Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK.
Injury. 2011 Feb;42(2):156-61. doi: 10.1016/j.injury.2010.06.024.
It has not yet been well established whether femoral shaft fracture malunion and malalignment lead to the development of knee osteoarthritis.This study has assessed a cohort of 62 patients after femoral shaft fracture at a median follow-up of 22 years (range 18–28). The mean age of the patients at time of follow-up was 42 years (33–80). Each patient was clinically examined for signs and symptoms of osteoarthritis, radiographs were taken to assess malalignment and radiographic osteoarthritic changes, and WOMAC and SF-36 (physical and mental) scores were measured.Radiographic changes consistent with osteoarthritis were present in only 5 (8%) ipsilateral and 3 (5%)contralateral knees. Clinical signs and symptoms of osteoarthritis were present in only two (3%)ipsilateral knees. However, 16 patients (26%) exhibited mild pain or stiffness in the ipsilateral knee,while only 4 patients (6%) had such findings in their ipsilateral knee (OR 4; p = 0.004).The median WOMAC score for knee pain was 3 (range 1–15; max 20), knee stiffness was 1 (0–8; max 8) and disability was 6 (0–55; max 68). The median SF-36 score for physical function was 85 (range 0–100; max 100).The mean coronal plane malunion was 58 (range 198 to 88). There was no significant association between any measures of malunion and the WOMAC scores, or the presence of either clinical or radiological osteoarthritis.It is concluded that femoral shaft malunion and malalignment does not cause an excess of knee arthritis at 22-year follow-up. However, a significant number of this cohort has developed mild symptoms of ipsilateral knee pain or stiffness at a median age of 42 years; the long-term significance of this is not known.
股骨干骨折愈合不良和对线不良是否会导致膝关节骨关节炎的发展尚未得到充分证实。本研究评估了一组 62 例股骨干骨折患者，随访中位数为 22 年（范围 18-28 年）。患者随访时的平均年龄为 42 岁（33-80 岁）。每位患者均进行了临床检查，以评估关节炎的体征和症状，拍摄 X 线片以评估对线不良和 X 线摄影骨关节炎变化，并测量 WOMAC 和 SF-36（身体和精神）评分。仅同侧膝关节有 5 例（8%）和对侧膝关节 3 例（5%）出现与骨关节炎一致的放射学变化。仅同侧膝关节有 2 例（3%）出现骨关节炎的临床症状和体征。然而，16 例（26%）患者出现同侧膝关节轻度疼痛或僵硬，而仅 4 例（6%）患者同侧膝关节有类似表现（OR 4；p = 0.004）。膝关节疼痛的 WOMAC 评分中位数为 3（范围 1-15；最大值 20），膝关节僵硬为 1（0-8；最大值 8），残疾为 6（0-55；最大值 68）。身体功能的 SF-36 评分中位数为 85（范围 0-100；最大值 100）。冠状面对线不良的平均为 58（范围 198 至 88）。任何对线不良测量值与 WOMAC 评分或临床或放射学骨关节炎的存在均无显著相关性。结论是，在 22 年随访时，股骨干愈合不良和对线不良不会导致膝关节关节炎过多。然而，该队列中有相当一部分患者在 42 岁的中位年龄时出现了同侧膝关节轻度疼痛或僵硬的症状；其长期意义尚不清楚。
