的最佳治疗方法仍存在争议。本研究旨在验证这样一个假设，即将来自同侧胫骨的结构性自体骨移植到距骨穹隆以治疗大或囊性 OCL 是否可以改善疼痛和功能。
32 例大或囊性 OCL 患者接受了来自同侧胫骨到距骨穹隆的结构性骨移植。使用主观的以患者为中心的工具和客观的临床结果对患者进行评估。平均年龄为 48.6±14.9 岁，平均随访时间为 19.5±13.3 个月。平均病变面积为 86.2±23.5mm，平均深度为 8.4±3.0mm。
末次随访时，与术前评分相比，美国矫形足踝协会评分（65.4±21.2 至 86.9±15.0，<0.05）、足功能指数（48.9±20.8 至 21.1±18.9，<0.05）、疼痛视觉模拟评分（4.7±3.0 至 1.4±1.5，<0.05）和患者报告的结局测量信息系统（PROMIS）物理功能评分（40.4±5.4 至 45.5±7.4，<0.05）均有改善。PROMIS 疼痛干扰评分（54.7±18.1 至 52.4±7.3，>0.05）无改善。手术满意度为 8.4±1.3/10，96%的患者愿意再次接受该手术。94%的患者恢复工作和/或运动。1 例患者术后 6 周发生深静脉血栓形成，1 例患者术后 18 个月行踝关节融合术。
本研究表明，从胫骨采集的结构性骨移植到距骨是治疗大或囊性 OCL 的一种安全有效的方法。其结果与其他描述的此类损伤治疗技术相当。
IV 级，病例系列研究。
