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距骨骨软骨损伤的诊断及关节镜治疗

Diagnosis and arthroscopic treatment of osteochondral lesions of the talus

摘要:

目的 总结、分析距骨骨软骨损伤的症状、体征、影像学特点、关节镜下治疗方法及手术效果.方法 2000年至2005年共收治34例距骨骨软骨损伤患者,对其临床资料包括症状、体征、X线片、MRI表现、关节镜手术方法等进行回顾性分析,术后随访根据主观和客观评分判断疗效.术前美国足踝外科后足评分平均(71±8)分,术前主观疼痛程度评分(7.5±1.3)分.结果 34例患者MRI均有骨软骨损伤征象,其中21例通过X线片检查发现距骨骨软骨损伤.距骨骨软骨损伤的主要症状为负重疼痛以及运动后加重,MRI诊断准确率较X线片高(χ2=16.07,P<0.001).31例患者获得随访,平均随访时间为28个月.术后美国足踝外科后足评分(91±9)分,显著高于术前(t=9.147,P<0.001);术后主观疼痛程度评分(2.4±2.3)分,显著低于术前(t=10.853,P<0.001);临床疗效优良率为87.1%.结论 MRI检查能够提高诊断的正确率,关节镜微创手术治疗距骨骨软骨损伤效果良好.

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abstracts:

Objective To summarize and analyze the diagnosis and arthroscopic treatment of osteochondral lesion of talus(OLT).Methods From 2000 to 2005 the data of 34 patients of OLT of the talus were retrospectively studied,including the symptom,physical examination,image,arthroscopic treatment.All patients took X-ray and MRI examination before the arthroscopic surgery.Arthroscopic debridement was performed for all patients,in addition to drilling in 5 cases,and microfracture in 18 cases.Before operation,ankle-hindfoot score of American Orthopaedic Foot and Ankle Society(AOFAS)was 71±8,and the score of pain(visual analogue scale,VAS)Was 7.5±1.3.Results Weight-bearing pain of the ankle joint aggravated after exercise was the predominant complaint of OLT.X-ray examination was negative in 13 cases,and all lesions were detected by MRI,which was signifcantly better than X-ray(χ2=16.07,P<0.001).Thirty-one patients were followed up for an average of 28 months.The average postoperative AOFAS was 91±9(t=9.147,P<0.001);And VAS was 2.4±2.3,which was significantly lower than that in pre-operation(t=10.853,P<0.001).Of the 31 patients,27(87.1%)had good or excellent results.Conclusions MRI could improve the accuracy of diagnosis.The results of arthroscopic treatment for OLT are satisfactory.

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作者: 郭秦炜 [1] 胡跃林 [1] 焦晨 [1] 敖英芳 [1] 于长隆 [1]
第一作者: 郭秦炜
期刊: 《中华外科杂志》2008年46卷3期 206-209页 MEDLINEISTICPKUCSCD
分类号: R6
栏目名称: 论著
DOI: 10.3321/j.issn:0529-5815.2008.03.016
发布时间: 2008-06-04
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