目的:研究距骨骨折螺旋CT轴扫、多平面(MPR)和三维(3D)重建图像的特点及其临床意义。方法:收集距骨骨折患者术前螺旋CT资料12例,同时进行了MPR和3D重建图像。着重分析距骨骨折线的走行、与关节面的关系、关节面塌陷程度等,并评价轴扫、MPR和3D重建图像的优势。结果:在12例距骨骨折者骨踝关节受累7例。MPR和3D重建图像可直观显示骨折详细情况。结论:螺旋CT轴扫、多平面和三维重建图像相结合,可更好显示距骨骨折的情况,能为临床术前诊断和治疗提供有价值的影像信息。
ObjectiveTo explore the feasibility of the repair and reconstruction of large talar lesions with three-dimensional (3D) printed talar components by biomechanical test.MethodsSix cadaveric ankle specimens were used in this study and taken CT scan and reconstruction. Then, 3D printed talar component and osteotomy guide plate were designed and made. After the specimen was fixed on an Instron mechanical testing machine, a vertical pressure of 1 500 N was applied to the ankle when it was in different positions (neutral, 10° of dorsiflexion, and 14° of plantar flexion). The pressure-bearing area and pressure were measured and calculated. Then osteotomy on specimen was performed and 3D printed talar components were implanted. And the biomechanical test was performed again to compare the changes in pressure-bearing area and pressure.ResultsBefore the talar component implantation, the pressure-bearing area of the talus varied with the ankle position in the following order: 10° of dorsiflexion > neutral position > 14° of plantar flexion, showing significant differences between positions ( P<0.05). The pressure exerted on the talus varied in the following order: 10° of dorsiflexion < neutral position < 14° of plantar flexion, showing significant differences between positions (P<0.05). The pressure-bearing area and pressure were not significantly different between before and after talar component implantations in the same position (P>0.05). The pressure on the 3D printed talar component was not significantly different from the overall pressure on the talus (P>0.05).ConclusionApplication of the 3D printed talar component can achieve precise repair and reconstruction of the large talar lesion. The pressure on the repaired site don’t change after operation, indicating the clinical feasibility of this approach.
Objective To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral “safe zone” for Hawkins type Ⅰ-Ⅲ talar neck fractures. Methods A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral “safe zone” parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups (P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale. Results The operation time in the study group was significantly shorter than that in the control group (P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups (P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant (P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups (P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups (P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients’ satisfaction in the study group were significantly better than those in the control group (P<0.05). ConclusionThe treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral “safe zone” can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.
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.
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.
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.
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.