距骨软骨损伤:病因、诊断、治疗及前景
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摘要
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.
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.
引文
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[2]Saxena A,Eakin C.Articular talar injuries in athletes:results of microfracture and autogenous bone graft.Am J Sports Med.2007;35(10):1680-1687.
[3]Ferkel RD,Zanotti RM,Komenda GA,et al.Arthroscopic treatment of chronic osteochondral lesions of the talus:long-term results.Am J Sports Med.2008;36(9):1750-1762.
[4]Berndt AL,Harty M.Transchondral fractures(osteochondritis dissecans)of the talus.J Bone Joint Surg Am.1959;41-a:988-1020.
[5]Cheng JC,Ferkel RD.The role of arthroscopy in ankle and subtalar degenerative joint disease.Clin Orthop Relat Res.1998;(349):65-72.
[6]Campbell CJ,Ranawat CS.Osteochondritis dissecans:the question of etiology.J Trauma.1966;6(2):201-221.
[7]Prado MP,Kennedy JG,Raduan F,et al.Diagnosis and treatment of osteochondral lesions of the ankle:current concepts.Rev Bras Ortop.2016;51(5):489-500.
[8]Flick AB,Gould N.Osteochondritis dissecans of the talus(transchondral fractures of the talus):review of the literature and new surgical approach for medial dome lesions.Foot Ankle.1985;5(4):165-185.
[9]van Bergen CJ,Gerards RM,Opdam KT,et al.Diagnosing,planning and evaluating osteochondral ankle defects with imaging modalities.World J Orthop.2015;6(11):944-953.
[10]Donnenwerth MP,Roukis TS.Outcome of arthroscopic debridement and microfracture as the primary treatment for osteochondral lesions of the talar dome.Arthroscopy.2012;28(12):1902-1907.
[11]Kirschke JS,Braun S,Baum T,et al.,Diagnostic Value of CTArthrography for Evaluation of Osteochondral Lesions at the Ankle.Biomed Res Int.2016;2016:3594253.
[12]Weber MA,Wünnemann F,Jungmann PM,et al.Modern Cartilage Imaging of the Ankle.Rofo.2017;189(10):945-956.
[13]Albano D,Martinelli N,Bianchi A,et al.Evaluation of reproducibility of the MOCART score in patients with osteochondral lesions of the talus repaired using the autologous matrix-induced chondrogenesis technique.Radiol Med.2017;122(12):909-917.
[14]Van Ginckel A,Witvrouw EE.In vivo deformation of thin cartilage layers:Feasibility and applicability of T2*mapping.J Orthop Res.2016;34(5):771-778.
[15]Tao H,Hu Y,Qiao Y,et al.T2-Mapping evaluation of early cartilage alteration of talus for chronic lateral ankle instability with isolated anterior talofibular ligament tear or combined with calcaneofibular ligament tear.J Magn Reson Imaging.2018;47(1):69-77.
[16]Kim HS,Yoon YC.Comparison of T2 Relaxation Values in Subtalar Cartilage between Patients with Lateral Instability of the Ankle Joint and Healthy Volunteers.Eur Radiol.2018;28(10):4151-4162.
[17]Elias I,Jung JW,Raikin SM,et al.Osteochondral lesions of the talus:change in MRI findings over time in talar lesions without operative intervention and implications for staging systems.Foot Ankle Int.2006;27(3):157-166.
[18]Anderson IF,Crichton KJ,Grattan-Smith T,et al.Osteochondral fractures of the dome of the talus.J Bone Joint Surg Am.1989;71(8):1143-1152.
[19]Cheng MR.Ferkel,and G.Applegate.Osteochondral lesions of the talus:a radiologic and surgical comparison.in Oral paper presented at the Annual Meeting of the Academy of Orthopaedic Surgeons(AAOS)New Orleans.1995.
[20]Huey DJ,Hu JC,Athanasiou KA.Unlike bone,cartilage regeneration remains elusive.Science.2012;338(6109):917-921.
[21]Verhagen RA,Struijs PA,Bossuyt PM,et al.Systematic review of treatment strategies for osteochondral defects of the talar dome.Foot Ankle Clin.2003;8(2):233-242,viii-ix.
[22]Klammer G,Maquieira GJ,Spahn S,et al.Natural history of nonoperatively treated osteochondral lesions of the talus.Foot Ankle Int.2015;36(1):24-31.
[23]Murawski CD,Kennedy JG.Operative treatment of osteochondral lesions of the talus.J Bone Joint Surg Am.2013;95(11):1045-1054.
[24]Grambart ST.Arthroscopic Management of Osteochondral Lesions of the Talus.Clin Podiatr Med Surg.2016;33(4):521-530.
[25]Polat G,Er?en A,Erdil ME,et al.Long-term results of microfracture in the treatment of talus osteochondral lesions.Knee Surg Sports Traumatol Arthrosc.2016;24(4):1299-1303.
