Donald D. Anderson, William R. Ledoux, Amy L. Lenz, Jason Wilken, Mark E. Easley, Cesar de Cesar Netto
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引用次数: 0
摘要
踝关节很少发生原发性骨关节炎(OA),尤其是与髋关节和膝关节相比。相反,踝关节 OA 通常在创伤后才会发生。然而,终末期踝关节 OA 的后果可能会使人极度衰弱,其损伤程度可与终末期肾病或充血性心力衰竭相媲美。令人不安的是,有证据表明,即使是在低能量旋转性踝关节骨折和与反复踝关节扭伤相关的慢性不稳定性之后,踝关节 OA 的发病率也会比人们通常认为的要高,尽管其发病率要低于严重创伤之后的发病率。人们对创伤后踝关节 OA 的发病机制知之甚少,但机械因素与之有关。更好地了解创伤后踝关节 OA 的发病率和机械病因,可以更好地预防和缓解创伤后踝关节 OA。新的手术和保守干预措施,包括改进的韧带修复策略和定制碳纤维支架,有望促进治疗,防止踝关节残余不稳和踝关节 OA 的发展。需要进行研究以填补与病因有关的关键知识空白,从而使干预措施能够针对关键因素。负重 CT 和双平面透视等新技术为更好地了解创伤、踝关节排列、残余踝关节不稳定性、OA 发展和足部/踝关节功能之间的关系提供了新的机会。本文首先回顾了创伤后踝关节 OA 的流行病学,提出了新的治疗方案可能成功预防踝关节 OA 的证据,然后重点介绍了在了解踝关节 OA 起源方面的最新技术进展,以确定未来的研究方向。
Ankle osteoarthritis: Toward new understanding and opportunities for prevention and intervention
The ankle infrequently develops primary osteoarthritis (OA), especially when compared to the hip and the knee. Ankle OA instead generally develops only after trauma. The consequences of end-stage ankle OA can nonetheless be extremely debilitating, with impairment comparable to that of end-stage kidney disease or congestive heart failure. Disconcertingly, evidence suggests that ankle OA can develop more often than is generally appreciated after even low-energy rotational ankle fractures and chronic instability associated with recurrent ankle sprains, albeit at a slower rate than after more severe trauma. The mechanisms whereby ankle OA develops after trauma are poorly understood, but mechanical factors are implicated. A better understanding of the prevalence and mechanical etiology of post-traumatic ankle OA can lead to better prevention and mitigation. New surgical and conservative interventions, including improved ligamentous repair strategies and custom carbon fiber bracing, hold promise for advancing treatment that may prevent residual ankle instability and the development of ankle OA. Studies are needed to fill in key knowledge gaps here related to etiology so that the interventions can target key factors. New technologies, including weight bearing CT and biplane fluoroscopy, offer fresh opportunities to better understand the relationships between trauma, ankle alignment, residual ankle instability, OA development, and foot/ankle function. This paper begins by reviewing the epidemiology of post-traumatic ankle OA, presents evidence suggesting that new treatment options might be successful at preventing ankle OA, and then highlights recent technical advances in understanding of the origins of ankle OA to identify directions for future research.
期刊介绍:
The Journal of Orthopaedic Research is the forum for the rapid publication of high quality reports of new information on the full spectrum of orthopaedic research, including life sciences, engineering, translational, and clinical studies.