Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study

Purpose

Long-term studies evaluating risk factors for development of ankle osteoarthritis (OA) following malleolar fractures are sparse.

Methods

We conducted a retrospective cohort study including consecutive patients treated by open reduction and internal fixation for malleolar fracture between January 1988 and December 1997. Perioperative information was obtained retrospectively. Patients were evaluated clinically and radiographically 12–22 years postoperatively. Radiographic ankle OA was determined on standardised radiographs using the Kellgren and Lawrence scale (grade 3–4 = advanced OA). Uni- and multivariate regression analyses were performed to determine risk factors for OA.

Results

During the inclusion period, 373 fractures (372 patients; 9% Weber A, 58% Weber B, 33% Weber C) were operated upon. The mean age at operation was 42.9 years. There were 102 patients seen at follow-up (mean follow-up 17.9 years). Those not available did not differ in demographics and fracture type from those seen. Advanced radiographic OA was present in 37 patients (36.3%). Significant risk factors were: Weber C fracture, associated medial malleolar fracture, fracture-dislocation, increasing body mass index, age 30 years or more and length of time since surgery.

Conclusions

Advanced radiographic OA was common 12–22 years after malleolar fracture. The probability of developing post-traumatic OA among patients having three or more risk factors was 60–70%.     

踝关节创伤后关节炎的相关危险因素:一项随访18年的回顾性研究

踝关节创伤后关节炎十分常见,其发生率比髋膝关节高得多,而目前对其危险因素评估的长期随访研究报道很少.作者对1988年1月～1997年12月的373例进行切开复位内固定的踝关节骨折进行了回顾性研究,并进行统计学分析.Pilon骨折、距骨骨折及年龄＜18岁者未纳入研究.踝关节炎的影像学诊断根据Kellgren&Lawrence标准,疼痛评估按照AOFAS评分.该研究中评估的危险因素包括:年龄、性别、体重指数、工作性质、骨折类型、是否合并脱位、内踝是否骨折、后踝是否骨折、伤后时间等.所有患者中有9％为Weber A型骨折,B型58％,C型33％,手术时的平均年龄为42.9岁.其中102例患者获得12.6 ～22.8年随访,平均17.9年,这102例患者随访时影像学有踝关节炎表现者为36.3％.     

Clusters of biochemical markers are associated with radiographic subtypes of osteoarthritis (OA) in subject with familial OA at multiple sites. The GARP study

OBJECTIVE: To assess the relationship of biochemical markers and radiographic signs of osteoarthritis (ROA) in the subjects with symptomatic osteoarthritis (OA) at multiple sites of the Genetics osteoARthritis and Progression (GARP) study. METHODS: We have measured eight biochemical markers, representing tissue turnover of cartilage, bone, synovium, and inflammation. ROA was assessed in the knees, hips, hands, vertebral facet joints and spinal disc degeneration (DD) by using the Kellgren score. A proportionate score was subsequently made for each joint location based on the number of joints with ROA. Principal component and linear mixed model analyses were applied to analyze the data. RESULTS: Three different clusters of markers were identified that may reflect different pathophysiological processes of OA. The first component appeared to be reflected by structural markers of cartilage and bone turnover and associated especially in subjects with hip ROA. The second component was reflected by a marker of inflammation and was associated with knee ROA, high Western Ontario and McMaster Universities (WOMAC) scores and body mass index (BMI). The third component included markers of cartilage turnover and was associated with ROA at hands, spine as well as age. High familial aggregation was observed for serum cartilage oligomeric matrix protein (S-COMP) (70%) and serum N-propeptide of collagen type IIA (S-PIIANP) (62%). CONCLUSION: Using a large well-characterized study and eight biochemical markers, we were able to observe three components that may reflect different molecular mechanisms (bone, cartilage, synovium turnover and inflammation). Our data suggested that these components contribute differently to ROA at different joint sites.     

腰椎小关节骨性关节炎危险因素的研究进展

腰椎小关节骨性关节炎是导致下腰痛的常见病因.本文综述了腰椎小关节骨性关节炎的危险因素.通过对相关研究的综合和分析,笔者认为:年龄大于50岁、男性或绝经后女性、偏向矢状面的腰椎小关节和腰椎间盘退变、L4、5节段是腰椎小关节骨性关节炎的危险因素.认识和理解腰椎小关节骨性关节炎的危险因素能对下腰痛的诊断和治疗提供帮助.     

