Objective CT-based metrics of articular fracture severity to assess risk for posttraumatic osteoarthritis.
Objective CT-based metrics of articular fracture severity to assess risk for posttraumatic osteoarthritis.
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DOI：
10.1097/bot.0b013e3181d7a0aa
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发表时间：
2010-12
影响因子：
2.3
通讯作者：
Brown TD
中科院分区：
文献类型：
--
作者：
Thomas TP;Anderson DD;Mosqueda TV;Van Hofwegen CJ;Hillis SL;Marsh JL;Brown TD
关节内骨折使患者易患创伤后骨关节炎（PTOA），并伴有慢性关节疼痛和功能下降。关节骨折治疗的成功取决于骨折的治疗方式以及骨折的类型和严重程度。本研究的目的是将基于CT的关节内骨折严重程度的客观指标与随后的关节退变相关联。假设损伤严重度指标（包括关节破坏、骨折能量和碎片移位/分散的客观指标）是PTOA的有用预测指标。采用新型CT图像分析技术对20例胫骨平台骨折的急性损伤特征进行量化，这些骨折采用关节外固定治疗，在软组织肿胀充分消退后进行最终的骨折复位手术。PTOA严重程度在损伤后2年使用Kelling-Lawrence（KL）放射学分级量表进行评估。通过对这些基于CT的严重程度指标的两年KL结局进行线性回归，开发了预测模型。涉及关节断裂和骨折能量的急性严重度综合评分成功预测了PTOA严重度（R2 = 0.70），而碎片移位/分散和外科医生意见与退行性变的相关性较低（R2 = 0.42和0.47）。综合度量和PTOA严重程度之间的一致性为88%。这项研究的结果表明，在这种具有挑战性的关节骨折中，基于CT的客观急性损伤严重程度指标可以可靠地预测中期PTOA结局。损伤特征的定量生物力学评估为改善骨折治疗和指导PTOA研究提供了新的可能性。
Intra-articular fractures predispose patients to post-traumatic osteoarthritis (PTOA), with associated chronic joint pain and decreased function. The success of articular fracture management is dependent on how the fracture is treated and on fracture type and severity. The purpose of the present study was to correlate objective CT-based indices of intra-articular fracture severity with subsequent joint degeneration. It was hypothesized that an injury severity metric that included objective measures of articular disruption, of fracture energy, and of fragment displacement/dispersal would be a useful predictor of PTOA. Novel CT-based image analysis techniques were utilized to quantify acute injury characteristics in a prospective series of twenty tibial plafond fractures managed by articulated external fixation, with later definitive surgical fracture reduction performed after soft-tissue swelling had sufficiently resolved. PTOA severity was assessed two years post-injury using the Kellgren-Lawrence (KL) radiographic grading scale. A predictive model was developed by linearly regressing these two-year KL outcomes on the CT-based severity metrics. A combined acute severity score involving articular disruption and fracture energy successfully predicted PTOA severity (R2 = 0.70), whereas fragment displacement / dispersal and surgeon opinion correlated much less well with degeneration (R2 = 0.42 and 0.47). The concordance between the combined metric and PTOA severity was 88%. The findings of this study indicate that objective CT-based metrics of acute injury severity can reliably predict intermediate-term PTOA outcomes in this challenging class of articular fractures. Quantitative biomechanical assessment of injury characteristics provides new possibilities to improve fracture management and to guide PTOA research.