[26]Choi WJ,Park KK,Kim BS,et al.Osteochondral lesion of the talus:is there a critical defect size for poor outcome?Am J Sports Med.2009;37(10):1974-1980.
[27]Shimozono Y,Coale M,Yasui Y,et al.Subchondral Bone Degradation After Microfracture for Osteochondral Lesions of the Talus:An MRI Analysis.Am J Sports Med.2018;46(3):642-648.
[28]Lee KB,Park HW,Cho HJ,et al.Comparison of Arthroscopic Microfracture for Osteochondral Lesions of the Talus With and Without Subchondral Cyst.Am J Sports Med.2015;43(8):1951-1956.
[29]Kumai T,Takakura Y,Kitada C,et al.Fixation of osteochondral lesions of the talus using cortical bone pegs.J Bone Joint Surg Br.2002;84(3):369-374.
[30]Shank JR,Benirschke SK,Swords MP.Treatment of Peripheral Talus Fractures.Foot Ankle Clin.2017;22(1):181-192.
[31]Ng A,Bernhard K.Osteochondral Autograft and Allograft Transplantation in the Talus.Clin Podiatr Med Surg.2017;34(4):461-469.
[32]Zhu Y,Xu X.Osteochondral Autograft Transfer Combined With Cancellous Allografts for Large Cystic Osteochondral Defect of the Talus.Foot Ankle Int.2016;37(10):1113-1118.
[33]Leumann A,Horisberger M,Buettner O,et al.Medial malleolar osteotomy for the treatment of talar osteochondral lesions:anatomical and morbidity considerations.Knee Surg Sports Traumatol Arthrosc.2016;24(7):2133-2139.
[34]Hannon CP,Smyth NA,Murawski CD,et al.Osteochondral lesions of the talus:aspects of current management.Bone Joint J.2014;96-b(2):164-171.
[35]Henak CR,Ross KA,Bonnevie ED,et al.Human talar and femoral cartilage have distinct mechanical properties near the articular surface.J Biomech.2016;49(14):3320-3327.
[36]Juras V,Zbyň?,Mlynarik V,et al.The compositional difference between ankle and knee cartilage demonstrated by T2 mapping at 7 Tesla MR.Eur J Radiol.2016;85(4):771-777.
[37]Hangody L.The mosaicplasty technique for osteochondral lesions of the talus.Foot Ankle Clin.2003;8(2):259-273.
[38]Hangody L,Kish G,Kárpáti Z,et al.Treatment of osteochondritis dissecans of the talus:use of the mosaicplasty technique--a preliminary report.Foot Ankle Int.1997;18(10):628-634.
[39]Sammarco GJ,Makwana NK.Treatment of talar osteochondral lesions using local osteochondral graft.Foot Ankle Int.2002;23(8):693-698.
[40]Flynn S,Ross KA,Hannon CP,et al.Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus.Foot Ankle Int.2016;37(4):363-372.
[41]Kubosch EJ,Erdle B,Izadpanah K,et al.Clinical outcome and T2assessment following autologous matrix-induced chondrogenesis in osteochondral lesions of the talus.Int Orthop.2016;40(1):65-71.
[42]Paul J,Sagstetter A,Kriner M,et al.Donor-site morbidity after osteochondral autologous transplantation for lesions of the talus.J Bone Joint Surg Am.2009;91(7):1683-1688.
[43]Gross AE,Agnidis Z,Hutchison CR.Osteochondral defects of the talus treated with fresh osteochondral allograft transplantation.Foot Ankle Int.2001;22(5):385-391.
[44]Adams SB,Dekker TJ,Schiff AP,et al.Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder.Foot Ankle Int.2018;39(1):28-34.
[45]Ahmad J,Maltenfort M.Arthroscopic Treatment of Osteochondral Lesions of the Talus With Allograft Cartilage Matrix.Foot Ankle Int.2017;38(8):855-862.
[46]Lanham NS,Carroll JJ,Cooper MT,et al.A Comparison of Outcomes of Particulated Juvenile Articular Cartilage and Bone Marrow Aspirate Concentrate for Articular Cartilage Lesions of the Talus.Foot Ankle Spec.2017;10(4):315-321.
[47]Shimozono Y,Yasui Y,Ross AW,et al.Scaffolds based therapy for osteochondral lesions of the talus:A systematic review.World JOrthop.2017;8(10):798-808.
[48]Gao F,Chen N,Sun W,et al.Combined Therapy with Shock Wave and Retrograde Bone Marrow-Derived Cell Transplantation for Osteochondral Lesions of the Talus.Sci Rep.2017;7(1):2106.
[49]Shang XL,Tao HY,Chen SY,et al.Clinical and MRI outcomes of HAinjection following arthroscopic microfracture for osteochondral lesions of the talus.Knee Surg Sports Traumatol Arthrosc.2016;24(4):1243-1249.
[50]Chahla J,Cinque ME,Shon JM,et al.Bone marrow aspirate concentrate for the treatment of osteochondral lesions of the talus:a systematic review of outcomes.J Exp Orthop.2016;3(1):33.
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