距骨骨软骨损伤治疗的研究进展  

Advances in the Treatment of Osteochondral Lesions of the Talus

作　　者：李永胜[1] 董傲铮铮 黄泽祈 李文翠[1] 邓桢翰 LI Yongsheng;DONG Aozhengzheng;HUANG Zeqi;LI Wencui;DENG Zhenhan(Department of Foot,Ankle,and Hand Surgery,The Second People's Hospital of Shenzhen,Shenzhen 518000,China;Shenzhen University,Shenzhen 518060,China;Department of Orthopectics,The First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]深圳市第二人民医院足踝外科手外科,深圳518000 [2]深圳大学,深圳518060 [3]温州医科大学附属第一医院关节外科,温州325000

出　　处：《四川大学学报（医学版）》2024年第2期273-278,共6页Journal of Sichuan University(Medical Sciences)

基　　金：广东省基础与应用基础研究基金(No.2023A1515220072、No.2021A1515010706、No.2023A1515010102);广东省重点临床学科-骨科(No.2000005);深圳市重点医学学科建设基金(No.SZXK025)资助。

摘　　要：距骨骨软骨损伤(osteochondral lesion of talus, OLT)是由创伤等原因造成距骨滑车局限性的软骨及软骨下骨损伤,包括距骨剥脱性骨软骨炎(osteochondritis dissecans of talus, OCD)和距骨骨软骨切线骨折;可从无症状发展为软骨下骨囊肿伴踝关节深部疼痛,多发生在距骨穹窿内侧和外侧,严重影响患者生活及工作,甚至导致残疾。本文对OLT的治疗进展及其优缺点进行综述。根据不同分型或临床症状,OLT可采取不同治疗方法,包括保守治疗和手术治疗等。保守治疗大多短时缓解症状,仅延缓病情。近年来发现单一的富血小板血浆注射、微骨折、带骨膜骨移植、距骨软骨移植、同种异体骨移植、机器人导航下逆行钻孔等方法,都可取得不错的疗效,后期在微骨折结合富血小板血浆注射、微骨折结合软骨移植及各种治疗方式结合距腓前韧带修复,均展现出良好疗效。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.

关 键 词：距骨骨软骨损伤 逆行钻孔 机器人导航 软骨移植 骨移植 微骨折 综述 

分 类 号：R687.3[医药卫生—骨科学]