Vascular Compromising Effect of Drilling for Osteochondral Lesions of the Talus: A 3-Dimensional Micro-Computed Tomography Study
Vascular Compromising Effect of Drilling for Osteochondral Lesions of the Talus: A 3-Dimensional Micro-Computed Tomography Study
复制标题
钻孔治疗距骨骨软骨损伤的血管损害效应：三维微型计算机断层扫描研究
DOI：
10.1016/j.arthro.2019.05.021
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发表时间：
2019
影响因子：
4.7
通讯作者：
Zhang Weiguang
中科院分区：
文献类型：
--
作者：
Wang Dingyu;Shen Zhongcheng;Fang Xuan;Jiao Chen;Guo Qinwei;Hu Yuelin;Yu Jiakuo;Jiang Dong;Zhang Weiguang
目的基于微计算机断层扫描（microCT）建立的三维血管微结构模型，探讨距骨骨软骨病变的最佳钻孔深度和方向。方法对12例患者灌注造影剂后进行显微ct扫描。将距骨穹窿划分为9个区，分别在0 ~ 5mm、5 ~ 10mm和10 ~ 15mm的软骨下深度测量血管密度。模拟了逆行钻孔的前外侧（AL）和后外侧（PL）入路，并评估了血管损害效果。结果0 ~ 5mm深度血管密度低于5 ~ 10mm （P= 0.001）和10 ~ 15mm (P= 0.007)，但5 ~ 10mm和10 ~ 15mm深度血管密度差异无统计学意义（P= 0.9999）。距骨内侧穹窿5 ~ 10mm深度的血管密度与邻近区域相似（P= 0.05）。距骨外侧穹窿周围5 ~ 10mm深度的血管密度在前部和内侧较高。前外侧入路干扰了跗骨管-跗骨窦的主要骨内血管，导致距骨颈部和体的广泛血管受损，而后外侧入路仅干扰了隧道附近的血管。结论软骨下0 ~ 5mm至5 ~ 10mm血管密度变化较大。距骨内侧穹窿周围5 ~ 10mm深度的血管密度相似，而距骨外侧穹窿的前部和内侧血管化较好。后外侧入路比前外侧入路造成的血管损伤少。顺行钻孔深度优于软骨下5 ~ 10mm深度。距骨内侧穹窿的骨软骨病变没有优选的钻孔方向，而在外侧穹窿的前方或内侧钻孔是优选的。后外侧入路可能是逆行钻孔更安全的选择。
PurposeTo explore an optimal drilling depth and direction for osteochondral lesions of the talus based on a 3-dimensional vascular microarchitecture model constructed with micro–computed tomography (microCT).MethodsTwelve tali were perfused with the contrast agent and then scanned with microCT. The talar dome was divided into 9 zones, and the vessel densities were measured at the subchondral depths of 0 to 5 mm, 5 to 10 mm and 10 to 15 mm in each zone. The anterolateral (AL) and posterolateral (PL) approaches of retrograde drilling were simulated and the vascular compromising effect was evaluated.ResultsThe vessel density of the 0- to 5-mm depth was lower than that of the 5- to 10-mm (P= .001) and 10- to 15-mm (P= .007) depths, but no significant difference was found between the 5- to 10-mm and 10- to 15-mm depths (P> .9999). The vessel density in the 5- to 10-mm depth of medial talar dome was similar to that of the adjacent zones (P= .05). Vessel density in the 5- to 10-mm depth around the lateral talar dome was higher in the anterior and medial side. The anterolateral approach disturbed the main intraosseous vessels from the tarsal canal–tarsal sinus, causing extensive vascular compromise in the talus neck and body, whereas the posterolateral approach disturbed only the vessels near the tunnel.ConclusionsThe vessel density changed greatly from the subchondral 0- to 5-mm to the 5- to 10-mm depth. The vessel densities of the 5- to 10-mm depth around the medial talar dome were similar, whereas the anterior and medial side of the lateral talar dome was better vascularized. The posterolateral approach caused less vascular damage than the anterolateral approach.Clinical RelevanceThe anterograde drilling depth was preferable to the subchondral 5- to 10-mm depth. There was no preferred drilling direction for the osteochondral lesion in the medial talar dome, whereas it is preferable to drill anteriorly or medially in the lateral dome. The posterolateral approach might be a safer alternative for retrograde drilling.