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.
ObjectiveTo investigate the effectiveness of corrective osteotomy for shortened medial foot column after old talar neck fracture.MethodsThe clinical data of 10 patients with shortened medial foot column after old talar neck fracture between June 2012 and May 2017 was retrospectively analyzed. There were 7 males and 3 females with an average age of 45.8 years (mean, 21-67 years). The time from fracture to corrective osteotomy was 9-60 months (mean, 20.9 months). The preoperative visual analogue scale (VAS) score was 7.1±1.2, the American Orthopaedic Foot and Ankle Society (AOFAS) score was 48.5±12.3, and the short-form 36 health survey scale (SF-36) score was 46.7±10.5. All 10 cases received open wedge osteotomy of medial talus. Among them, 2 received subtalar fusion and Achilles tendon lengthening, 2 lateralizing calcaneal osteotomy, and 2 Achilles tendon lengthening.ResultsAll incisions healed by first intention. All patients were followed up 13-72 months (mean, 38.0 months). The X-ray film showed that the angle between longitudinal axis of 1st metatarsal bone and talus increased from (?9.6±4.5) ° before operation to (1.3±2.7) ° at last follow-up (t=16.717, P=0.000); the angle between longitudinal axis of calcaneus and tibia increased from (?12.0±7.4) ° before operation to (?1.5±4.8) ° at last follow-up (t=5.711, P=0.000). At last follow-up, the VAS score, AOFAS score, and SF-36 score were 1.6±1.0, 88.3±5.4, and 85.4±9.2, respectively, which increased significantly when compared with the preoperative scores (t=13.703, P=0.000; t=14.883, P=0.000; t=16.919, P=0.000). X-ray film and CT showed that the osteotomy and arthrodesis sites healed well at 2-4 months after operation.ConclusionIt’s a proper procedure of anatomic reduction and reconstruction for patients with shortened medial foot column and good articular cartilage morphology after old talar fracture. Opening wedge osteotomy of medial talus is recommended and can obtain satisfactory clinical and radiographic results.
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.
Objective To analyse and summarize the diagnosis, treatment, and cl inical effects of talus lateral process fracture. Methods Between February 2001 and March 2009, 21 male patients with an average age of 33.6 years (range, 18-46years) with talus lateral process fractures were treated. Fracture was caused by fall ing from height in 18 cases, by tumbl ing in 2 cases, and by sprain in 1 case. According to Hawkins classification, there were 4 cases of type I, 15 cases of type II, and 2 cases of type III, all being closed fractures. The disease course was from 2 hours to 26 days. In 17 patients whose fracture fragments were more than 1 cm × 1 cm × 1 cm or whose fracture fragments shifting was more than 1 mm, open reduction and internal fixation with AO hollow titanium nails were performed in 14 patients, open reduction and internal fixation with door-shape self-made nail in 1 patient, and open reduction and internal fixation with absorbable screws in 2 patients. In 4 patients whose fracture fragments were less than 0.6 cm × 0.5 cm × 0.5 cm or whose fracture fragments shifting was less than 1 mm, fragments removel was performed in 2 patients, Kirschner pins in 1 patient, and plaster conservative therapy in 1 patient. In patients with l igaments injury, the l igaments was reconstructed during the operation. Results All the incisions achieved primary heal ing. Twenty-one patients were followed up 9.5 months to 8 years. No ankle pain occurred and the range of joint motion was normal after operation. The X-ray films showed that all cases achieved fracture union. And the healing time was from 8 weeks to 14 weeks (10 weeks on average). According toAmerican Orthopeadic Foot amp; Ankle Society (AOFAS) for foot, the results were excellent in 17 cases, good in 3 cases, and moderate in 1 case; the excellent and good rate was 95.24%. Conclusion The size and displacement of fracture fragment should be considered first in the treatment of lateral process fracture of talus; in patients who are compl icated by lateral malleolus l igament injury, the l igament should be reconstructed to avoid the chronic non-stabil ity of lateral ankle.
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.
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。
Objective To explore the effectiveness and mechanism of pure platelet-rich plasma (P-PRP) on osteochondral injury of talus. Methods Thirty-six patients with osteochondral injury of talus selected between January 2014 and October 2017 according to criteria were randomly divided into control group (group A), leukocyte PRP (L-PRP) group (group B), and P-PRP group (group C), with 12 cases in each group. There was no significant difference in gender, age, disease duration, and Hepple classification among the three groups (P>0.05). Patients in the groups B and C were injected with 2.5 mL L-PRP or P-PRP at the bone graft site, respectively. Patients in the group A were not injected with any drugs. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were used to evaluate the effectiveness before operation and at 3, 6, and 12 months after operation. Study on the therapeutic mechanism of P-PRP: MC3T3-E1 cells were randomly divided into control group (group A), L-PRP group (group B), and P-PRP group (group C). Groups B and C were cultured with culture medium containing 5% L-PRP or P-PRP respectively. Group A was cultured with PBS of the same content. MTT assay was used to detect cell proliferation; ELISA was used to detect the content of matrix metalloprotein 9 (MMP-9) protein in supernatant; alkaline phosphatase (ALP) activity was measured; and real-time fluorescence quantitative PCR (qRT-PCR) was used to detect the expression of osteopontin (OPN), collagen type Ⅰ, and MMP-9 in cells. Western blot was used to detect the expression of MMP-9 in supernatant and phosphoinositide 3-kinase (PI3K), phosphorylated protein kinase B (pAKT), and phosphorylated c-Jun (p-c-Jun) in cells. ResultsAll patients were followed up 13-25 months, with an average of 18 months. No complication such as wound infection and internal fixation failure occurred. MRI showed that the degree of injury was similar between the three groups before operation, and patients in the three groups all recovered at 6 months after operation. Moreover, group C was superior to groups A and B. Compared with preoperation, AOFAS scores and VAS scores in the three groups were all significantly improved at each time point after operation (P<0.05). AOFAS score of group C was significantly higher than that of groups A and B at 3, 6, and 12 months after operation (P<0.05); there was no significant difference in VAS score between the three groups (P>0.05). Study on the therapeutic mechanism of P-PRP: The absorbance (A) value, ALP activity, the relative mRNA expression of OPN and collagen type Ⅰ in group C were significantly higher than those in groups A and B (P<0.05), and those in group B were significantly higher than those in group A (P<0.05). The relative expression of MMP-9 protein and mRNA and the content of MMP-9 protein detected by ELISA in group B were significantly higher than those in groups A and C, while those in group C were significantly lower than those in group A (P<0.05). Western blot detection showed that the relative expression of PI3K, pAKT, and p-c-Jun protein in group B was significantly higher than those in groups A and C (P<0.05), but there was no significant difference between groups A and C (P>0.05). Conclusion P-PRP is superior to L-PRP for osteochondral injury of talus, which may be related to the inhibition of PI3K/AKT/AP-1 signaling pathway in the osteoblast, thereby reducing the secretion of MMP-9.