ObjectiveTo summarize the surgical treatment methods for avascular necrosis of the talus. Methods The recent domestic and international literature related to avascular necrosis of the talus was extensively conducted. The pathogenesis, surgical treatment methods, and prognosis were summarized. Results The clinical symptoms of avascular necrosis of the talus at early stage are not obvious, and most patients have progressed to Ficat-Arlet stages Ⅲ-Ⅳ and require surgical treatment. Currently, surgical treatments for this disease include core decompression, vascularized bone flap transplantation, arthroplasty, and arthrodesis, etc. Early avascular necrosis of the talus can be treated conservatively, and if treatment fails, core decompression can be considered. Arthrodesis is a remedial surgery for patients with end-stage arthritis and collapse, and in cases of severe bone loss, tibiotalocalcaneal arthrodesis and bone grafting are required. Vascularized bone flap transplantation is effective and plays a role in all stages of avascular necrosis of the talus, but the appropriate donor area for the flap still needs further to be studied. ConclusionThe surgical treatment and the system of treatment for different stages of avascular necrosis of the talus still need to be refined.
In order to study the curative effect of vascularized bone graft in the treatment of avascular necrosis of talus, 24 patients were treated with vascularized bone grafts, in which 9 cases had received 1st cuneiform bone graft with a malleolaris anteriomedialis, 4 cases with the 1st cuneiform bone graft with the medial tarsal artery and 11 cases with vascularized cuboid bone graft with the lateral tarsal artery. All of the patients were followed up for 3-5.5 years. The clinical observation and X-ray examination showed that function of the ankle joint was completely or almost normal in 16 cases, and the bone repair was excellent. There was slight pain in the ankle joint in 4 cases. The efficiency rate of the treatment was 83.3%. It could be concluded that vascularized bone graft might be an effective method in the treatment of avascular necrosis of talus.
目的:研究距骨骨折螺旋CT軸掃、多平面(MPR)和三維(3D)重建圖像的特點及其臨床意義。方法:收集距骨骨折患者術前螺旋CT資料12例,同時進行了MPR和3D重建圖像。著重分析距骨骨折線的走行、與關節面的關系、關節面塌陷程度等,并評價軸掃、MPR和3D重建圖像的優勢。結果:在12例距骨骨折者骨踝關節受累7例。MPR和3D重建圖像可直觀顯示骨折詳細情況。結論:螺旋CT軸掃、多平面和三維重建圖像相結合,可更好顯示距骨骨折的情況,能為臨床術前診斷和治療提供有價值的影像信息。
ObjectiveTo summarize the research progress of surgical procedures in osteochondral lesions of the talus (OLT).MethodsBy consulting the related literature of OLT in recent years, the advantages and disadvantages of various surgical treatment schemes were analyzed and summarized.ResultsThere are many surgical treatments for OLT, including bone marrow stimulation, osteochondral transplantation, autologous chondrocyte transplantation, and biologically assisted therapy. Various schemes have different indications and limitations. With the continuous development of various technologies, the effectiveness of OLT treatment will gradually improve.ConclusionThere are still many difficulties and controversies in the treatment of OLT, and there is no unified treatment plan. It is suggested that individualized operation plan should be formulated according to the specific conditions of patients.
Objective To compare the effectiveness of supramalleolar osteotomy (SMOT) and ankle arthrodesis (AA) in the treatment of inverted ankle osteoarthritis (OA) in Takakura 3A stage with talus tilt. Methods The clinical data of 41 patients with inverted ankle OA in Takakura 3A stage with talus tilt admitted between January 2016 to January 2020 and met the selection criteria were retrospectively analyzed, and they were divided into SMOT group (21 cases) and AA group (20 cases) according to the surgical method. There was no significant difference in baseline data such as gender, age, affected side, cause of injury, and preoperative talar tilt angle (TT), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) score, short-form 36 health survey scale (SF-36) score, and sagittal range of motion (ROM) between the two groups (P>0.05). The operation time, intraoperative blood loss, partial weight-bearing time, and complications were recorded in the two groups. AOFAS ankle-hindfoot score, VAS score, SF-36 score, and sagittal ROM were used to evaluate the effectiveness. Bone healing was observed and the time of bony healing was recorded. In the SMOT group, the tibial lateral surface angle (TLS), TT, and the tibial articular surface angle (TAS) were measured on ankle joint weight-bearing anteroposterior and lateral X-ray films and compared with those before operation. And Takakura staging assessment was also performed. ResultsThe operation time and intraoperative blood loss in AA group were significantly less than those in SMOT group (P<0.05). Patients in both groups were followed up 24-36 months, with an average of 28.9 months. Incision infection occurred in 2 patients in SMOT group and 1 patient in AA group, respectively, and no vascular or nerve injury occurred in both groups. The partial weight-bearing time of SMOT group was significantly less than that of AA group (P<0.05), but there was no significant difference in bony healing time between the two groups (P>0.05). At last follow-up, the difference of VAS score and SF-36 score before and after operation of AA group were less than those of SMOT group, and the difference of sagittal ROM before and after operation in SMOT group was less than that of AA group, with significant differences (P<0.05). The difference of AOFAS ankle-hindfoot score before and after operation in AA group was slightly greater than that in SMOT group, but the difference was not significant (P>0.05). The above scores in both groups significantly improved when compared with those before operation (P<0.05). Sagittal ROM in AA group was significantly less than that before operation (P<0.05), while there was no significant difference in SMOT group (P>0.05). In the SMOT group, 17 patients (81.0%) showed improvement in imaging staging, 2 patients (9.5%) showed no improvement in staging, and 2 patients (9.5%) showed stage aggravation. TLS, TAS, and TT significantly improved when compared with those before operation (P<0.05). At last follow-up, 2 patients in SMOT group received AA due to pain and stage aggravation, and 1 patient with bone nonunion underwent bone graft. Subtalar joint fusion was performed in 1 case of subtalar arthritis in AA group.Conclusion For inverted ankle OA in Takakura 3A stage with talus tilt, both SMOT and AA can significantly releave pain, improve foot function and quality of life, but AA has more definite effectiveness and better patient satisfaction.
