距骨骨软骨损伤治疗方案的个性化组合

Personalized combination of treatment options for osteochondral lesions of the talus

背景:距骨骨软骨损伤根据不同分型或临床症状,采取不同的治疗方法,包括保守治疗、手术治疗和生物制剂治疗。保守治疗大多可短时缓解症状和延缓病情;近年来关节镜下微骨折、克氏针钻孔、距骨软骨移植、自体骨软骨细胞移植、干细胞移植和生物制剂富血小板血浆等方法,都取得了不错的疗效。目的:对距骨骨软骨损伤的治疗进展进行总结,为其临床治疗提供参考。方法:第一作者以“talus,osteochondral lesions of the talus,微骨折,移植术,富血小板血浆,干细胞”为检索词,检索Pub Med数据库及中国知网2019年1月至2024年1月的相关文章。共纳入67篇文献进行综合分析。结果与结论:(1)目前治疗距骨骨软骨损伤的方式较多,对于Hepple分型Ⅰ和Ⅱ型病变保守康复治疗和生物制剂可缓解病情;Hepple分型Ⅲ型及以上且病变直径<15 mm选择微骨折或克氏针钻孔骨髓刺激治疗,但长期疗效不佳;更大病变面积选择置换和再生策略,移植失败是其最主要风险;(2)生物制剂治疗作为一种治疗新方式,多用于组合治疗;(3)针对距骨骨软骨损伤的治疗,需要考虑到软骨损伤的面积、部位等诸多因素,其治疗方案的选择还应考虑医疗技术开展情况以及患者接受程度、经济状况等因素,建议对各种方案进行个性化组合治疗,以取得更为良好的效果。

BACKGROUND:For the treatment of osteochondral lesions of the talus,different treatment methods are adopted according to different types or clinical symptoms,including rehabilitation treatment,surgical treatment and biological agent treatment.Most of the rehabilitation treatment relieved the symptoms and delayed the disease in a short time.In recent years,arthroscopic microfractures,kirschner wire drilling,talus cartilage transplantation,autologous osteochondrocyte transplantation,stem cell transplantation,and biological preparation platelet-rich plasma can achieve good results.OBJECTIVE:To summarize the progress in the treatment of osteochondral lesions of the talus and provide a reference for their clinical treatment.METHODS:Using English search terms“talus,osteochondral lesions of the talus”and Chinese search terms“microfracture,transplantation,platelet-rich plasma,stem cell,”we searched the PubMed and CNKI databases for related articles published from January 2019 to January 2024.A total of 67 articles were included for comprehensive analysis.RESULTS AND CONCLUSION:(1)There are many ways to treat osteochondral lesions of the talus.Conservative rehabilitation and biological agents can alleviate the condition for Hepple type I and II lesions.Microfracture or Kirschner wire drilling bone marrow stimulation treatment is used for Hepple type III and above and lesion diameter<15 mm,but the long-term efficacy is poor.Replacement and regeneration strategies are used for larger lesions,and transplant failure is the main risk.(2)Biological agent treatment is a new treatment method and is often used in combination therapy.(3)In view of the treatment of osteochondral lesions of the talus,many factors such as the area and location of cartilage injury should be taken into account.The selection of the treatment plan should also take into account the level of medical technology,patient acceptance,economic status and other factor.Personalized combination treatment of various schemes is recommended to achieve good results.