Department of Orthopedics, Shanghai Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Medicine (Baltimore). 2021 Mar 26;100(12):e24330. doi: 10.1097/MD.0000000000024330.
This study aimed to investigate the therapeutic effects of osteotomy combined with lateral ligament reconstruction on the osteochondral lesion of patients with talar injuries and varus ankles.Seventy five patients with talar injuries and varus ankles who received osteotomy combined with lateral ligament reconstruction for the osteochondral lesions from June 2008 to December 2014 were retrospectively reviewed. Patients were followed up for 32.4 ± 15.3 months after surgeries, and the AOFAS-AH score, VAS score and SF36 score were determined preoperatively and postoperatively. The iconographic data were compared preoperatively and postoperatively, including tibial anterior surface angle (TAS), TTS, TT, and tibial lateral surface angle (TLS) angles.After surgeries, the AOFAS-AF score increased from 43.2 ± 8.1 to 82.1 ± 5.6, the VAS score decreased from 6.9 ± 2.3 to 1.8 ± 1.5, and the SF36 score increased from 48.7 ± 9.4 to 83.5 ± 6.2. TAS increased from 83.3 ± 5.1 to 90.3 ± 6.1, TTS increased from 70.3 ± 6.1 to 82.5 ± 5.4, TT decreased from 12.9 ± 6.1 to 6.9 ± 5.7, and TLS increased from 76.5 ± 4.1 to 81.2 ± 3.3 (P < .05).Osteotomy combined with lateral ligament reconstruction is effective for the treatment of talar osteochondral lesion with varus ankle, which could relieve the arthritic symptoms induced by cartilage lesions. By correcting the force line on lower limbs and metapedes with osteotomy completely, the treatments on talar osteochondral lesion and lateral ligament reconstruction are the critical factors with better results.
本研究旨在探讨截骨术联合外侧韧带重建治疗距骨损伤伴内翻踝骨软骨病变的疗效。回顾性分析 2008 年 6 月至 2014 年 12 月接受截骨术联合外侧韧带重建治疗距骨损伤伴内翻踝骨软骨病变的 75 例患者。术后随访 32.4±15.3 个月，术前及术后采用美国足踝外科协会踝-后足评分（AOFAS-AH）、视觉模拟评分（VAS）和健康调查简表（SF-36）评分评估，比较影像学数据，包括胫骨前表面角（TAS）、距骨倾斜角（TTS）、胫距关节距离（TT）和胫骨外侧表面角（TLS）。术后 AOFAS-AH 评分由 43.2±8.1 分提高至 82.1±5.6 分，VAS 评分由 6.9±2.3 分降低至 1.8±1.5 分，SF-36 评分由 48.7±9.4 分提高至 83.5±6.2 分；TAS 由 83.3±5.1°增加至 90.3±6.1°，TTS 由 70.3±6.1°增加至 82.5±5.4°，TT 由 12.9±6.1 缩短至 6.9±5.7 缩短，TLS 由 76.5±4.1°增加至 81.2±3.3°，差异均有统计学意义（P<.05）。结论：截骨术联合外侧韧带重建治疗伴内翻踝的距骨骨软骨病变有效，可缓解软骨病变引起的关节炎症状。通过截骨术完全纠正下肢和跗骨的力线，距骨骨软骨病变和外侧韧带重建的治疗是获得更好疗效的关键因素。