Risk factors can classify individuals who develop accelerated knee osteoarthritis: Data from the osteoarthritis initiative

We assessed which combinations of risk factors can classify adults who develop accelerated knee osteoarthritis (KOA) or not and which factors are most important. We conducted a case‐control study using data from baseline and the first four annual visits of the Osteoarthritis Initiative. Participants had no radiographic KOA at baseline (Kellgren‐Lawrence [KL]<2). We classified three groups (matched on sex): (i) accelerated KOA: > 1 knee developed advance‐stage KOA (KL = 3 or 4) within 48 months; (ii) typical KOA: > 1 knee increased in radiographic scoring (excluding those with accelerated KOA); and (iii) No KOA: no change in KL grade by 48 months. We selected eight predictors: Serum concentrations for C‐reactive protein, glycated serum protein (GSP), and glucose; age; sex; body mass index; coronal tibial slope, and femorotibial alignment. We performed a classification and regression tree (CART) analysis to determine rules for classifying individuals as accelerated KOA or not (no KOA and typical KOA). The most important baseline variables for classifying individuals with incident accelerated KOA (in order of importance) were age, glucose concentrations, BMI, and static alignment. Individuals <63.5 years were likely not to develop accelerated KOA, except when overweight. Individuals >63.5 years were more likely to develop accelerated KOA except when their glucose levels were > 81.98 mg/dl and they did not have varus malalignment. The unexplained variance of the CART = 69%. These analyses highlight the complex interactions among four risk factors that may classify individuals who will develop accelerated KOA but more research is needed to uncover novel risk factors. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:876–880, 2018.

     

股骨髋臼撞击综合征患者髋关节镜术后并发髋关节炎的危险因素分析

目的:探讨股骨髋臼撞击(femoro-acetabular impingement,FAI)综合征患者髋关节镜术后并发髋关节炎(hip osteoarthritis,HOA)的危险因素,减少和预防HOA的发生。方法:自2018年9月至2020年9月采用髋关节镜手术治疗106例FAI患者,男40例,女66例;年龄20～55(33.05±10.19)岁;运动伤51例,交通事故伤36例,钝物砸伤19例;病程5～19(12.02±3.69) d。术后随访18个月,根据是否发生HOA将患者分为HOA组23例和无HOA组83例。采用多元Logistic回归分析影响FAI患者髋关节镜术后并发HOA的危险因素。结果:经单因素分析,HOA组年龄50～70岁、女性、身体质量指数>30 kg·m^-2、体力劳动、凸轮型、术后并发感染、术后末次随访髋关节关节活动度(range of motion,ROM)及T?nnis分级1级及以上比例均高于无HOA组(P<0.05),相对骨骼肌指数(relative appendicular skeletal muscle index,RAS...     

家族性髋关节骨关节炎的病例报道

例1 女,47岁。以“双髋疼痛、活动受限6年,加重5个月”于2010年2月入院。患者于6年前无明显诱因开始出现双髋疼痛,逐渐跛行,人院前5个月症状明显加重,无法正常行走。术前X线片显示双侧髋关节骨关节炎（图1）,Harris评分双侧均为38分。入院后行双侧髋关节置换术,术后功能恢复满意。     

Risk factors for eclampsia: a case-control study

OBJECTIVE: Our purpose was to characterize the risk factors of eclampsia in women with preeclampsia. PATIENTS AND METHODS: A case-control study was conducted at Monastir hospital to investigate risk factors for eclampsia between 1st January 1995 and 30th June 2000. Cases were matched to preeclamptic controls on a 2:1 ratio. Univariate analysis was used to determine which of the independent variables were significantly different between the groups. Those with significant differences were then entered into multiple logistic regression analysis to determine the characteristics that were independently related to eclampsia. RESULT: A total of 41 cases of eclampsia were ascertained from deliveries. The ratio of eclampsia cases to number of deliveries over the study period was 1.87 per 1000. The first seizures occurred at home in 59% of the cases. Univariate analysis revealed statistical significance for the following variables associated with eclampsia: systolic hypertension > or =160 mmHg and diastolic > or =110 mmHg, headache, visual symptoms, vivid deep tendon reflexes, proteinuria >3+ or >3 g d(-1), uric acid concentration > or =350 micromol l(-1), serum creatinine concentration >100 micromol l(-1) and aminotransferase aspartate >30 IU l(-1). A history of abortion appears to be the protective factor against eclampsia. However, with subsequent multivariate analysis, only vivid deep tendon reflexes and elevated uric acid concentration remained significant. CONCLUSION: These data indicate a need for improved prenatal care and medical attention focused on prodroms of eclampsia as well as the detection of preeclampsia to reduce the incidence of eclampsia.     

