Lan Tian, McCarthy Helen S, Hulme Charlotte H, Wright Karina T, Makwana Nilesh
Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Oswestry, UK.
School of Pharmacy and Bioengineering, Keele University, UK.
J Arthrosc Jt Surg. 2021 Jul-Sep;8(3):231-237. doi: 10.1016/j.jajs.2021.04.002.
Osteochondral lesions of the talus (OLTs) are a common complication following trauma, involving both the articular cartilage and the underlying subchondral bone, with variable aetiologies and often presenting with non-specific symptoms. Diagnosis of OLTs requires a combination of clinical assessment and imaging and despite many different treatment options, there is no generalised consensus regarding which option is the most effective. Left untreated, OLTs risk progressing to osteoarthritis. Acute non-displaced OLTs can be treated non-operatively. However, OLTs refractory to non-surgical care for three to six months may be suitable for surgical care. In these cases, conservative treatments are often unsuccessful, particularly for larger and more severe defects and so the majority require surgical intervention. Although bone marrow stimulation techniques remain the "gold standard" for lesions <150 mm, there still requires a need for better long term clinical data and cost-benefit analyses compared with other treatment options. Biological attempts at either regenerating or replacing the articular cartilage are however demonstrating some promising results, but each with their own advantages and disadvantages. In this review, we summarise the clinical management of OLTs and present the current concepts of different treatment regimes.
距骨骨软骨损伤（OLTs）是创伤后常见的并发症，累及关节软骨及其下方的软骨下骨，病因多样，且常表现为非特异性症状。OLTs的诊断需要临床评估和影像学检查相结合，尽管有许多不同的治疗选择，但对于哪种选择最有效尚无普遍共识。若不治疗，OLTs有发展为骨关节炎的风险。急性无移位的OLTs可采用非手术治疗。然而，经三到六个月非手术治疗无效的OLTs可能适合手术治疗。在这些情况下，保守治疗往往不成功，尤其是对于较大和较严重的缺损，因此大多数需要手术干预。尽管骨髓刺激技术仍是直径<150mm损伤的“金标准”，但与其他治疗选择相比，仍需要更好的长期临床数据和成本效益分析。然而，在再生或替换关节软骨方面的生物学尝试显示出一些有前景的结果，但每种方法都有其自身的优缺点。在本综述中，我们总结了OLTs的临床管理，并介绍了不同治疗方案的当前概念。
