Service de chirurgie orthopédique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France.
Service de chirurgie orthopédique, hôpital Salengro, 2, avenue Oscar-Lambret, 59000 Lille, France.
Orthop Traumatol Surg Res. 2021 Dec;107(8S):103068. doi: 10.1016/j.otsr.2021.103068. Epub 2021 Sep 20.
The analysis of osteochondral lesions of talus (OLT) is currently mostly descriptive, not permitting an understanding of the different nosological frameworks of these lesions. Better knowledge of the characteristics of patients with OLT should make it possible to optimize the surgical indications and anticipate the associated lesions, which should not be overlooked. The main objective of this study was, therefore, to assess the characteristics of patients with OLT, and to analyze the lesions encountered.
OLTs correspond to variable entities responding to specific treatments.
This was a prospective multicenter descriptive study including all patients operated on for an OLT, aged between 15 and 65 years, across 10 French specialist centers. The demographic, clinical and radiological data of the patients were analyzed.
OLTs predominantly affect males and patients in their thirties. Two types of OLT should be distinguished: a lateral OLT; smaller and more superficial, most often presenting with painful instability, in the context of trauma, and a medial OLT; more frequent, wider and deeper.
Two nosological frameworks exist for OLTs, and correspond to precise surgical indications: medial lesions of more than 10mm and more than 5mm in depth, with isolated anteromedial pain and significant functional impairment, most often idiopathic, generally requiring treatment by osteochondral autografts. Lateral lesions less than 5mm in depth and less than 10mm, often superficial, following trauma or ankle laxity, associated with lateral ligament damage in one-third of cases, and a clinical presentation associated to instability and pain, requiring treatment most often by microfracture with associated ligament repair.
III.
目前，距骨骨软骨损伤（OLT）的分析主要是描述性的，无法了解这些损伤的不同分类框架。更好地了解 OLT 患者的特征应能够优化手术适应证，并预测不应忽视的相关损伤。因此，本研究的主要目的是评估 OLT 患者的特征，并分析所遇到的损伤。
OLT 对应于不同的实体，需要特定的治疗方法。
这是一项前瞻性多中心描述性研究，纳入了在法国 10 个专业中心接受 OLT 手术的所有年龄在 15 至 65 岁之间的患者。分析了患者的人口统计学、临床和影像学数据。
OLT 主要影响男性和三十多岁的患者。应区分两种类型的 OLT：外侧 OLT；较小且较浅，通常在创伤后出现疼痛性不稳定，伴有前内侧疼痛，功能受损显著，最常见于特发性，通常需要骨软骨自体移植物治疗。内侧 OLT 更常见、更宽且更深。
OLT 存在两种分类框架，对应于明确的手术适应证：内侧病变大于 10mm 且深度大于 5mm，伴有孤立的前内侧疼痛和明显的功能障碍，通常为特发性，通常需要骨软骨自体移植物治疗。外侧病变深度小于 5mm 且小于 10mm，通常较浅，继创伤或踝关节松弛后出现，三分之一的病例伴有外侧韧带损伤，以及与不稳定和疼痛相关的临床表现，最常通过微骨折联合相关韧带修复治疗。
III 级。
