骨赘和关节间隙变窄的发展与距骨骨软骨病变中骨软骨碎片的软骨变性有关。

IF 1.5 4区 医学 Q3 ORTHOPEDICS Journal of Orthopaedic Science Pub Date : 2024-09-01 DOI:10.1016/j.jos.2023.08.013
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引用次数: 0

摘要

背景:在距骨骨软骨损伤(OLT)的手术过程中,根据影响手术治疗指征和临床结果的软骨状况,选择保留或切除骨软骨碎片。然而,通过放射学评估很难预测骨软骨碎片上软骨的关节镜和组织学表现。我们关注骨关节炎(OA)在平片上的变化,以预测OLT的软骨状况。本研究旨在评估OA的变化,包括骨赘和关节间隙变窄,是否可以预测OLT软骨的关节镜和组织学表现。方法:本研究包括70例OLT患者。在平片上对骨赘和关节间隙狭窄进行评分。在计算机断层扫描图像上测量病变大小。使用国际软骨修复学会(ICRS)等级对碎片的软骨表面进行关节镜评估。使用Mankin评分对32个脚踝的活检标本进行组织学分析。分析OA评分、病变大小、ICRS分级和Mankin评分之间的关系。结果:随着ICRS分级的增加,OA变化频繁,尤其是在胫腓内侧关节。ICRS 1级患者的OA评分显著低于ICRS 2、3和4级患者。ICRS 3级和4级患者的病变大小明显小于ICRS 1级和2级患者。组织学分析显示,随着ICRS等级的恶化,Mankin评分不断增加。结论:膝关节骨性关节炎的改变,如骨赘形成和关节间隙变窄,与关节镜下OLT关节表面和骨软骨碎片软骨变性有关。关节软骨状况可以通过平片上OA的变化来预测,这有助于OLT患者选择合适的治疗方法。证据等级:Ⅳ级,系列案件。
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Development of osteophytes and joint space narrowing is associated with cartilage degeneration of the osteochondral fragment in the osteochondral lesion of the talus

Background

During surgery for osteochondral lesions of the talus (OLT), preservation or excision of the osteochondral fragment is chosen based on the cartilage condition which influences the indication and clinical outcomes of surgical treatments. However, it is difficult to predict arthroscopic and histological findings of the cartilage on osteochondral fragments by radiographic evaluation. We focused on osteoarthritis (OA) changes on plain radiographs to predict the cartilage condition of the OLT. This study aimed to evaluate whether OA changes, including osteophyte and joint space narrowing, could predict arthroscopic and histological findings of the cartilage in OLT.

Methods

Seventy ankles with OLT were included in this study. Osteophytes and joint space narrowing were scored on plain radiographs. Lesion sizes were measured on computed tomography images. The cartilage surfaces of fragments were arthroscopically assessed using the International Cartilage Repair Society (ICRS) grade. Biopsy specimens from 32 ankles were histologically analyzed using the Mankin score. The relationships between OA scores, lesion size, ICRS grades, and Mankin score were analyzed.

Results

OA changes were frequently observed with increasing ICRS grades, especially in the medial tibiotalar joint. OA scores in patients with ICRS grade 1 were significantly lower than those in ICRS grades 2,3, and 4. The lesion sizes in patients with ICRS grade 3 and 4 were significantly smaller than those in patients with ICRS grade 1 and 2. Histological analysis showed increasing Mankin scores as the ICRS grade worsened. A mild correlation existed between the OA and Mankin scores (rs = 0.494).

Conclusions

OA changes, such as osteophyte formation and joint space narrowing, are associated with arthroscopic findings of the articular surface and cartilage degeneration in osteochondral fragment in OLT. Articular cartilage conditions can be predicted by OA changes on plain radiographs, which is useful for choosing the appropriate treatment for patients with OLT.

Level of evidence

Level Ⅳ, case series.

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来源期刊
Journal of Orthopaedic Science
Journal of Orthopaedic Science 医学-整形外科
CiteScore
3.00
自引率
0.00%
发文量
290
审稿时长
90 days
期刊介绍: The Journal of Orthopaedic Science is the official peer-reviewed journal of the Japanese Orthopaedic Association. The journal publishes the latest researches and topical debates in all fields of clinical and experimental orthopaedics, including musculoskeletal medicine, sports medicine, locomotive syndrome, trauma, paediatrics, oncology and biomaterials, as well as basic researches.
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