重大战斗创伤后的骨关节炎：武装部队创伤康复结果研究
Osteoarthritis after major combat trauma: the Armed Services Trauma Rehabilitation Outcome Study.
作者信息
Behan Fearghal P, Bennett Alexander N, Watson Fraje, Schofield Susie, Miller Eleanor F, O'Sullivan Oliver, Boos Christopher J, Fear Nicola T, Cullinan Paul, Conaghan Philip G, Bull Anthony M J
机构信息
Department of Bioengineering, Imperial College London, London, UK.
Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland.
出版信息
Rheumatol Adv Pract. 2025 Mar 14;9(2):rkaf033. doi: 10.1093/rap/rkaf033. eCollection 2025.
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] 94 [83-100]} and symptoms [median 80 (IQR 60-90) 85 (70-95), < 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) 94 (83-100); symptoms: 80 (IQR 60-90) 85 (70-95), < 0.01]. Knee-injured participants had worse KOOS values [pain: 67 (IQR 55-85), symptoms: 55 (IQR 35-73), < 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) 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.
目的
调查受伤与未受伤的英国现役军人在膝关节骨关节炎的临床和影像学指标上的差异。
方法
本研究是一项对前瞻性队列研究进行的伤后8年的横断面分析。从武装部队创伤康复结局研究中的565名未受伤和579名匹配（在性别、年龄、军衔、军团和部署角色方面）的主要战斗受伤参与者中获取膝关节损伤和骨关节炎结局评分（KOOS）、影像学Kellgren和Lawrence（KL）评分以及国际骨关节炎研究学会评分（关节间隙变窄、硬化、骨赘）；35人有膝关节损伤，142人截肢但无膝关节损伤。使用Kruskal-Wallis检验比较KOOS和影像学指标的组间差异。对损伤对影像学特征的影响进行多因素逻辑回归分析。
结果
受伤时的平均年龄为25.7岁（标准差5.2）。受伤参与者在疼痛方面的KOOS值更差{中位数89[四分位间距（IQR）72 - 100] 对94[83 - 100]}，症状方面也更差[中位数80（IQR 60 - 90）对85（70 - 95），P < 0.001]，并且影像学变量评分高于未受伤参与者。受伤但未截肢/无膝关节损伤的参与者的KOOS值比未受伤参与者更差[疼痛：92（IQR 75 - 100）对94（83 - 100）；症状：80（IQR 60 - 90）对85（70 - 95），P < 0.01]。膝关节受伤的参与者的KOOS值[疼痛：67（IQR 55 - 85），症状：55（IQR 35 - 73），P < 0.001]比所有亚组都差，且影像学指标比受伤但未截肢的参与者更差。截肢者的KL评分（≥1）和硬化比受伤但未截肢的参与者更差。截肢者患膝关节骨关节炎（KOA；KL≥1）的几率比未受伤参与者高4.04倍（95%置信区间2.45，6.65），膝关节受伤的参与者患KOA的几率比未受伤参与者高4.06倍（95%置信区间1.89 - 8.74）。受伤参与者（无膝关节损伤/截肢）患KOA的几率比未受伤参与者高1.74倍（95%置信区间1.27，2.69）。
结论
重大战斗创伤（除膝关节损伤或截肢外）对KOA的发展有重大影响。
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