磁共振成像与踝关节骨折相关距骨骨软骨损伤的预后
Magnetic Resonance Imaging and Outcomes of Osteochondral Lesions of the Talus Associated With Ankle Fractures.
作者信息
Özcan Seçkin, Koçkara Nizamettin, Camurcu Yalkın, Yurten Hakan
机构信息
Yalova State Hospital, Yalova, Turkey.
Faculty of Medicine, Orthopedics and Traumatology Department, Mengücek Gazi Education and Research Hospital, Erzincan Binali Yıldırım University, Erzincan, Turkey.
出版信息
Foot Ankle Int. 2020 Oct;41(10):1219-1225. doi: 10.1177/1071100720937243. Epub 2020 Jul 2.
BACKGROUND
Osteochondral lesions of the talus (OCLTs) secondary to ankle fractures have previously been reported in the literature. However, no study has evaluated OCLTs using magnetic resonance imaging (MRI) following ankle fracture treatment. The purpose of our study was to investigate accompanying OCLTs in patients with an ankle fracture and evaluate its relationship with the clinical outcomes.
METHODS
Fifty-six patients with ankle fractures who were treated with either a nonoperative or operative method at our center between June 2016 and February 2017 were included in this prospective comparative study (37 men and 19 women; mean age, 44.6 ± 13 years; range, 20-65 years). The mean American Orthopaedic Foot & Ankle Society (AOFAS) scores were used to evaluate the clinical results in all patients in the second month and second year. The second-month ankle MR images were evaluated for OCLTs in all patients. Thirty patients were treated operatively and 26 nonoperatively.
RESULTS
Accompanying OCLTs were detected in 19 of 56 patients (34%). Our results showed no statistically significant association between OCLT and fracture type, as well as the treatment type. In the second postoperative month, the mean AOFAS scores were 87.2 ± 10.8 and 77.6 ± 12.0 in patients with and without OCLTs, respectively ( = .005). In the second postoperative year, the mean AOFAS scores were 81.3 ± 6.8 and 86.2 ± 8.4 in patients with and without OCLTs, respectively ( = .031). The mean AOFAS score significantly decreased in the OCLT group in the second-year control, whereas a significant increase was observed in patients without OCLTs ( = .026 and < .001, respectively).
CONCLUSION
According to our results, the accompanying OCLTs were found in one-third of patients treated for ankle fractures. We observed a significant correlation between OCLT presence and the AOFAS score. According to the AOFAS score, OCLTs statistically significantly affected clinical results at 2 years.
LEVEL OF EVIDENCE
Level II, prospective comparative study.
背景
既往文献中曾报道过踝关节骨折继发的距骨骨软骨损伤（OCLTs）。然而，尚无研究在踝关节骨折治疗后使用磁共振成像（MRI）对OCLTs进行评估。本研究的目的是调查踝关节骨折患者中伴发的OCLTs，并评估其与临床结局的关系。
方法
本前瞻性比较研究纳入了2016年6月至2017年2月期间在我院采用非手术或手术方法治疗的56例踝关节骨折患者（37例男性和19例女性；平均年龄44.6±13岁；范围20 - 65岁）。采用美国矫形足踝协会（AOFAS）平均评分在第2个月和第2年评估所有患者的临床结果。对所有患者的第2个月踝关节MR图像进行OCLTs评估。30例患者接受手术治疗，26例接受非手术治疗。
结果
56例患者中有19例（34%）检测到伴发OCLTs。我们的结果显示OCLT与骨折类型以及治疗方式之间无统计学显著关联。术后第2个月，有和无OCLTs的患者平均AOFAS评分分别为87.2±10.8和77.6±12.0（P = 0.005）。术后第2年，有和无OCLTs的患者平均AOFAS评分分别为81.3±6.8和86.2±8.4（P = 0.031）。在第2年的对照中，OCLT组的平均AOFAS评分显著降低，而无OCLTs的患者则显著升高（分别为P = 0.026和P < 0.001）。
结论
根据我们的结果，在接受踝关节骨折治疗的患者中有三分之一发现了伴发的OCLTs。我们观察到OCLT的存在与AOFAS评分之间存在显著相关性。根据AOFAS评分，OCLTs在2年时对临床结果有统计学显著影响。
证据级别
II级，前瞻性比较研究。
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