Foot and Ankle Sports Medicine Center, Department of Orthopedics, General Hospital of Central Theater Command, Wuhan, Hubei Province, PR China.
Hubei University of Medicine, Shiyan, Hubei Province, PR China.
Foot Ankle Int. 2023 Oct;44(10):1003-1012. doi: 10.1177/10711007231185084. Epub 2023 Aug 2.
Retrograde drilling remains technically challenging, because of the difficulty of identifying the accurate location of cysts during surgery. This study's aim was to evaluate the 3-dimensional (3D) image-based surgical navigation-assisted endoscopic retrograde drilling technique for subchondral bone lesions of the talus.
From March 2017 to June 2020, a total of 21 cases with Hepple stage V subchondral bone lesions of the talus were treated with 3D image-based surgical navigation-assisted endoscopic retrograde drilling and bone graft technique. Arthroscopic views were categorized per Pritsch classifications. The correlation between the drilled tunnel with preoperative cystic lesions were assessed under postoperative computer tomographic (CT) scans. The American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS) scores, and Foot and Ankle Ability Measure (FAAM) sports scales were evaluated at the preoperative and final consultation. All complications were recorded.
On postoperative CT scans, in 20 cases (95.2%), the drilled tunnel was judged to have been in the center of previous cysts. Only 9 cases (42.9%) showed intact normal cartilage (grade 0, group A); 12 cases (57.1%) had intact, but soft, cartilage (grade I, group B). The median follow-up time was 24 (24, 30) months, and at final follow-up, there were no significant differences between the mean AOFAS and VAS scores in both groups (89.0 ± 6.4 vs 88.3 ± 7.0 and 1 vs 0.5) or postoperative FAAM sports scales (28.2 ± 2.2 vs 26.6 ± 4.9, = .363). Two patients had revision surgery in group B.
The 3D image-based surgical navigation-assisted endoscopic retrograde drilling and bone graft technique for the subchondral bone lesions of the talus in this small case series showed encouraging results.
Level IV, retrospective case series.
由于术中难以准确识别囊肿的位置，逆行钻孔仍然具有技术挑战性。本研究旨在评估基于三维（3D）图像的手术导航辅助内镜逆行钻孔技术治疗距骨软骨下骨病变。
2017 年 3 月至 2020 年 6 月，采用基于 3D 图像的手术导航辅助内镜逆行钻孔植骨技术治疗 Hepple Ⅴ期距骨软骨下骨病变 21 例。根据 Pritsch 分类评估关节镜下视图。根据术后计算机断层扫描（CT）评估钻孔隧道与术前囊肿病变的相关性。术前和末次随访时评估美国矫形足踝协会（AOFAS）评分、视觉模拟评分（VAS）和足踝能力测量（FAAM）运动评分。记录所有并发症。
术后 CT 扫描显示，20 例（95.2%）钻孔隧道被认为位于先前囊肿的中心。只有 9 例（42.9%）显示完整正常软骨（0 级，A 组）；12 例（57.1%）显示完整但软骨柔软（1 级，B 组）。中位随访时间为 24（24，30）个月，末次随访时，两组 AOFAS 和 VAS 评分的平均值差异均无统计学意义（89.0±6.4 比 88.3±7.0 和 1 比 0.5）或术后 FAAM 运动评分（28.2±2.2 比 26.6±4.9，=0.363）。B 组有 2 例患者行翻修手术。
在本小病例系列中，基于 3D 图像的手术导航辅助内镜逆行钻孔和植骨技术治疗距骨软骨下骨病变显示出令人鼓舞的结果。
IV 级，回顾性病例系列。
