Surgeon, Department of Hand, Plastic and Reconstructive Surgery, Burn Center-Hand and Plastic Surgery, University of Heidelberg, BG Trauma Center Ludwigshafen, Germany.
Managing Senior Consultant and Professor, Department of Hand, Plastic and Reconstructive Surgery, Burn Center-Hand and Plastic Surgery, University of Heidelberg, BG Trauma Center Ludwigshafen, Germany.
J Foot Ankle Surg. 2020 Mar-Apr;59(2):307-313. doi: 10.1053/j.jfas.2019.03.025.
Talar osteochondral lesions (OCLs) lead to progressive stages of talar destruction. Core decompression with cancellous bone grafting (CBG) is a common treatment for Berndt and Harty stages II and III. However, in a subset of patients, talar revascularization may fail. Surgical angiogenesis using vascularized medial femoral condyle (MFC) autografts may improve on these outcomes. These 2 treatment strategies were directly compared via a prospective preliminary randomized trial including 20 participants with talar core decompression followed by either cancellous (CBG group, n = 10) or vascularized MFC (MFC group, n = 10) bone grafting. Outcome analysis was performed with visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Lower Extremity Functional Scale (LEFS), and contrast-enhanced magnetic resonance imaging (MRI) scans. At 12 months of follow-up, the mean VAS score was reduced from 6.6 ± 2.5 preoperatively to 4 ± 1.9 in the CBG group and from 5.2 ± 2.9 preoperatively to 1 ± 1.1 in the MFC group (p < .001). The LEFS improved from 53.4 ± 13.1 to 62.6 ± 16.2 CBG and from 53 ± 9.3 to 72.4 ± 7.4 MFC (p = .114). AOFAS improved from 71 ± 12.1 to 84.1 ± 12.5 in CBG and from 70.5 ± 7.4 to 95.1 ± 4.8 in MFC (p = .019). The MRI scans in the CBG group demonstrated 9 partial malperfusions and 1 hypervascularized bone graft, whereas the MFC group had 8 well-vascularized grafts incorporated into the talus and 1 partial malperfusion. Vascularized MFC autografts provide superior pain relief along with improvement of physical function in patients with talar OCL stage II and III compared with CBG. To confirm these promising results, further multicenter randomized controlled trials are required.
距骨骨软骨病变（OCL）导致距骨进行性破坏。对于 Berndt 和 Harty II 期和 III 期，骨芯减压联合松质骨移植（CBG）是一种常见的治疗方法。然而，在一部分患者中，距骨可能会出现再血管化失败。使用带血管的股骨内侧髁（MFC）自体移植物进行外科血管生成可能会改善这些结果。通过前瞻性初步随机试验直接比较了这两种治疗策略，该试验纳入了 20 名接受距骨骨芯减压术的患者，随后分别接受松质骨（CBG 组，n=10）或带血管的 MFC（MFC 组，n=10）植骨。通过视觉模拟量表（VAS）、美国矫形足踝协会（AOFAS）踝关节-后足评分、下肢功能量表（LEFS）和对比增强磁共振成像（MRI）扫描进行结果分析。在 12 个月的随访中，CBG 组的 VAS 评分从术前的 6.6±2.5 降至 4±1.9，MFC 组从术前的 5.2±2.9 降至 1±1.1（p<.001）。LEFS 从 53.4±13.1 改善至 62.6±16.2 CBG 和从 53±9.3 改善至 72.4±7.4 MFC（p=0.114）。AOFAS 在 CBG 组从 71±12.1 改善至 84.1±12.5，在 MFC 组从 70.5±7.4 改善至 95.1±4.8（p=0.019）。CBG 组的 MRI 扫描显示 9 个部分灌注不良和 1 个过度血管化的移植物，而 MFC 组有 8 个血运良好的移植物植入距骨和 1 个部分灌注不良。与 CBG 相比，带血管的 MFC 自体移植物可提供更好的疼痛缓解，并改善距骨 OCL II 期和 III 期患者的身体功能。为了证实这些有希望的结果，需要进一步进行多中心随机对照试验。
