早期多认为踝关节疼痛的主要原因是踝关节损伤, 但近期研究结果指出, 距骨骨软骨损伤作为踝关节疼痛的原因在临床更为常见。本文章的目的在于对OCL的分型、诊断以及治疗作一综述。通过系统检索的方法, 检索PubMed和EMBASE等数据库, 检索语种为英语, 无时间限制。急性骨软骨病变会模仿脚踝扭伤的临床情况, 因此, 如果症状持续2~3周后, AP, 横向和榫踝关节的X-射线。如果这些都是负面的, CT扫描很少会错过病变, 但最准确的成像MRI, 它可以准确地评估软骨损伤.根据现有的文献结果, 对于较小的距骨骨软骨损伤(<15 mm), 清创和骨髓刺激是目前效果最好的治疗方法;也有作者指出, 自体软骨移植或骨软骨移植可用于较大损伤的OCL治疗。由于距骨骨软骨损伤在临床检查时容易漏诊, 我们建议对存在踝关节背屈或跖屈位内翻暴力损伤的患者, 应高度警惕距骨骨软骨损伤的可能。
This narrative review aims to present the current concepts about classification,diagnosis and treatment of osteochondral lesions of the talus (OCL).OCL is a more common source of ankle those previously recognised and often present as complications of ankle injuries.No time restriction was applied in the English literature search in Pubmed and EMBASE,and focus was laid on the classification,diagnosis and treatment of OCL.An acute OCL will mimic the clinical picture of a sprained ankle,therefore if symptoms persist after 2~3 weeks,AP,lateral and mortise X-Ray views of the ankle are indicated.If these are negative,a CT scan will rarely miss the lesion,but the most accurate imaging is the MRI,which can accurately assess cartilage damage.Debridement and bone marrow stimulation is according to available information,the surgical technique which currently yields best results for small lesions(<15 mm) while ACI or osteochondral transplantation are recommended by several authors for large lesions.In view of OCL are easily missed in clinical practice,we recommend that there should be a high index of suspicion especially in forceful inversion injuries of ankle in dorsiflexion or plantarflexion.
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