Retrograde Drilling and Bone Graft for Hepple Stage V Subchondral Bone Lesion of Talus Using 3D Image-Based Navigation-Assisted Endoscopic Technique.

IF 2.4 2区医学 Q2 ORTHOPEDICS

Foot & Ankle International Pub Date : 2023-10-01 Epub Date: 2023-08-02 DOI:10.1177/10711007231185084

Xinchen Wu, Yanjun Zhong, Shijun Wei, Helin Wu, Boyu Zheng, Feng Xu

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引用次数: 0

Abstract

Background: Retrograde drilling remains technically challenging, because of the difficulty of identifying the accurate location of cysts during surgery. This study's aim was to evaluate the 3-dimensional (3D) image-based surgical navigation-assisted endoscopic retrograde drilling technique for subchondral bone lesions of the talus.

Methods: From March 2017 to June 2020, a total of 21 cases with Hepple stage V subchondral bone lesions of the talus were treated with 3D image-based surgical navigation-assisted endoscopic retrograde drilling and bone graft technique. Arthroscopic views were categorized per Pritsch classifications. The correlation between the drilled tunnel with preoperative cystic lesions were assessed under postoperative computer tomographic (CT) scans. The American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS) scores, and Foot and Ankle Ability Measure (FAAM) sports scales were evaluated at the preoperative and final consultation. All complications were recorded.

Results: On postoperative CT scans, in 20 cases (95.2%), the drilled tunnel was judged to have been in the center of previous cysts. Only 9 cases (42.9%) showed intact normal cartilage (grade 0, group A); 12 cases (57.1%) had intact, but soft, cartilage (grade I, group B). The median follow-up time was 24 (24, 30) months, and at final follow-up, there were no significant differences between the mean AOFAS and VAS scores in both groups (89.0 ± 6.4 vs 88.3 ± 7.0 and 1 vs 0.5) or postoperative FAAM sports scales (28.2 ± 2.2 vs 26.6 ± 4.9, P = .363). Two patients had revision surgery in group B.

Conclusion: The 3D image-based surgical navigation-assisted endoscopic retrograde drilling and bone graft technique for the subchondral bone lesions of the talus in this small case series showed encouraging results.

Level of evidence: Level IV, retrospective case series.

查看原文本刊更多论文

应用三维图像导航辅助内窥镜技术逆行钻孔植骨治疗距骨Hepple V期软骨下骨病变。

背景：逆行钻孔在技术上仍然具有挑战性，因为在手术中很难确定囊肿的准确位置。本研究的目的是评估基于三维（3D）图像的外科导航辅助内窥镜逆行钻孔技术对距骨软骨下骨病变的治疗效果。方法：自2017年3月至2020年6月，共有21例距骨Hepple V期软骨下骨病变采用基于3D图像的手术导航辅助内镜逆行钻孔和骨移植技术进行治疗。关节镜检查按照Pritsch分类法进行分类。在术后计算机断层扫描（CT）下评估钻孔隧道与术前囊性病变之间的相关性。在术前和最后的咨询中评估了美国足踝矫形学会（AOFAS）评分、视觉模拟量表（VAS）评分和足踝能力测量（FAAM）运动量表。记录所有并发症。结果：在术后CT扫描中，20例（95.2%）患者判断钻孔隧道位于先前囊肿的中心。只有9例（42.9%）显示完整的正常软骨（0级，A组）；12例（57.1%）软骨完整但柔软（Ⅰ级，B组）。中位随访时间为24（24，30）个月，在最终随访时，两组的平均AOFAS和VAS评分之间没有显著差异（89.0 ± 6.4对88.3 ± 7.0和1 vs 0.5）或术后FAAM运动量表（28.2 ± 2.2对26.6 ± 4.9，P = .363）。B组有两名患者接受了翻修手术。结论：在这个小病例系列中，基于3D图像的手术导航辅助内镜逆行钻孔和骨移植技术治疗距骨软骨下骨病变显示出令人鼓舞的结果。证据级别：第四级，回顾性案例系列。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Foot & Ankle International 医学-整形外科

CiteScore

5.60

自引率

22.20%

发文量

144

审稿时长

2 months

期刊介绍： Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers. The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008. The journal focuses on the following areas of interest: • Surgery • Wound care • Bone healing • Pain management • In-office orthotic systems • Diabetes • Sports medicine