系统回顾：成人不稳定性踝关节骨折手术治疗至少 3 年随访的放射学结果

Q2 Health Professions

Foot Pub Date : 2024-11-15 DOI:10.1016/j.foot.2024.102143

Anthony Uzoma Okoye , Linzy Houchen-Wolloff , Jitendra Mangwani , Nimra Akram , Despina Laparidou , David Nelson , Sam Cooke

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引用次数: 0

摘要

背景放射学检查对许多肌肉骨骼疾病的诊断和治疗至关重要，包括检测手术治疗的不稳定踝关节骨折患者最早出现的退行性病变（骨关节炎 (OA)）。尽管踝关节 OA 的发病率很高，但利用影像学手段进行早期检测的研究仍然很少。主要发现通过 5 次数据库检索发现了 767 项研究，筛选了 492 篇摘要标题，并选择了 53 篇论文进行全面审查。其中只有 8 篇文章符合纳入标准。共有 905 名年龄在 18 岁及以上的参与者（平均 46.4 岁，53.8% 为男性）出现了不同的踝关节骨折分类。其中韦伯分类 423 例，OTA/AO 225 例，劳格-汉森分类 204 例，内侧踝关节 53 例。在这些病例中，34.7%的病例在不同的成像模式下发现了 OA（至少 3 年随访）。我们的研究结果表明，轻度至中度 OA 很常见，功能预后主要良好至极佳。结论每 3 名接受开放复位内固定术治疗的不稳定踝关节骨折患者中，就有 1 人在手术 3-7 年后出现放射学 OA 征象，但功能预后良好。我们无法将观察到的放射学 OA 等级与临床 OA 联系起来。尽管X光在早期发现OA方面的灵敏度较低，但我们发现缺乏利用核磁共振成像和/或CT成像的研究，这表明需要进一步研究。临床医生应考虑使用MRI/CT成像来早期检测不稳定踝关节骨折患者的OA，以提高早期检测率，从而改善患者报告的结果。

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A systematic review: Radiological findings at a minimum of 3 years follow-up for unstable ankle fractures in adults treated with surgery

Background

Radiological investigations are critical to diagnosis and treatment of many musculoskeletal diseases including detecting earliest degenerative changes (osteoarthritis (OA)) seen in patients with unstable ankle fractures managed surgically. Despite the high incidence of ankle OA, research into early detection using imaging remains sparse.

Objectives

To identify the incidence of OA on postoperative imaging in adults with unstable ankle fractures after a minimum follow-up of 3 years with a correlation to patient reported outcomes.

Key findings

767 studies were identified on 5 database searches, and 492 abstract titles were screened, while 53 papers were selected for full review. From these only 8 articles met the inclusion criteria. A total of 905 participants aged 18 years and above (mean 46.4 years, 53.8 % male) presented with a range of ankle fracture classifications. This includes 423 cases of Weber classification, 225 cases of OTA/AO, 204 Lauge-Hansen classification, and 53 medial malleoli. From these, 34.7 % cases of OA were identified (minimum of the 3-year follow-up) on different imaging modalities. Our results revealed that mild to moderate OA is common, and functional outcome is mainly good to excellent.

Conclusion

1 in 3 patients treated for unstable ankle fracture with open reduction internal fixation will show signs of radiological OA after 3–7 years of index procedure, though with good functional outcome. We were unable to correlate the grade of radiological OA observed with clinical OA. Despite the low sensitivity of X-ray in early detection of OA, we identified a lack of studies in utilising MRI and/or CT imaging, indicating the need for further research. Clinicians should consider using MRI/CT imaging for early detection of OA for patients following unstable ankle fractures, to improve early detection and consequently improve patient reported outcomes.

Level of Clinical Evidence

Systematic review = 1.

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来源期刊

Foot Health Professions-Podiatry

CiteScore

2.00

自引率

0.00%

发文量

期刊介绍： The Foot is an international peer-reviewed journal covering all aspects of scientific approaches and medical and surgical treatment of the foot. The Foot aims to provide a multidisciplinary platform for all specialties involved in treating disorders of the foot. At present it is the only journal which provides this inter-disciplinary opportunity. Primary research papers cover a wide range of disorders of the foot and their treatment, including diabetes, vascular disease, neurological, dermatological and infectious conditions, sports injuries, biomechanics, bioengineering, orthoses and prostheses.