Osteochondral talar lesions and ankle biomechanics
Osteochondral talar lesions and ankle biomechanics
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发表时间：
2017
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通讯作者：
M. Zengerink
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作者：
M. Zengerink
距骨软骨缺损（OCD）涉及关节软骨和软骨下骨。患者通常是年轻，活跃的人，在负重时踝关节疼痛。创伤，如踝关节扭伤，是最常见的病因。大多数距骨强迫症都是通过关节镜治疗的，在此过程中，骨髓刺激技术旨在填补缺损并覆盖软骨下骨。本文旨在通过研究踝关节生物力学，评估现有技术和开发新技术来确定距骨强迫症最有效的手术治疗方法，以及如何改进治疗方法。为了达到这一目的，我们研究了治疗结果、踝关节镜下的并发症、踝关节的正常运动模式和关节镜下距骨穹窿的通路。此外，还开发了一种新的talar强迫症的二级治疗方法。本文共分11章进行了研究。最重要的发现是：关节镜下骨髓刺激治疗是原发性骨软骨病变的首选治疗方法。在踝关节镜检查中使用背屈法的并发症数量明显低于文献中提到的。踝关节运动时有限螺旋轴的平均取向导致了内旋反转和外旋外翻的耦合。这种耦合的缺失可能表明有病变。平均而言，距骨后中央穹窿的一部分很难通过关节镜到达。一种新的局灶金属种植体是距骨强迫症的一种有前途的二次治疗选择。
An osteochondral defect (OCD) of the talus involves the articular cartilage and subchondral bone. Patients are often young, active people with deep ankle pain during weightbearing. Trauma, like an ankle sprain, is the most frequent etiologic factor. Most talar OCDs are treated by means of arthroscopy, during which a bone marrow stimulation technique aims at filling of the defect and covering the subchondral bone. This thesis aims at defining the most effective surgical treatment for talar OCDs, and how to improve treatment by investigating ankle biomechanics, evaluating existing techniques and developing new techniques. To accomplish this aim, treatment results, complications in ankle arthroscopy, normal motion patterns of the ankle and arthroscopic access to the talar dome were studied. Furthermore, a new secondary treatment method for talar OCDs was developed. The aims were investigated in a total of 11 chapters. The most important findings were: Arthroscopic treatment by means of bone marrow stimulation is the treatment of choice for primary osteochondral lesions. Use of the dorsiflexion method in ankle arthroscopy is related to a significantly lower number of complications than mentioned in literature. The mean orientation of the finite helical axes during ankle motion leads to coupling of inversion to internal rotation and eversion to external rotation. Absence of this coupling may indicate pathology. On average, a part of the posterocentral talar dome is hard to reach by arthroscopy. A new focal metal implant is a promising secondary treatment option for talar OCDs.