Risk factors predicting desmoid occurrence in patients with familial adenomatous polyposis: a meta‐analysis

Aim Desmoid tumours (DT) are myofibroblastic proliferations occurring in 15% of patients with familial adenomatous polyposis (FAP). Several small series have analysed the incidence of DT and predisposing risk factors. Using meta‐analytical techniques, this study aimed to identify risk factors for DT development in patients with FAP. Method Studies of sporadic DT were excluded. The study end‐points were the incidence of DT in FAP and DT development by gender, adenomatous polyposis coli (APC) mutation, family history of DT and previous abdominal surgery. A random effect Mantel–Haenszel model was used to calculate odds ratios for each risk factor and age group. Results Ten studies of 4625 patients with FAP fulfilled our inclusion criteria. A total of 559 (12%) patients developed DT. Cumulative analysis demonstrated that 80% of DT developed by age 40, the peak incidence rate being in the second and third decades. A positive family history of DT was the most significant risk factor (OR 7.02, 95% CI 4.15–11.9, P < 0.001). An APC mutation 3′ to codon 1399 (OR 4.37, 95% CI 2.14–8.91, P < 0.001) and previous abdominal surgery (OR 3.35, 95% CI 1.33–8.41, P = 0.01) were also implicated. Women were more likely to develop DT (OR 1.57, 95% CI 1.13–2.18, P = 0.007). Conclusion There is consistency amongst polyposis registries in documenting the incidence and risk factors for DT development. Having a positive family history for DT is of greater significance than a 3′ mutation, suggesting the existence of modifier genes, independent of the APC genotype–phenotype correlation. Few of these risk factors are modifiable. Delaying prophylactic surgery could be appropriate in female patients with a 3′ APC mutation and attenuated polyposis.     

Risk factors for deterioration of erectile function: the Krimpen study

This report from the Krimpen study explored the relationship between the determinants for worsening of erectile function in the open population. In Krimpen aan den IJssel (a municipality near Rotterdam), all men aged 50–75 years, without cancer of the prostate or the bladder and without a history of radical prostatectomy or neurogenic bladder disease, were invited to participate in June 1995. The response rate was 50%. The follow-up was until June 2004. At baseline a visit to a health centre for the measurement of urinalysis, height, weight and blood pressure was part of the ongoing study. During baseline and at the first follow-up, second follow-up and third follow-up, a self-administered booklet consisting of a compilation of validated questionnaires including the International Continence Society male sex questionnaire was completed. At the urology outpatient clinic, a urological workup was measured. All participants were asked to keep a frequency–volume chart for 3 days. A multivariate Cox-proportional hazard model was constructed to find the determinants of worsening of erectile function, correcting for age. Total follow-up time was 4948 person years consisting of 975 men. During follow-up, 441 events of worsening of erectile function occurred. Multivariate Cox-proportional hazard ratio analyses showed that body mass index (BMI), irritative lower urinary tract symptoms, diabetes mellitus, chronic obstructive pulmonary disease (COPD) and sexual inactivity were determinants with significant hazard ratios. In addition to age, determinants for a deterioration of erectile function based on multivariate longitudinal analyses are BMI, diabetes mellitus, COPD, sexual inactivity and irritative IPSS. The mechanism of various determinants is discussed.     

