Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Inha University Hospital, Incheon, Republic of Korea.
Am J Sports Med. 2021 Mar;49(4):1031-1039. doi: 10.1177/0363546520988739.
Internal fixation of an osteochondral lesion of the talus (OLT) can restore the congruency of the talus and maintain the subchondral bone and innate hyaline cartilage. However, OLT that is indicated for fixation is rarely encountered; hence, not many studies report on the results after the procedure.
To evaluate the clinical and radiological outcomes after internal fixation of chronic OLT involving a large bone fragment of at least 10 mm in diameter and 3 mm in depth on computed tomography (CT).
Case series; Level of evidence, 4.
We retrospectively reviewed the data of 26 patients with OLT treated with internal fixation between August 2014 and April 2018. Of the patients, 15 were male and 11 were female, with a mean age of 16 years (range, 11-29 years). The primary radiological outcome measurement was bone union assessed on the 6-month postoperative CT scan. Clinical outcomes were assessed at a mean of 27.7 months postoperatively.
Twenty patients (77%) achieved bone union on postoperative CT scan. The mean 100-mm visual analog scale (VAS) improved from 30.5 ± 8.5 preoperatively to 13.4 ± 9.7 postoperatively ( < .001). The mean Foot Function Index (FFI) improved from 30.5 ± 6.7 preoperatively to 13.7 ± 9.8 postoperatively ( < .001). A malleolar osteotomy was not necessary to approach the lesion in 88% of patients. A bone fragment with an irregular margin and low density on the preoperative CT scan was significantly associated with nonunion (odds ratio: 7.67, 95% confidence interval: 2.67 to 22.02, = .008). The difference in clinical outcomes between patients with skeletally immature ankles and those with skeletally mature ankles was not statistically significant. Patient age did not correlate with postoperative 100-mm VAS (Pearson correlation coefficient, = -0.07, = 0.72) or the postoperative FFI (Pearson correlation coefficient, = -0.05, = .80).
Internal fixation of an OLT involving a large bone fragment resulted in satisfactory clinical and radiologic outcomes. We found that patients with skeletally immature and mature ankles attained healing at comparable rates after the internal fixation of OLT.
距骨骨软骨损伤（OLT）的内固定可以恢复距骨的吻合，并维持软骨下骨和固有透明软骨。然而，OLT 很少需要固定，因此，很少有研究报告术后结果。
评估 CT 显示至少 10mm 直径和 3mm 深度的大骨块的慢性 OLT 行内固定后的临床和影像学结果。
病例系列；证据水平，4 级。
我们回顾性分析了 2014 年 8 月至 2018 年 4 月期间接受内固定治疗的 26 例 OLT 患者的数据。患者中，男性 15 例，女性 11 例，平均年龄 16 岁（11-29 岁）。主要的影像学结果测量是术后 6 个月 CT 扫描评估的骨愈合情况。术后平均 27.7 个月进行临床评估。
20 例（77%）患者在术后 CT 扫描中实现了骨愈合。100mm 视觉模拟评分（VAS）从术前的 30.5±8.5 分改善至术后的 13.4±9.7 分（<0.001）。足部功能指数（FFI）从术前的 30.5±6.7 分改善至术后的 13.7±9.8 分（<0.001）。88%的患者不需要行外踝截骨来处理病变。术前 CT 扫描显示骨碎片边缘不规则且密度低与不愈合显著相关（比值比：7.67，95%置信区间：2.67-22.02， =.008）。踝关节未成熟与成熟患者的临床结果差异无统计学意义。患者年龄与术后 100mm VAS（Pearson 相关系数， = -0.07， =.72）或术后 FFI（Pearson 相关系数， = -0.05， =.80）均无相关性。
涉及大骨块的 OLT 内固定可获得满意的临床和影像学结果。我们发现，OLT 内固定术后，未成熟和成熟踝关节患者的愈合率相当。
