摘要
足踝扭傷之後有高達70%的機率會併發距骨骨軟骨損傷（osteochondral lesions of the talus），雖然有部分的距骨骨軟骨損傷可以經由保守治療而痊癒，然而針對較為嚴重的且未癒合的病灶，手術治療仍有其角色。針對距骨骨軟骨損傷的手術治療，大至上以其侵犯的直徑做為治療上選擇的依據，原則上，直徑小於10mm的病灶均可以以內視鏡、微創的方式治療：其中，若軟骨完整未破裂，可以以內視鏡定位後由距骨遠端做反向的減壓，避免軟骨的直接傷害，若軟骨已經破裂，則僅能直接從關節側做直接順向的減壓。然而倘若病灶的直徑已超過10mm，目前主流的做法往往必須將關節整個打開，清除病灶後，以自體或者異體的骨軟骨片做移植。
參考文獻
1.Waterman BR, Owens BD, Davey S, et al. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am 2010;92:2279-84.
2. Ramponi L, Yasui Y, Murawski CD, et al. Lesion Size Is a Predictor of Clinical Outcomes After Bone Marrow Stimulation for Osteochondral Lesions of the Talus: A Systematic Review. Am J Sports Med 2017;45:1698-705.
3. Murawski CD, Kennedy JG. Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 2013;95:1045-54.
4. Corominas L, Sanpera I, Jr, Masrouha K, et al. Retrograde Percutaneous Drilling for Osteochondritis Dissecans of the Head of the Talus: Case Report and Review of the Literature. J Foot Ankle Surg 2016;55:328-32.
5. Zengerink M, Struijs PA, Tol JL, et al. Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 2010;18:238-46.
延伸閱讀
- Cheng, Y. M., Chang, J. K., Hsu, C. Y., Huang, S. D., & Lin, S. Y. (1994). 下脛骨骨切術矯治踝關節炎. The Kaohsiung Journal of Medical Sciences, 10(8), 430-437. https://doi.org/10.6452/KJMS.199408.0430
- 洪麗雯、鄭旭棠（2020）。脛骨前撕裂傷。臺灣醫界，63(11)，16-19。https://www.airitilibrary.com/Article/Detail?DocID=17263603-202011-202012110012-202012110012-16-19
- Chen, Y. W., Huang, P. J., Hsu, C. Y., Kuo, C. H., Cheng, Y. M., Lin, S. Y., Chen, L. H., & Chiang, H. C. (1998). 遠端脛骨併踝關節骨折之手術治療一觀血復位及內固定術. The Kaohsiung Journal of Medical Sciences, 14(1), 31-35. https://doi.org/10.6452/KJMS.199801.0031
- 戴有志、黃慧君（2007）。傷科手法治療踝關節扭傷及後遺關節黏連。中醫骨傷科醫學雜誌，(6)，11-15。https://doi.org/10.30098/JCOT.200712.0003
- King, H. C., Yang, P. T. C., Liu, Z. L., & Yang, D. J. (1988). 足踝外側韌帶斷裂實驗報告. Journal of Orthopaedic Surgery Taiwan, 5(3), 208-219. https://www.airitilibrary.com/Article/Detail?DocID=10116923-198809-5-3-208-219-a