Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, 734-8551, Japan.
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, 734-8551, Japan.
J Orthop Sci. 2024 Jul;29(4):1097-1102. doi: 10.1016/j.jos.2023.06.002. Epub 2023 Jun 23.
Poor clinical outcomes in bone marrow stimulation (BMS) for the osteochondral lesion of the talus (OLT) are caused by subchondral bone deterioration. It is reported that microfracture induces endochondral ossification in the subchondral bone, which may affect the subchondral bone condition after BMS. This study analyzed osteosclerotic patterns of the bed in OLTs on computed tomography (CT) images and the relationship between the subchondral bone condition and clinical outcomes of BMS.
Sixty-nine ankles in 61 patients with OLT were included. Hounsfield unit (HU) on the bed of OLTs was measured on CT images and the pattern of osteosclerosis or absorption in the bed was analyzed. In these patients, 25 ankles in 24 patients underwent BMS. They were divided into 2 groups according to the presence of bone marrow edema (BME) one year after surgery, and clinical outcomes were compared.
HUs in the anterior region were significantly higher than those of other areas. In patients with BMS, the JSSF scale for BME positive group (88.0 ± 7.7 points) was significantly lower than that for BME negative group (95.0 ± 6.1 points) (p < 0.05) at the final follow-up. On preoperative CT images, HU values of the central region in the BME-positive group were significantly lower than those in the BME-negative group (p < 0.05).
Osteosclerotic changes in the anterior part of the bed were frequently observed, and BMS for the area with low HU values decreased clinical outcomes. BMS should be performed with attention to subchondral bone condition to obtain good clinical outcomes.
4, case series.
骨髓刺激（BMS）治疗距骨骨软骨病变（OLT）的临床效果不佳，其原因在于软骨下骨恶化。有报道称，微骨折术会在软骨下骨中诱导软骨内骨化，这可能会影响 BMS 后的软骨下骨状况。本研究通过 CT 图像分析 OLT 病灶床的骨硬化模式，并探讨软骨下骨状况与 BMS 临床效果的关系。
共纳入 61 例患者的 69 个踝关节，在 CT 图像上测量 OLT 病灶床的 Hounsfield 单位（HU）值，并分析病灶床的骨硬化或吸收模式。在这些患者中，24 例患者的 25 个踝关节接受了 BMS 治疗。根据术后 1 年是否存在骨髓水肿（BME），将其分为 BME 阳性组和 BME 阴性组，比较两组的临床效果。
OLT 病灶床的前区 HU 值明显高于其他区域。在接受 BMS 治疗的患者中，BME 阳性组的 JSSF 量表评分（88.0±7.7 分）明显低于 BME 阴性组（95.0±6.1 分）（p<0.05）。在术前 CT 图像上，BME 阳性组中央区域的 HU 值明显低于 BME 阴性组（p<0.05）。
病灶床前区常出现骨硬化改变，而对 HU 值较低区域进行 BMS 治疗会降低临床效果。为获得良好的临床效果，BMS 时应注意软骨下骨状况。
4，病例系列研究。
