高尿酸血症预示着距骨骨软骨损伤关节镜下微骨折术后的不良临床结局。
Hyperuricemia predicts adverse clinical outcomes after arthroscopic microfracture of osteochondral lesions of the talus.
作者信息
Li Yuanqiang, Wang Zhenyu, Zheng Guo, Ma Lin, Li Xin Xin, Liang Yan, Xie Xinyu, Zhang Xiaolin, Yuan Chengsong, Chen Wan
机构信息
Sports Medicine Center, First Affiliated Hospital of the Army Medical University, No. 30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China.
Orthopedics, People's Hospital of Wulong District, No. 3 Jianshe East Road, Fengshan Street, Wulong District, Chongqing, 408500, China.
出版信息
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2025 Jun 25;41:6-13. doi: 10.1016/j.asmart.2025.04.004. eCollection 2025 Jul.
PURPOSE
To investigate the correlation of serum uric acid levels with the clinical outcomes of arthroscopic microfracture in osteochondral lesions of the talus (OLTs) and determine the cut-off point for predicting outcomes.
METHODS
A total of 134 OLTs patients who underwent arthroscopic microfracture from November 2008 to June 2019 were included: 42 in the hyperuricemia group (≥ 420 μmol/L) and 92 in the non-hyperuricemia group (< 420 μmol/L). Clinical characteristics recorded and analyzed included Visual Analog Scale (VAS score), American Orthopaedic Foot & Ankle Society score (AOFAS), and 36-Item Short Form Health Survey score (SF-36). Logistic regression identified risk factors, and Receiver Operating Characteristic Curves (ROC) determined the serum uric acid cut-off value for predicting outcomes, which was prospectively validated.
RESULTS
Significant improvement were observed in postoperative range of motion score, VAS score, AOFAS score, and SF-36 score across all patients (P < 0.05). However, the VAS score for the non-hyperuricemia group was lower; In contrast, the AOFAS and SF-36 scores were higher than the hyperuricemia group during the last visit (P < 0.05). Multivariate analysis identified age, serum uric acid, osteochondral defect size, and urate deposition as independent risk factors for clinical outcomes, and the cut-off value for the serum uric acid American Orthopaedic Foot & Ankle Society score 445 μmol/L with sensitivity and specificity of 87.25 % and 81.25 %, respectively. Additionally, the derivation set demonstrated a sensitivity of 85.71 % and specificity of 83.33 % in predicting poor outcomes.
CONCLUSION
Hyperuricemia predicts adverse clinical outcomes after arthroscopic microfracture of osteochondral lesions of the talus, strict postoperative drop uric acid treatment, especially hyperuricemia OLTs serum uric acid levels ≥ 445μmol/L.
LEVEL OF EVIDENCE
Level IV, case series.
目的
探讨血清尿酸水平与距骨骨软骨损伤（OLTs）关节镜下微骨折临床疗效的相关性，并确定预测疗效的截断点。
方法
纳入2008年11月至2019年6月期间接受关节镜下微骨折治疗的134例OLTs患者：高尿酸血症组（≥420μmol/L）42例，非高尿酸血症组（<420μmol/L）92例。记录并分析的临床特征包括视觉模拟评分（VAS评分）、美国矫形足踝协会评分（AOFAS）和36项简明健康调查评分（SF-36）。逻辑回归确定危险因素，受试者工作特征曲线（ROC）确定预测疗效的血清尿酸截断值，并进行前瞻性验证。
结果
所有患者术后活动范围评分、VAS评分、AOFAS评分和SF-36评分均有显著改善（P<0.05）。然而，非高尿酸血症组的VAS评分较低；相比之下，末次随访时AOFAS和SF-36评分高于高尿酸血症组（P<0.05）。多因素分析确定年龄、血清尿酸、骨软骨缺损大小和尿酸盐沉积是临床疗效的独立危险因素，血清尿酸的截断值为445μmol/L时，对美国矫形足踝协会评分的敏感性和特异性分别为87.25%和81.25%。此外，在预测不良预后方面，推导集的敏感性为85.71%，特异性为83.33%。
结论
高尿酸血症预示距骨骨软骨损伤关节镜下微骨折术后临床疗效不佳，术后应严格降尿酸治疗，尤其是血清尿酸水平≥445μmol/L的高尿酸血症OLTs患者。
证据水平
IV级，病例系列。
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