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距骨骨软骨损伤的治疗进展

[Advances in the Treatment of Osteochondral Lesions of the Talus].

作者信息

Li Yongsheng, Dong Aozhengzheng, Huang Zeqi, Li Wencui, Deng Zhenhan

机构信息

( 518000) Department of Foot, Ankle, and Hand Surgery, The Second People's Hospital of Shenzhen, Shenzhen 518000, China.

出版信息

Sichuan Da Xue Xue Bao Yi Xue Ban. 2024 Mar 20;55(2):273-278. doi: 10.12182/20240360206.

Abstract

Osteochondral lesion of the talus (OLT) is a localized cartilage and subchondral bone injury of the talus trochlea. OLT is caused by trauma and other reasons, including osteochondritis dissecans of the talus (OCD) and talus osteochondral tangential fracture. OLT can develop from being asymptomatic to subchondral bone cysts accompanied by deep ankle pain. OLT tends to occur on the medial and lateral sides of the talar vault. OLT seriously affects the patients' life and work and may even lead to disability. Herein, we reviewed advances in the treatment of OLT and the strengths and weaknesses of various treatments. Different treatment methods, including conservative treatments and surgical treatments, can be adopted according to the different subtypes or clinical symptoms of OLT. Conservative treatments mostly relieve symptoms in the short term and only slow down the disease. In recent years, it has been discovered that platelet-rich plasma injection, microfracture, periosteal bone grafting, talar cartilage transplantation, allograft bone transplantation, reverse drilling under robotic navigation, and other methods can achieve considerable benefits when each of these treatment methods is applied. Furthermore, microfracture combined with platelet-rich plasma injections, microfracture combined with cartilage transplantation, and various other treatment methods combined with anterior talofibular ligament repair have all led to good treatment outcomes.

摘要

距骨骨软骨损伤(OLT)是距骨滑车的局限性软骨及软骨下骨损伤。OLT由创伤等原因引起,包括距骨剥脱性骨软骨炎(OCD)和距骨骨软骨切线骨折。OLT可从无症状发展为伴有踝关节深部疼痛的软骨下骨囊肿。OLT往往发生在距骨穹窿的内侧和外侧。OLT严重影响患者的生活和工作,甚至可能导致残疾。在此,我们综述了OLT治疗的进展以及各种治疗方法的优缺点。根据OLT的不同亚型或临床症状,可采用不同的治疗方法,包括保守治疗和手术治疗。保守治疗大多只能在短期内缓解症状,且只能延缓病情发展。近年来发现,富血小板血浆注射、微骨折、骨膜移植、距骨软骨移植、同种异体骨移植、机器人导航下反向钻孔等方法在应用时均可取得显著疗效。此外,微骨折联合富血小板血浆注射、微骨折联合软骨移植以及各种其他治疗方法联合修复距腓前韧带均取得了良好的治疗效果。

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本文引用的文献

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Surgical Treatment for Osteochondral Lesions of the Talus.距骨骨软骨病变的手术治疗。
Arthroscopy. 2021 Dec;37(12):3393-3396. doi: 10.1016/j.arthro.2021.10.002.

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