距骨软骨病变的改良逆行钻孔技术:技术说明

Dheeraj Makkar, H. Kim, Yeo Eui Dong, M. Hwang
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引用次数: 0

摘要

距骨软骨病变通常表现为创伤后软骨脱落或软骨完整的骨囊性病变。骨软骨骨折需要顺行入路治疗。用骨移植物逆行钻孔和填塞可以用完整的软骨治疗病变。由于软骨下病变累及距骨穹的后部,这些病变很难用图像增强器定位。我们描述了一种方法,其中使用踝关节镜观察软骨下病变,并使用ACL夹具精确定位病变。我们对两名患者进行了逆行钻孔:一名29岁的男性和一名34岁的男性。每位患者均表现为距骨后内侧软骨下囊性病变。我们通过修改标准的逆行钻孔技术来治疗这两例患者。术前和术后采用AOFAS评分和踝关节x线片对患者进行评估。随访3个月时的x光片显示距骨穹窿轮廓保持良好,植骨完全融合。两名患者的AOFAS评分均大于90分,根据Saxena和Eakin标准,均为优秀。这种方法减少了辐射暴露、侵入性和手术时间。
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A modified retrograde drilling technique of osteochondral lesions of the talus: A technical note
Osteochondral lesions of the talus typically present as cartilage denudation after trauma or as cystic lesions in the bone with intact cartilage. Osteochondral fractures require an anterograde approach for treatment. Retrograde drilling and packing with a bone graft can treat lesions with intact cartilage. Because subchondral lesions involve the posterior aspect of the talar dome, these lesions can be difficult to localize with an image intensifier.We describe a method in which ankle arthroscopy is used to visualize a subchondral lesion, along with an ACL jig to target the lesion precisely.: We performed retrograde drilling in two patients: a 29-year-old man and a 34-year-old man. Each patient presented with a subchondral cystic lesion in the posteromedial aspect of the talus. We treated both patients by modifying the standard technique for retrograde drilling. Patients were evaluated before and after surgery using the AOFAS score and X-rays of the ankle joint. The X-rays taken at the 3-month follow-up showed a well-maintained contour of the talar dome with complete incorporation of the bone graft. The AOFAS scores for both patients were greater than 90, excellent per the Saxena and Eakin criteria. This method decreases radiation exposure, invasiveness, and surgical time of the procedure.
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