距骨软骨损伤:病因、诊断、治疗及前景

Osteochondral lesions of the talus:etiology,diagnosis,treatment and prospects

背景:由于踝关节在运动中所承受的巨大压力和关节软骨受伤后有限的自行修复能力,距骨软骨损伤的治疗一直都是一个巨大的难题。目的:系统综述距骨软骨损伤的病因、临床表现、诊断方法、临床分级、治疗方法以及细胞疗法和组织工程等新疗法。方法:由第一作者检索PubMed数据库发表的相关文章,限定文章语言种类为"English",检索词为"talus,cartilage",初检文章535篇,筛选后对70篇文章进行分类总结。结果与结论:创伤目前仍被认为是距骨软骨损伤的主要致病因素;依据患者的症状体征和影像学表现目前临床已经基本可以准确判断出距骨软骨损伤的病变范围及程度。针对小面积的距骨软骨损伤,微骨折术和其他的一些辅助疗法例如关节镜技术的应用都取得了良好的效果;然而对于大面积的缺损,目前临床上应用的疗法都存在一定的缺点和局限性,以组织工程为基础的疗法最有可能治愈距骨软骨损伤。

BACKGROUND:Osteochondral lesion of the talus is a common disease of foot and ankle surgery,which has the characteristics of high morbidity,high misdiagnosis rate and difficulty in curing.OBJECTIVE:To summarize the etiology,clinical manifestations,diagnostic methods,clinical grading,treatment methods,and new therapies such as cell therapy and tissue engineering for osteochondral lesion of the talus.METHODS:The first author retrieved PubMed databases for relevant articles.The keywords were“talus,cartilage”.Initially,535 articles were retrieved,and finally 70 articles were included in result analysis.RESULTS AND CONCLUSION:Trauma is still considered to be the main pathogenic factor of talus cartilage injury.According to the imaging findings,the clinical scope of talar cartilage injury can be accurately determined.The clinically applied therapies have certain shortcomings and limitations.Tissue engineering-based therapies are currently the most likely to cure osteochondral lesion of the talus.