距骨颈入路病灶清理植骨治疗距骨囊肿

Talar neck approach for debridement and bone grafting to treat talar cyst

目的探讨距骨颈入路病灶清理植骨治疗距骨囊肿的手术方法,并评价其疗效。方法回顾性分析2014年7月至2017年12月收治的距骨囊肿患者9例,其中男7例,女2例,11~47岁,平均30.6岁。左足5例,右足4例。所有病例均应用距骨颈入路病灶清理植骨治疗距骨囊肿。术前术后行踝关节正侧位X线片、CT及MRI检查,评估距骨囊肿大小以及累及关节面的情况。术中应用距骨颈入路小切口行病灶清理,并取自体髂骨植骨,修复病灶清理后的骨缺损。术后根据美国AOFAS踝-后足功能评分标准进行踝关节功能评分。结果9例全部获随访,随访时间8~20个月,平均12.4个月。术后行踝关节X线片、CT和MRI检查,所有患者距骨囊肿清理后的骨缺损得到修复,踝关节疼痛明显减轻,AOFAS评分从70.2(60~82)分上升到92(85~100)分。踝关节活动正常,无感染、复发及血管神经损伤等并发症发生。结论距骨颈入路病灶清理植骨是治疗距骨囊肿的有效手术方式,创伤小,不破坏关节面,对距骨血运无明显影响,对周围软组织损伤小,大大缩短住院时间。

Objective To explore the application and efficacy of talar neck approach for debridement and bone grafting in the treatment of talar cyst. Methods Clinical data of 9 cases of talar cysts treated during Jul. 2014 and Dec. 2017 were retrospectively analyzed, including 7 males and 2 females, aged 11~47 years, average 30.6 years. The lesions involved 5 left feet and 4 right feet. X ray, CT and MRI were performed before operation to evaluate the size of cysts and articular surfaces involved. During operation, all lesions were debrided with talar neck approach, and bone defects were repaired with autologous cancellous bones harvested from iliac crests. After operation, the functions of ankles were evaluated with AOFAS score. Results All 9 cases were followed up for 8-20 months, average 12.4 months. All bone defects were repaired, and ankle pain was significantly alleviated. The AOFAS score rose from 70.2(60-82) to 92(85-100). The ankles could function normally. No infection, recurrence or complication were observed. Conclusion Talar neck approach for debridement and bone grafting is effective to treat talar cyst. This non-traumatic way does not damage the articular cartilage or adjacent ligament tissues, does not affect blood supply of the talus, and can shorten the hospitalization time.