Objective To provide a comprehensive overview of the surgical treatments of osteochondral lesion of talus (OLT) and offer valuable insights for clinical practice. Methods The advantages and limitations of surgical treatments for OLT were comprehensively summarized through an extensive review of domestic and abroad relevant literature in recent years. Results Currently, there exist numerous surgical treatments for the OLT, all of which can yield favorable outcomes. However, each method possesses its own set of merits and demerits. The short-term effectiveness of bone marrow stimulation in treating primary OLT with a diameter less than 15 mm is evident, but its long-term effectiveness diminishes over time. Autologous osteochondral transplantation (AOT) and osteochondral allograft transplantation (OAT) are suitable for OLT with large defects and subchondral bone cysts. However, incomplete anatomical matching between the donor and recipient bones may results in the formation of new subchondral bone cysts, while AOT also presents potential complications at the donor site. In contrast to AOT and OAT, particulated juvenile cartilage allograft transplantation obviates the need for additional osteotomy. Furthermore, juvenile cartilage exhibits enhanced potential in delivering active chondrocytes to the site of cartilage defect, surpassing that of adult cartilage in tissue repair efficacy. Cell transplantation has demonstrated satisfactory effectiveness; however, it is associated with challenges such as the requirement for secondary surgery and high costs. Autologous matrix-induced chondrogenesis technology has shown promising effectiveness in the treatment of primary and non-primary OLT and OLT with large defect and subchondral bone cysts. However, there is a scarcity of relevant studies, most of which exhibit low quality. Adjuvant therapy utilizing biological agents represents a novel approach to treating OLT; nevertheless, due to insufficient support from high-quality studies, it has not exhibited significant advantages over traditional treatment methods. Furthermore, its long-term effectiveness remain unclear. Conclusion The optimal choice of surgical treatment for OLT is contingent not only upon the characteristics such as nature, size, and shape but also takes into consideration factors like advancements in medical technology, patient acceptance, economic status, and other pertinent aspects to deliver personalized treatment.
ObjectiveTo investigate the effectiveness of arthroscopic talocalcaneal coalition resection in painful adults via a modified posterior approach.MethodsBetween January 2015 and December 2017, 9 patients with painful talocalcaneal coalition accepted arthroscopic resection via the posterior malleolus high lateral observation approach combined with the lower medial operation approach. Of them, 6 were male and 3 were female, aged from 19 to 30 years (mean, 24 years). Among them, 2 cases had no definite local trauma and 7 cases had a history of sprain of foot and ankle. The disease duration ranged from 6 to 30 months, with a median of 12 months. Rozansky classification of talocalcaneal coalition for the 9 patients: 5 cases (5 feet) were type Ⅰ, 2 cases (2 feet) type Ⅱ, and 2 cases (2 feet) type Ⅲ. The patients had no sequelae of limb dysfunction and no limb joint surgery in the past. All the patients received anteroposterior and lateral X-ray films and CT scans of the ankle joint during follow-up. The visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score were used to evaluate the effectiveness.ResultsThe operation time was 60-90 minutes (mean, 76 minutes). All patients were followed up 12-24 months (mean, 18 months). All the incisions healed by first intention, without infection, skin necrosis, lower extremity deep vein thrombosis, vascular nerve and tendon injury, bone bridge recurrence, and other complications. The ankle function recovered well and the pain was relieved obviously after operation, and the patients returned to work at 3-5 months after operation, with an average of 3.9 months. At last follow-up, the VAS score was 0.7±0.5, which was significantly improved (t=20.239, P=0.000) when compared with preoperative score (4.2±0.5); the AOFAS ankle-hind foot score was 94±4, which was significantly improved (t=?27.424, P=0.000) when compared with preoperative score (62±2). According to AOFAS ankle-hindfoot scoring system, the results were excellent in 7 cases and good in 2 cases at last follow-up.ConclusionIt is more intuitive, more space, and more flexibility for operation via the modified posterior malleolus high lateral observation approach combined with the lower medial operation approach in talocalcaneal coalition. It is feasible to remove talocalcaneal coalition programmatically according to the specific anatomic signs during the operation.
Objective To discuss the etiology, cl inical manifestation, imaging, staging, and treatment of bone necrosis of the second metatarsal head, the navicular bone, and the talus so as to provide more information for cl inical appl ication. Methods The related home and abroad l iterature concerning bone necrosis of the second metatarsal head, the navicular bone, and the talus in recent years was reviewed extensively. And the cl inical manifestation, imaging, staging, and treatment were summarized and analyzed. Results Bone necrosis of the second metatarsal head, the navicular bone, and thetalus were more closely related to the particular anatomy; the environmental and genetic factors also lead to such diseases. The cl inical presentation was typically local pain and swell ing around the joint, frequently with restricted joint motion in severe cases. Both radiographs and MRI were used to be the main criteria for diagnosis and staging of these diseases. According to different phases, conservative therapy was effective in treating osteonecrosis at early stage. While surgical treatments such as osteotomy, fixation, and arthrodesis were used in late-stage bone necrosis. Conclusion The current methods of treatment have achieved good effect, but long-term cl inical follow-up is needed and the new surgery should be further studied.