15%的距骨骨软骨病变为双侧病变，而仅有 1/3 的双侧病变为双侧症状性病变。
15% of Talar Osteochondral Lesions Are Present Bilaterally While Only 1 in 3 Bilateral Lesions Are Bilaterally Symptomatic.
机构信息
Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands.
出版信息
J Bone Joint Surg Am. 2022 Sep 21;104(18):1605-1613. doi: 10.2106/JBJS.22.00122. Epub 2022 Jul 21.
BACKGROUND
The primary aim of the present study was to determine the prevalence of osteochondral lesions of the contralateral talus in patients with computed tomography (CT)-confirmed osteochondral lesions of the talus (OLT). The secondary aims were to determine if the contralateral lesions were symptomatic and to describe the demographic characteristics and radiographic presentation of patients with bilateral OLT.
METHODS
To identify patients with bilateral OLT, we utilized a cross-sectional database of consecutive patients with a CT-proven OLT who had undergone bilateral CT scanning at our hospital between January 1989 and June 2021. The primary outcome was the prevalence of bilateral OLT. Patients with bilateral OLT were grouped into a unilaterally symptomatic group and a bilaterally symptomatic group. Patient and lesion characteristics were compared between these groups as well as between the symptomatic and asymptomatic ankles in the unilaterally symptomatic group. Radiographic examination included lesion volume, location, and morphology.
RESULTS
Of 1,062 patients with OLT, 161 (15%) had bilateral OLT. Of the patients with bilateral OLT, 53 (33%) were bilaterally symptomatic. Patients who were bilaterally symptomatic were younger (p = 0.03) and more likely to present with a non-traumatic etiology (p < 0.01) in comparison with those who were unilaterally symptomatic. No differences were observed between the unilaterally and bilaterally symptomatic groups in terms of lesion morphology, volume, or location. In the unilaterally symptomatic group, lesion volume was significantly larger in symptomatic ankles in comparison with the contralateral, asymptomatic ankles (p < 0.01), but no significant differences were observed in terms of lesion morphology or location.
CONCLUSIONS
In patients presenting with symptomatic OLT, the prevalence of bilateral OLT was 15%, and 1 in 3 patients with bilateral OLT were symptomatic on both sides. Larger lesion volume was associated with the presence of symptoms in patients with bilateral OLT. For patients with bilateral OLT, the treating team should be aware that younger patients and patients without a history of trauma are at a higher risk for having bilateral symptoms.
LEVEL OF EVIDENCE
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
背景
本研究的主要目的是确定在计算机断层扫描（CT）证实的距骨骨软骨病变（OLT）患者中，对侧距骨骨软骨病变的患病率。次要目的是确定对侧病变是否有症状，并描述双侧 OLT 患者的人口统计学特征和影像学表现。
方法
为了确定双侧 OLT 患者，我们利用了一个连续的 CT 证实的 OLT 患者的横断面数据库，这些患者在 1989 年 1 月至 2021 年 6 月期间在我们医院接受了双侧 CT 扫描。主要结果是双侧 OLT 的患病率。将双侧 OLT 患者分为单侧症状组和双侧症状组。比较这些组之间以及单侧症状组中单侧症状和无症状踝关节之间的患者和病变特征。影像学检查包括病变体积、位置和形态。
结果
在 1062 例 OLT 患者中，有 161 例（15%）存在双侧 OLT。在双侧 OLT 患者中，53 例（33%）双侧均有症状。双侧症状患者比单侧症状患者更年轻（p = 0.03），更可能有非创伤性病因（p < 0.01）。在单侧和双侧症状组之间，病变形态、体积或位置无差异。在单侧症状组中，与对侧无症状踝关节相比，症状踝关节的病变体积明显更大（p < 0.01），但病变形态或位置无显著差异。
结论
在出现症状性 OLT 的患者中，双侧 OLT 的患病率为 15%，双侧 OLT 患者中有 1/3 的双侧均有症状。双侧 OLT 患者的病变体积越大，症状出现的可能性越大。对于双侧 OLT 患者，治疗团队应意识到年轻患者和无创伤史的患者双侧出现症状的风险更高。
证据水平
预后 III 级。请参阅作者说明以获取完整的证据水平描述。
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