Chen Xiao Qiang, Liu Jianquan, Wang Tianyu, Zhao Zhe, Li Yongsheng, Cheng Xiang Yu, Li Wencui
Hand and Foot Surgery Department, Shenzhen Second People's Hospital, The First Hospital Affiliated to Shenzhen University, Shenzhen, China.
Front Surg. 2024 May 27;11:1404513. doi: 10.3389/fsurg.2024.1404513. eCollection 2024.
To investigate the short-term clinical efficacy of robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus (OCLT).
This study was divided into two groups: experimental group: robot-assisted retrograde drilling group; control group: arthroscopic microfracture group. A total of 6 OCLT patients who were treated with robot navigation-assisted retrograde drilling and 10 OCLT patients who were treated with arthroscopic microfracture between October 2020 and October 2021 were retrospectively analyzed. There were 11 males and five females, with a mean age of 36 years. The patients were followed up for 6-12 months to compare the changes in the OCLT lesion area by magnetic resonance imaging (MRI), visual analogue scale/score (VAS) and American Orthopedic Foot and Ankle Society score (AOFAS) before and after surgery.
All 16 patients were followed up for an average of 8 months, and no complications such as joint infection, nerve injury, or active bleeding occurred during the follow-up period. Only one patient suffered discomfort involving transient postoperative pain in the operative area, but did not experience long-term numbness or chronic pain. Postoperative MRI revealed that none of the patients had severe signs of osteonecrosis, osteolysis or cystic changes of the talus, with lesion areas smaller than those before surgery. The difference was statistically significant (< 0.01). The patients in the experimental group showed a more significant improvement in the last 3 months than in the first 3 months of the follow-up period. At the last follow-up, the VAS score was 3 points in the experimental group and 2.2 points in the control group, and the AOFAS score was 88.6 points in the experimental group and 88 points in the control group, all of which were significantly higher than those before operation, and the differences were statistically significant, but there was no statistically significant difference between the groups.
Both robot navigation-assisted retrograde drilling and arthroscopic microfracture for bone marrow stimulation (BMS) to treat OCLT in all patients obtained satisfactory effects in the short term. In addition, the follow-up revealed that with excellent efficacy and few complications, robot navigation-assisted retrograde drilling was safe and minimally invasive, and greatly reduced operative time. Consequently, robot navigation-assisted retrograde drilling for BMS was a safe and effective procedure for the treatment of OCLT.
探讨机器人辅助逆行钻孔与关节镜下微骨折术治疗距骨骨软骨损伤（OCLT）的短期临床疗效。
本研究分为两组：实验组：机器人辅助逆行钻孔组；对照组：关节镜下微骨折组。回顾性分析2020年10月至2021年10月期间6例行机器人导航辅助逆行钻孔治疗的OCLT患者和10例行关节镜下微骨折治疗的OCLT患者。其中男性11例，女性5例，平均年龄36岁。对患者进行6至12个月的随访，通过磁共振成像（MRI）、视觉模拟量表/评分（VAS）和美国矫形足踝协会评分（AOFAS）比较手术前后OCLT病变面积的变化。
16例患者均获平均8个月的随访，随访期间均未出现关节感染、神经损伤或活动性出血等并发症。仅1例患者出现手术区域短暂术后疼痛等不适，但未出现长期麻木或慢性疼痛。术后MRI显示，所有患者均未出现距骨严重骨坏死、骨质溶解或囊性变迹象，病变面积均小于术前，差异有统计学意义（<0.01）。实验组患者在随访期的后3个月较前3个月改善更为显著。末次随访时，实验组VAS评分为3分，对照组为2.2分；实验组AOFAS评分为88.6分，对照组为88分，均显著高于术前，差异有统计学意义，但两组间差异无统计学意义。
机器人导航辅助逆行钻孔和关节镜下微骨折术通过骨髓刺激（BMS）治疗OCLT，在所有患者中均获得了满意的短期疗效。此外，随访显示，机器人导航辅助逆行钻孔疗效优异、并发症少，具有安全、微创的特点，并大大缩短了手术时间。因此，机器人导航辅助逆行钻孔BMS术是治疗OCLT的一种安全有效的方法。
