重大战斗创伤后骨关节炎：武装部队创伤康复结果研究。

IF 2.1 Q3 RHEUMATOLOGY

Rheumatology Advances in Practice Pub Date : 2025-03-14 eCollection Date: 2025-01-01 DOI:10.1093/rap/rkaf033

Fearghal P Behan, Alexander N Bennett, Fraje Watson, Susie Schofield, Eleanor F Miller, Oliver O'Sullivan, Christopher J Boos, Nicola T Fear, Paul Cullinan, Philip G Conaghan, Anthony M J Bull

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引用次数: 0

摘要

目的：探讨受伤和未受伤英国军人膝关节骨性关节炎临床和影像学指标的差异。方法：本研究是一项前瞻性队列研究，在损伤后8年进行横断面分析。膝关节损伤和骨关节炎结局评分（oos）、放射学Kellgren和Lawrence评分（KL）和国际骨关节炎研究协会评分（关节间隙狭窄、硬化、骨肉瘤）来自武装部队创伤康复结果研究的565名未受伤和579名匹配（按性别、年龄、军衔、团和部署角色）的主要战斗受伤参与者；35例膝部受伤，142例膝部截肢，无膝部损伤。Kruskal-Wallis试验用于比较各组间kos和x线测量值。对损伤对影像学特征的影响进行多元logistic回归分析。结果：损伤时平均年龄25.7岁（标准差5.2）。受伤参与者表现出更差的疼痛oos值{中位数89[四分位数范围（IQR） 72-100] vs 94[83-100]}和症状[中位数80 (IQR 60-90) vs 85 (70-95), P vs 94 (83-100)；症状：80 (IQR 60-90) vs 85 (70-95)， P P与未受伤的参与者和膝盖受伤的参与者相比，膝关节骨关节炎（KOA）的几率增加4.06倍（95% CI 1.89-8.74）；KL≥1)。受伤参与者（无膝关节损伤/截肢）的KOA发生率比未受伤参与者增加1.74倍（95% CI 1.27, 2.69）。结论：重大战斗创伤（除膝关节损伤或截肢外）对KOA的发展有重要影响。

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Osteoarthritis after major combat trauma: the Armed Services Trauma Rehabilitation Outcome Study.

Objective: To investigate the differences in clinical and radiographic knee OA markers between injured and uninjured UK service personnel.

Methods: This study was a cross-sectional analysis, 8 years post-injury, of a prospective cohort study. The Knee Injury and Osteoarthritis Outcome Scores (KOOS), radiographic Kellgren and Lawrence (KL) scores and Osteoarthritis Research Society International scores (joint space narrowing, sclerosis, osteophytes) were obtained from 565 uninjured and 579 matched (on sex, age, rank, regiment and role on deployment) major combat injured participants from the Armed Services Trauma Rehabilitation Outcome study; 35 had a knee injury and 142 had an amputation without knee injury. Kruskal-Wallis tests were used to compare between groups for KOOS and radiographic measures. A multiple logistic regression was performed on the effects of injury on radiographic features.

Results: The mean age at injury was 25.7 years (s.d. 5.2). Injured participants demonstrated worse KOOS values for pain {median 89 [interquartile range (IQR) 72-100] vs 94 [83-100]} and symptoms [median 80 (IQR 60-90) vs 85 (70-95), P < 0.001] and higher scores for radiographic variables than uninjured participants. Injured non-amputated/non-knee-injured participants had worse KOOS values than uninjured participants [pain: 92 (IQR 75-100) vs 94 (83-100); symptoms: 80 (IQR 60-90) vs 85 (70-95), P < 0.01]. Knee-injured participants had worse KOOS values [pain: 67 (IQR 55-85), symptoms: 55 (IQR 35-73), P < 0.001] than all subgroups and worse radiographic measures than injured non-amputated participants. KL score (≥1) and sclerosis were worse for amputees than injured non-amputated participants. Amputees had 4.04-fold increased odds (95% CI 2.45, 6.65) vs uninjured participants and knee-injured participants had 4.06-fold increased odds (95% CI 1.89-8.74) than uninjured participants of knee osteoarthritis (KOA; KL ≥1). Injured participants (without knee injury/amputation) had 1.74-fold (95% CI 1.27, 2.69) increased odds of KOA than uninjured participants.

Conclusion: Major combat trauma (in addition to knee injury or amputation) has a substantial effect on the development of KOA.

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