Is elevated contact stress predictive of post-traumatic osteoarthritis for imprecisely reduced tibial plafond fractures?
Is elevated contact stress predictive of post-traumatic osteoarthritis for imprecisely reduced tibial plafond fractures?
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DOI：
10.1002/jor.21202
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发表时间：
2011-01
影响因子：
2.8
通讯作者：
Brown, Thomas D.
中科院分区：
文献类型：
--
作者：
Anderson, Donald D.;Van Hofwegen, Christopher;Marsh, J. Lawrence;Brown, Thomas D.
尽管人们普遍认为，关节内骨折的残余不协调使关节承受接触应力，易患创伤后骨关节炎（PTOA），但缺乏客观证据。本研究检验了一个假设，即接触应力暴露升高的指标可以预测PTOA的发生。对10例胫骨平台骨折患者的踝关节进行了初步治疗，使用跨越固定器，随后对关节面进行螺钉固定。根据这些患者踝关节中有限元计算的术后接触应力分布的早期报告，根据至少2年随访X线片评估Kelling-Lawrence（KL）评分，以表征PTOA的存在/严重程度。在该时间点，7例患者发生PTOA（KL ≥ 2）。计算了五种不同的接触应力暴露指标，所有指标均与KL评分表现出极好的一致性，范围为88%至95%。当包括应力暴露时间时，一个指标能够以100%的可靠性预测PTOA发展（KL ≥ 2），所有指标的预测可靠性均大于94%。这些发现，虽然在一个小的人群中，支持接触应力暴露阈值的存在，超过该阈值，不协调减少的胫骨平台骨折很可能发展为PTOA。
Despite the widely held belief that residual incongruities from intra-articular fractures subject the joint to contact stresses that predispose to post-traumatic osteoarthritis (PTOA), objective evidence has been lacking. This study tested the hypothesis that a metric of elevated contact stress exposure would predict the onset of PTOA. The ankles of ten tibial plafond fracture patients were treated initially using a spanning fixator, with subsequent screw fixation of the articular surface. Following up on an earlier report of finite element computed post-operative contact stress distributions in these patients’ ankles, Kellgren-Lawrence (KL) scores were assessed from minimum two-year follow-up radiographs to characterize the presence/severity of PTOA. At that time point, seven patients had developed PTOA (KL ≥ 2). Five different metrics of contact stress exposure were calculated, all of which exhibited excellent concordance with KL scores, ranging from 88% to 95%. When time of stress exposure was included, one metric was able to predict PTOA development (KL ≥ 2) with 100% reliability, and all metrics exhibited greater than 94% prediction reliability. These findings, albeit in a small population, support the existence of a contact stress exposure threshold above which incongruously reduced tibial plafond fractures are highly likely to develop PTOA.
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影响因子：
2.8
作者：
Anderson, Donald D.;Mosqueda, Teresa;ThomaS, Thaddeus;Hermanson, Evan L.;Brown, Thomas D.;Marsh, J. Lawrence
通讯作者：
Marsh, J. Lawrence
影响因子：
2.3
作者：
Thomas TP;Anderson DD;Mosqueda TV;Van Hofwegen CJ;Hillis SL;Marsh JL;Brown TD
通讯作者：
Brown TD
影响因子：
3.5
作者：
Anderson, Donald D.;Goldsworthy, Jane K.;Brown, Thomas D.
通讯作者：
Brown, Thomas D.
DOI：
10.1115/1.2720918
发表时间：
2007-06-01
影响因子：
1.7
作者：
Ateshian, Gerard A.;Ellis, Benjamin J.;Weiss, Jeffrey A.
通讯作者：
Weiss, Jeffrey A.
影响因子：
2.4
作者：
MAXIAN, TA;BROWN, TD;WEINSTEIN, SL
通讯作者：
WEINSTEIN, SL