Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
Foot Ankle Int. 2022 Nov;43(11):1465-1473. doi: 10.1177/10711007221119111. Epub 2022 Sep 19.
Several factors are thought to contribute to posttraumatic osteoarthritis (PTOA) development, including the posttraumatic inflammatory response. The purpose of this study was to compare 2 injuries at the same joint with a different severity and prognosis. This study compared the intra-articular inflammatory response after rotational ankle fracture (lower energy and less PTOA) with tibial plafond fracture (higher energy and more PTOA).
This prospective comparative study was conducted at a level 1 trauma center between 2014-2019. Patients between 18 and 60 years of age with acute ankle or tibial plafond fractures were enrolled. Patients with preexisting ankle OA, autoimmune disease, additional injury, or open fractures were excluded. Synovial fluid aspirations were obtained within 24 hours of injury. The concentrations of interleukin (IL)-1β, IL-1 receptor antagonist (IL-1RA), IL-6, IL-8, and IL-10 and matrix metalloproteinase (MMP)-1, MMP-3, and MMP-13 were quantified.
Aspiration were obtained from 29 plafond fractures and 36 ankle fractures. Mean age was 43 years, and patients were predominately female (64%). Age, gender, and comorbidities did not vary between cohorts. Of the plafond fractures, 13 were 43-B and 16 were 43-C injuries. Ankle fractures were predominately 44-B injuries, and 15 ankle fracture had articular impaction. IL-10, IL-1β, IL-6, IL-8, MMP-1, MMP-3, and MMP-13 were all significantly higher in acute plafond fractures as compared to acute ankle fractures.
This study compared articular inflammatory marker profiles after fractures of different severities. Several cytokines were elevated in plafond fractures as compared to ankle fractures, suggesting a greater inflammatory response with plafond fractures. Given the difference in prognosis for and higher rate of PTOA after plafond fractures, these data strengthen the case that postinjury inflammatory response plays a role in PTOA development. Given that the postinjury inflammatory response is one of the few modifiable variables of these injuries, future research in this area remains important.
Level II, prospective.
多种因素被认为会导致创伤后骨关节炎（PTOA）的发生，包括创伤后的炎症反应。本研究的目的是比较同一关节的两种不同严重程度和预后的损伤。本研究比较了旋转踝关节骨折（能量较低，PTOA 发生率较低）和胫骨平台骨折（能量较高，PTOA 发生率较高）后的关节内炎症反应。
这是一项于 2014 年至 2019 年在一家 1 级创伤中心进行的前瞻性比较研究。纳入年龄在 18 至 60 岁之间的急性踝关节或胫骨平台骨折患者。排除有踝关节 OA、自身免疫性疾病、其他损伤或开放性骨折的患者。在受伤后 24 小时内采集滑液抽吸物。定量检测白细胞介素（IL）-1β、IL-1 受体拮抗剂（IL-1RA）、IL-6、IL-8 和 IL-10 以及基质金属蛋白酶（MMP）-1、MMP-3 和 MMP-13 的浓度。
从 29 例胫骨平台骨折和 36 例踝关节骨折中抽取了滑液。平均年龄为 43 岁，患者主要为女性（64%）。两组患者的年龄、性别和合并症无差异。胫骨平台骨折中，43-B 型骨折 13 例，43-C 型骨折 16 例。踝关节骨折主要为 44-B 型骨折，15 例踝关节骨折有关节面挤压。与急性踝关节骨折相比，急性胫骨平台骨折的 IL-10、IL-1β、IL-6、IL-8、MMP-1、MMP-3 和 MMP-13 均显著升高。
本研究比较了不同严重程度骨折后的关节炎症标志物谱。与踝关节骨折相比，胫骨平台骨折中的几种细胞因子升高，提示胫骨平台骨折后的炎症反应更强烈。鉴于胫骨平台骨折的预后和 PTOA 发生率较高，这些数据进一步证实了受伤后炎症反应在 PTOA 发生中的作用。鉴于受伤后的炎症反应是这些损伤中少数可改变的变量之一，该领域的未来研究仍然很重要。
二级，前瞻性。
