第一跖骨头孤立性骨软骨缺损:手术治疗方案回顾及病例报告

James Craven FRCPodS, MSc, Andy Naismith FRCPodS, BSc
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引用次数: 0

摘要

骨软骨缺损(OCD)是一种影响软骨下骨和上覆软骨的局灶性病理。骨软骨缺损(OCD)在足部和踝关节的存在是公认的。尽管如此,他们往往被认为是一个阴险的发现,容易误诊,这可能导致显着的衰弱受影响的个人。这些病变形成的机制仍有争议。此外,在没有任何其他病理的情况下,影响第一跖趾关节的孤立性骨软骨缺损的发生率尚不清楚。有一系列的外科治疗方式描述治疗骨软骨缺损。策略通常包括软骨再生或关节面置换:然而,对于应用于第一跖趾关节的最佳手术处理尚无一致的指导方针。下面的概念综述旨在探讨与骨软骨缺损的外科治疗有关的文献,包括采用软骨下钻孔技术的创新方法的案例研究。骨软骨缺损的治疗方法有多种。手术结果通常来源于与膝关节和后足有关的文献,很少或没有关于前足的研究。纳入的病例研究表明,采用新型超前骨软骨钻孔技术治疗第一跖骨时,患者满意度(PSQ-10)评分为阳性,足部功能(MOXFQ)得到改善,疼痛减轻。进一步研究当代软骨再生和替代策略在该部位的应用是必要的。
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Isolated Osteochondral defect of the first metatarsal head: A review of surgical treatment options & case report
Osteochondral defects (OCD) are a focal pathology affecting the sub-chondral bone and overlying cartilage. The presence of Osteochondral defects (OCD) within the foot and ankle are well established. Despite this, they are often regarded as an insidious finding, prone to misdiagnosis which can result in significant debilitation to the affected individual. The mechanisms underlying the formation of these lesions remain disputed. Moreover, the incidence of isolated Osteochondral defects affecting the first Metatarsophalangeal joint in the absence of any additional pathology is unknown.
There are a range of surgical treatment modalities described to treat Osteochondral defects. Strategies typically involve cartilage regeneration or replacement of the articular surface: however there are no consensus guidelines regarding the optimum surgical management when applied to the first Metatarsophalangeal joint. The following concepts review aims to explore the literature pertaining to the surgical management of Osteochondral defects including an innovative approach case study employing subchondral drilling technique.
Osteochondral defects are managed with a variety of surgical procedures. Surgical outcomes are often derived from literature relating to the knee and hindfoot with little or no study on the forefoot. The included case study demonstrates positive patient satisfaction (PSQ-10) score, improved foot function (MOXFQ) and pain reduction with a novel antegraded Osteochondral drilling technique when applied to the first metatarsal. Further study into the application of contemporary cartilage regeneration and replacement strategies in this location is warranted.
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来源期刊
Foot & ankle surgery (New York, N.Y.)
Foot & ankle surgery (New York, N.Y.) Orthopedics, Sports Medicine and Rehabilitation, Podiatry
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