距骨骨軟骨損傷

距骨骨軟骨損傷踝關(guān)節(jié)扭傷

發(fā)生率：每天約1/10000運(yùn)動員：每天約5.23~9.35/10000AnkleinjuriesamongUnitedStateshighschoolsportsathletes,2005-2006.JAthlTrain.2007;42(3):381-387.踝關(guān)節(jié)扭傷流行病學(xué)調(diào)查顯示：在70項(xiàng)體育運(yùn)動中，踝關(guān)節(jié)扭傷在其中24項(xiàng)占第一位踝關(guān)節(jié)骨軟骨損傷在踝關(guān)節(jié)扭傷和骨折中的發(fā)生率高達(dá)50%Articulartalarinjuriesinathletes:resultsofmicrofractureandautogenousbonegraft.AmJSportsMed.2007;35(10):1680-1687.踝關(guān)節(jié)扭傷骨軟骨損傷滑膜增生骨贅形成纖維粘連Chaetal.Intra-articularLesionsinChronicLateralAnkleInstabilityClinicsinOrthopedicSurgeryVol.4,No.4,2012關(guān)節(jié)應(yīng)力測定外踝不穩(wěn)-關(guān)節(jié)應(yīng)力（靜態(tài)）外踝不穩(wěn)-關(guān)節(jié)應(yīng)力（動態(tài)）外踝不穩(wěn)-前移內(nèi)旋應(yīng)力增加TheinvivokinematicsofthetibiotalarjointafterlateralankleInstability.AmJSportsMed.2009November;37(11):2241–2248.踝關(guān)節(jié)骨折復(fù)位不良-關(guān)節(jié)應(yīng)力Osteochondraldefectsintheankle:whypainful?Knee

SurgSportsTraumatol

Arthrosc(2010)18:570–580骨軟骨損傷脛骨遠(yuǎn)端骨軟骨損傷距骨骨軟骨損傷發(fā)生率低：2.6%（23/880）微骨折術(shù)：術(shù)前52-術(shù)后87（AOFAS）ArthroscopicTreatmentofOsteochondralLesionsoftheDistalTibiaFoot&AnkleInternational/Vol.28,No.8/August2007PosttraumaticSubchondralBoneContusionsandFracturesoftheTalotibialJoint:Occurrenceof“Kissing”Lesions.AJR:175,December2000骨軟骨損傷脛骨遠(yuǎn)端骨軟骨損傷距骨骨軟骨損傷OsteochondralLesionsoftheDistalTibialPlafond:LocalizationandMorphologicCharacteristicswithanAnatomicalGrid.Foot&AnkleInternational/Vol.30,No.6/June2009距骨骨軟骨損傷—診斷臨床表現(xiàn)無特異性：關(guān)節(jié)軟骨無神經(jīng)支配X線和CT：關(guān)節(jié)軟骨不能顯影MRI可以提示軟骨損傷關(guān)節(jié)鏡可以發(fā)現(xiàn)需要處理的骨軟骨損傷診斷方法比較-MDCT、MRI、關(guān)節(jié)鏡Prospectivestudyondiagnosticstrategiesinosteochondrallesionsofthetalus.THEJOURNALOFBONEANDJOINTSURGERY.VOL.87-B,No.1,JANUARY2005診斷分期MRI的Mintz分級0級：正常1級：軟骨呈高信號但形態(tài)完整2級：軟骨纖維化或出現(xiàn)裂隙3級：軟骨呈瓣?duì)钕破鸨┞豆琴|(zhì)4級：骨軟骨游離5級：骨軟骨塊移位MintzDN.Osteochondrallesionsofthetalus:anewmagneticresonancegradingsystemwitharthroscopiccorrelation.Arthroscopy19:353–359軟骨損傷0級軟骨損傷1級軟骨呈高信號但形態(tài)完整軟骨損傷1級軟骨損傷2級軟骨纖維化或出現(xiàn)裂隙軟骨損傷2級軟骨損傷3級軟骨呈瓣?duì)钕破鸨┞豆琴|(zhì)軟骨下骨囊性變軟骨下骨囊性變形成原因：創(chuàng)傷破壞軟骨下骨形成過程：負(fù)重的壓力導(dǎo)致軟骨中的水分進(jìn)入損傷的軟骨下骨，松質(zhì)骨中液體壓力增高逐漸形成囊腫部位：距骨內(nèi)側(cè)多見Thenaturehistoryofosteochondrallesionsintheankle.InstrCourseLect.2010;59:375-86.軟骨損傷4級/5級軟骨游離移位軟骨損傷4級/5級軟骨損傷4級/5級MRI診斷的準(zhǔn)確率文獻(xiàn)報道，MRI對踝關(guān)節(jié)軟骨損傷診斷準(zhǔn)確率為81～92％DipaolaJD.Characterizingosteochondrallesionsbymagneticresonanceimaging.Arthroscopy7:101–104Keun-BaeLee.AcomparisonofarthroscopicandMRIfindingsinstagingofosteochondrallesionsofthetalus.KneeSurgSportsTraumatol

