ABSTRACT
Objective: To investigate the short-term clinical efficacy of robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus (OCLT). Methods: This study was divided into two groups: experimental group: robot-assisted retrograde drilling group; control group: arthroscopic microfracture group. A total of 6 OCLT patients who were treated with robot navigation-assisted retrograde drilling and 10 OCLT patients who were treated with arthroscopic microfracture between October 2020 and October 2021 were retrospectively analyzed. There were 11 males and five females, with a mean age of 36 years. The patients were followed up for 6-12 months to compare the changes in the OCLT lesion area by magnetic resonance imaging (MRI), visual analogue scale/score (VAS) and American Orthopedic Foot and Ankle Society score (AOFAS) before and after surgery. Results: All 16 patients were followed up for an average of 8 months, and no complications such as joint infection, nerve injury, or active bleeding occurred during the follow-up period. Only one patient suffered discomfort involving transient postoperative pain in the operative area, but did not experience long-term numbness or chronic pain. Postoperative MRI revealed that none of the patients had severe signs of osteonecrosis, osteolysis or cystic changes of the talus, with lesion areas smaller than those before surgery. The difference was statistically significant (P < 0.01). The patients in the experimental group showed a more significant improvement in the last 3 months than in the first 3 months of the follow-up period. At the last follow-up, the VAS score was 3 points in the experimental group and 2.2 points in the control group, and the AOFAS score was 88.6 points in the experimental group and 88 points in the control group, all of which were significantly higher than those before operation, and the differences were statistically significant, but there was no statistically significant difference between the groups. Conclusion: Both robot navigation-assisted retrograde drilling and arthroscopic microfracture for bone marrow stimulation (BMS) to treat OCLT in all patients obtained satisfactory effects in the short term. In addition, the follow-up revealed that with excellent efficacy and few complications, robot navigation-assisted retrograde drilling was safe and minimally invasive, and greatly reduced operative time. Consequently, robot navigation-assisted retrograde drilling for BMS was a safe and effective procedure for the treatment of OCLT.
ABSTRACT
OBJECTIVE: To compare the clinical effects of external fixator versus DVR system for the treatment of AO type C distal radius fractures. METHODS: The clinical data of 52 patients with type C distal radial fractures treated with external fixator or DVR system respectively from January 2009 to December 2013 were analyzed retrospectively. In DVR system group, 31 patients were treated by open reduction and internal fixation with DVR system, involved 11 males and 20 females, with an average age of(47.3±10.9) years ranging from 24 to 65 years;according to AO/ASIF classification, 12 cases were type C1, 15 cases were type C2, 4 cases were type C3. In external fixator group, 21 patients were treated by closed reduction and cross wrist external fixation, involved 8 males and 13 females, with an average age of (48.1±12.1) years ranging from 26 to 69 years; according to AO/ASIF classification, 7 cases were type C1, 11 cases were type C2, 3 cases were type C3. The postoperative images, wrist joint functions and Gartland-Wetley scores were evaluated and compared. RESULTS: Thirty-one patients in DVR system group were followed up for 20.4 months(ranged from 13 to 36 months) and in external fixator group 21 patients were followed up for 17.1 months (ranged from 11 to 33 months) respectively. X-rays showed all fractures healed. The palm dip and radial inclination in the DVR system group were significantly better than in the external fixator group(P<0.05), while there was no significant difference in radial height and Gartland-Werley score(P>0.05). There was 1 case of wrist stiffness in the DVR system group; 2 cases of pin tract infection, 1 case of fixator loosening and 2 cases of wrist stiffness in the external fixator group. CONCLUSIONS: Clinical outcomes of DVR system fixation for type C distal radial fractures are better than that of external fixator fixation. However, DVR system fixation costs more and requires a secondary surgery to remove the internal fixation. The choices of surgical method depend on the clinical conditions of the patients.
