距骨软骨损伤的诊疗进展

Progress on diagnosis and treatment of cartilage injury of the talus

距骨软骨损伤的诊断可依据患者的症状、病史、MRI检查、详细的体格检查及关节镜检查,治疗上包括保守治疗和手术治疗,保守治疗风险较小,对于轻度损伤效果好;手术治疗包括清创、骨髓刺激术、内固定术以及软骨移植、自体软骨细胞移植、关节腔内注射生物附加物、超声波及电磁刺激技术、组织工程技术等。目前临床最常使用的方法是清创骨髓刺激术、软骨移植及自体软骨细胞移植术。清创、骨髓刺激术在关节镜下微创进行,操作简单、费用低、手术效果好、患者术后疼痛轻,但其术后形成的是纤维软骨,对于小范围损伤成功率较高,一旦失败将造成更大范围的缺损。软骨移植术可以Ⅰ期完成手术,达到透明软骨恢复,但是供区存在不同程度的病理性变化。软骨细胞移植术能解决初次治疗失败后遗留的较大骨软骨缺损,不影响供区,可达到透明软骨修复。但其治疗时间长,必须分期手术及治疗费用较高。各种治疗方法近期治疗效果满意,但远期疗效仍值得商榷。对于自体软骨细胞移植术及新兴的组织工程学治疗技术,仍具有广阔的科研前景。

The diagnosis of osteochondral lesions of the talus can be based on the patients＇symptoms,medical history,MRI,detailed physical examination and arthroscopy. Its treatment includes conservative treatment and surgical treatment. Conservative treatment includes rest,partial-weight bearing,plaster immobilization,wear the orthopedic support,take the non-steroidal anti-inflammatory drugs and so on. Conservative treatment is less risky and effective for mild injuries. Surgical treatment includes debridement,marrow stimulation,internal fixation and cartilage transplantation,autologous chondrocyte transplantation,articular cavity injection biological additions,ultrasonic and electromagnetic stimulation technology,tissue engineering technology,etc. Currently,there are various treatment methods,each with indications and advantages and disadvantages. Among these methods,the most commonly used ones are debridement,marrow stimulation,cartilage transplantation and autologous chondrocyte transplantation,and they deserve extensive promotion. Debridement and marrow stimulation are performed minimally traumatically under arthroscopy. The operation is simple and inexpensive with positive effects and mild pain. There is a higher rate of success for small-scale injuries,but if the operation fails,it will result in a wider range of defects,because of the fibrous cartilages formed after the operation. The cartilage transplantation can be performed in an one-stage operation. After the operation,the hyaline cartilage can be restored,but there are different levels of pathological changes in the donor sites. Chondrocytes transplantation can solve the problem of larger osteochondral defects left after the initial treatment failure,and the donor cartilage can be repaired without affecting the donor sites. But the disadvantages are its long time treatment,staged operations and higher cost. As far as all these treatments are concerned,recent treatment effects are satisfactory,but the long-term efficacy is still questionable. For the autologous chondrocyte transplantation and emerging tissue engineering treatment technology,there is still broad research prospect.