Arthrosc(2008)16:1047–1051距骨骨軟骨損傷的治療骨髓刺激技術(shù)：微骨折/逆行鉆孔組織移植骨軟骨固定部分關(guān)節(jié)面置換體外沖擊波（ESW）脈沖電磁場（PEMFs）治療方法的選擇病灶較小：骨髓刺激技術(shù)-微骨折/鉆孔病灶較大：骨軟骨移植、骨軟骨固定、部分關(guān)節(jié)面置換MicrofractureforOsteochondralLesionsoftheAnkle:OutcomeAnalysisandOutcomePredictorsof105CasesArthroscopy:TheJournalofArthroscopicandRelatedSurgery,Vol24,No1(January),2008:pp106-112OsteochondralLesionoftheTalus.TheAmericanJournalofSportsMedicine.Vol.37,No.10,2009治療方法的比較治療方法的比較微骨折目的：病變?nèi)睋p的再血管化方法：微骨折穿透軟骨下骨誘導(dǎo)纖維軟骨形成微骨折－局灶型骨軟骨損傷微骨折－局灶型骨軟骨損傷微骨折的療效影響微骨折療效的因素MicrofractureforOsteochondralLesionsoftheAnkle:OutcomeAnalysisandOutcomePredictorsof105CasesArthroscopy:TheJournalofArthroscopicandRelatedSurgery,Vol24,No1(January),2008:pp106-112影響微骨折療效的因素OsteochondralLesionoftheTalus.TheAmericanJournalofSportsMedicine.Vol.37,No.10,2009影響微骨折療效的因素Arthroscopictreatmentforosteochondrallesionsofthetalus:analysisofoutcomepredictors.ChinMedJ2010;123(3):296-300磁共振軟骨顯像二次探查（男性，36歲）二次探查（男性，41歲）二次探查20例患者中40%不完全愈合Second-LookArthroscopicFindingsandClinicalOutcomesAfterMicrofractureforOsteochondralLesionsoftheTalus.TheAmericanJournalofSportsMedicine.Vol.37,Supplement1,2009距骨囊性變-微骨折病灶較?。ㄖ睆?lt;8mm）軟骨面不完整距骨囊性變-微骨折距骨囊性變-逆行鉆孔病灶較小（直徑<8mm）軟骨面完整透視定位定位方法X線、CTMRI計算機(jī)輔助關(guān)節(jié)鏡下導(dǎo)航逆行鉆孔-CT定位OsteochondralLesionsoftheTalus:Computer-assistedRetrogradeDrilling-FeasibilityandAccuracyinInitialExperiences.RadiologyJanuary2001,Volume218:Number1逆行鉆孔-MRI定位OsteochondralLesionsoftheTalus:RetrogradeDrillingwithHigh-Field-StrengthMRGuidance.Radiology:Volume252:Number3—September2009逆行鉆孔-計算機(jī)輔助導(dǎo)航Arthroscopic-ControlledNavigationforRetrogradeDrillingofOsteochondralLesionsoftheTalus.Foot&AnkleInternational/Vol.31,No.10/October2010距骨囊性變-逆行鉆孔保留軟骨面；打通硬化骨ArthroscopicManagementofOsteochondralLesionsoftheTalus:ResultsofDrillingandUsefulnessofMagneticResonanceImagingBeforeandAfterTreatment.Arthroscopy:TheJournalofArthroscopicandRelatedSurgery,Vol16,No3(April),2000:pp299-304逆行鉆孔+植骨Fluoroscopy-guidedretrogradecore