第二跖骨头、舟状骨和距骨坏死的研究进展

RESEARCH PROGRESS OF BONE NECROSIS OF SECOND METATARSAL HEAD, NAVICULAR BONE, AND TALUS

目的探讨第2跖骨头、舟状骨和距骨坏死的病因、临床及影像学表现、分期及其治疗方法,为临床应用提供参考。方法广泛查阅近年来国内外第2跖骨头、舟状骨和距骨坏死的相关文献,对其病因、临床及影像学表现、分期及治疗方法进行总结回顾和综合分析。结果第2跖骨头、舟状骨和距骨坏死多与其特殊的解剖结构关系密切,环境因素和遗传因素等也会导致疾病的发生。该类疾病常导致足部疼痛、肿胀,严重者行走受限。足部X线片和MRI表现是诊断与分期的主要依据。根据分期不同,对早期患者多采用保守治疗,晚期或保守治疗无效者则采用截骨内固定、关节融合等手术方法治疗,可取得良好效果。结论目前的治疗方法虽取得了较好的治疗效果,但其疗效尚需长期临床随访,新的治疗方法仍有待进一步研究。

Objective To discuss the etiology, clinical manifestation, imaging, staging, and treatment of bone necrosis of the second metatarsal head, the navicular bone, and the talus so as to provide more information for clinical application. Methods The related home and abroad literature concerning bone necrosis of the second metatarsal head, the navicular bone, and the talus in recent years was reviewed extensively. And the clinical manifestation, imaging, staging, and treatment were summarized and analyzed. Results Bone necrosis of the second metatarsal head, the navicular bone, and the talus were more closely related to the particular anatomy; the environmental and genetic factors also lead to such diseases. The clinical presentation was typically local pain and swelling around the joint, frequently with restricted joint motion in severe cases. Both radiographs and MRI were used to be the main criteria for diagnosis and staging of these diseases. According to different phases, conservative therapy was effective in treating osteonecrosis at early stage. While surgical treatments such as osteotomy, fixation, and arthrodesis were used in late-stage bone necrosis. Conclusion The current methods of treatment have achieved good effect, but long-term clinical follow-up is needed and the new surgery should be further studied.