关节镜下微骨折术与逆行软骨下骨钻孔术治疗距骨骨软骨病变的比较。
Comparison of Arthroscopic Microfracture and Retrograde Subchondral Drilling in the Treatment of Osteochondral Lesions of Talus.
机构信息
Bahçeşehir University Medical School, Department of Orthopedics and Traumatology, VM Medicalpark Pendik Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey.
出版信息
Acta Chir Orthop Traumatol Cech. 2024;91(4):234-238. doi: 10.55095/ACHOT2024/031.
PURPOSE OF THE STUDY
In our study, it was aimed to evaluate the efficacy of microfracture and retrograde subchondral drilling on clinical outcomes in patients who underwent ankle arthroscopy due to osteochondral lesion of medial talus.
MATERIAL AND METHODS
Twenty eight patients with osteochondral lesion of talus less than 1.5 cm2 treated with ankle arthroscopy were evaluated retrospectively. Microfracture was performed in 16 patients and retrograde subchondral drilling was performed in 12 patients that there was no loss of integrity in the cartilage layer or cartilage layer is partially preserved during ankle arthroscopy. Postoperative evaluations of the patients were done with Foot and Ankle Ability Measure (FAAM) and results of both group were compared statistically.
RESULTS
The mean activities of daily living scale was 93.4±3.2 and sportive activity scale was 90.1±5.7 in the retrograde drilling group. In the micro-fracture group, mean activities of daily living scale was 93.8±4.1 and mean sportive activity scale was 88.9±9.5. No significant difference was found as a result of statistical comparisons of both groups results.
DISCUSSION
It has been determined that the size and preservation of the integrity of talar osteochondral lesions are important factors on clinical results. Results of arthroscopic debridement, microfracture and drilization are not good in lesions larger than 1.5 cm2 and lesions with impaired integrity. In our study, depending on the general literature, osteochondral lesions in talus were less than 1.5 cm2 in patients who underwent arthroscopic micro fracture and retrograde drilling.
CONCLUSIONS
Both microfracture and retrograde subchondral drilling are effective treatment methods with good clinical results for talar osteochondral lesions less than 1,5cm2 . Retrograde subchondral drilling can be an alternative treatment method with the reliability of clinical results in patients with no loss of the integrity of the cartilage layer or cartilage layer is partially preserved.
KEY WORDS
talus, osteochondral lesion, microfracture, subchondral drilling.
研究目的
在我们的研究中，旨在评估关节镜下治疗距骨骨软骨病变患者时，微骨折和逆行软骨下钻孔对临床结果的疗效。
材料与方法
回顾性评估了 28 例接受踝关节镜检查的距骨骨软骨病变小于 1.5cm²的患者。16 例患者行微骨折治疗，12 例患者行逆行软骨下钻孔治疗，术中软骨层无完整性丧失或部分保留。术后采用足踝能力测量（FAAM）对患者进行评估，并对两组结果进行统计学比较。
结果
逆行钻孔组的日常生活活动量表评分为 93.4±3.2，运动量表评分为 90.1±5.7。微骨折组日常生活活动量表评分为 93.8±4.1，运动量表评分为 88.9±9.5。两组结果比较无统计学差异。
讨论
已经确定距骨骨软骨病变的大小和完整性保存是临床结果的重要因素。对于大于 1.5cm²和完整性受损的病变，关节镜下清创、微骨折和钻孔的效果不佳。在我们的研究中，根据一般文献，接受关节镜微骨折和逆行钻孔治疗的患者，距骨骨软骨病变小于 1.5cm²。
结论
微骨折和逆行软骨下钻孔对于小于 1.5cm²的距骨骨软骨病变都是有效的治疗方法，具有良好的临床效果。对于软骨层无完整性丧失或部分保留的患者，逆行软骨下钻孔是一种可靠的治疗方法，具有良好的临床效果。
关键词
距骨；骨软骨病变；微骨折；软骨下钻孔。
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