Risk factors for the incidence and progression of radiographic osteoarthritis of the knee among Japanese

This longitudinal study aimed to identify risk factors for the incidence and progression of radiographic knee osteoarthritis (OA). We examined the inhabitants of Miyagawa village aged ≥65 years every two years between 1997 and 2007. Anteroposterior radiographs of both knees were graded for OA using the Kellgren-Lawrence (K/L) grading system. Knee OA was defined as grade ≥2. We recorded the incidence of knee OA among participants in whom both knees changed from K/L grades 0 or 1 to ≥2 over a four-year follow-up period. We also recorded the progression of knee OA using this threshold among patients in whom one or both knees changed from K/L grades 2 or 3 to any higher grade over the follow-up period. Baseline data obtained from standard questionnaires, physical findings and X-rays included age, gender, body mass index (BMI), osteoporosis, Heberden’s nodes, knee range of motion (ROM), knee pain and cigarette smoking. The rates of incidence and progression of knee OA among 360 participants (241 women, 119 men) who fulfilled the study criteria were 4.0 and 6.0% per year, respectively. Female gender (odds ratio [OR] 2.849, 95% confidence interval [CI] 1.170–6.944) and high BMI (OR 1.243, 95% CI 1.095–1.411) were significantly associated with the incidence of knee OA, and restricted knee ROM (OR 0.941, 95% CI 0.892–0.992) was significantly associated with knee OA progression. Patients with a low knee ROM relative to grade of radiographic knee OA require more careful follow-up than those with a higher ROM.     

Risk factors for Peyronie's disease: a case-control study

OBJECTIVE: To test some hypotheses about risk factors for Peyronie's disease (PD). PATIENTS AND METHODS: In a case-control study, 82 patients with PD, consecutively diagnosed at the first author's institution, were compared with 246 men visiting the same institution for dermatological diseases. Univariate and multivariate logistic regression analyses were used to assess the data. RESULTS: From the multivariate logistic regression analysis the risk factors for PD were: a history of genital and/or perineal injuries, transurethral prostatectomy, cystoscopy, diabetes mellitus, hypertension, lipoma, propranolol in therapy, Dupuytren's contracture in the medical history, ever having smoked, alcohol consumption, fibromatous lesions of the genital tract of the partner, and surgical intervention on the genital tract of the partner. CONCLUSION: The results of the present study are in line with the hypothesis that, in addition to genetic predisposition, trauma of the penis and systemic vascular diseases are risk factors for PD. Smoking and alcohol consumption also seem to have some role in the development of the disease.     

Risk factors for multiorgan failure: a case-control study

The aim of this study was to identify factors associated with Multiple Organ Failure (MOF), and assess possible interactions between the risk factors identified as such. We studied 40 MOF cases and 120 controls, out of all the surgery and trauma patients who needed intensive care at our institution in a 24-month period. The univariate analyses showed that age, hypovolemic shock, massive volume administration (MVA), sepsis, and time of evolution before arriving to the hospital (TE) were significantly associated with MOF. Logistic regression analysis showed that neither age nor MVA were independently associated with MOF after adjusting for all of the other variables. Interactions seemed to be present between age, sepsis, and shock. We conclude that in our surgery and trauma ICU adult patient population, hypovolemic shock, sepsis, and TE are independent risk factors for MOF. The importance of the association between shock and sepsis is discussed, as well as the possible relevance of TE as a risk factor.     

壶腹周围癌危险因素的病例对照研究

目的：探讨壶腹周围癌发病的相关危险因素,为有效预防和控制壶腹周围癌提供理论依据。 方法：采用1:1配对病例对照研究,收集湖南省人民医院肝胆外科2003—2014年间122例壶腹周围癌患者（病例组）和同期122例非肿瘤、非消化系统疾病患者（对照组）,对可能的危险因素进行条件Logistic回归分析。 结果：在控制了混杂因素后,壶腹周围癌的危险因素为吸烟、饮酒及乙肝感染。其结果为,随着每日吸烟量（支）的增加壶腹周围癌的患病率随之增加,其中现在不吸烟者、<20支/d、20~39支/d、≥40支/d者的优势比（OR）分别为0.450（95% CI=0.205~0.988）、0.500（95% CI=0.092~2.730）、 2.571（95% CI=1.074~6.156）、3.000（95% CI=0.312~28.841）;每日饮酒<40 g、40~99 g、≥100 g者患壶腹周围癌的OR值分别为3.000（95% CI=0.312~28.841）、65.289（95% CI=0.006~70.239）、4.50（95% CI=0.972~20.827）;乙肝感染者患壶腹周围癌的危险性是无乙肝病史者的3.25倍（95% CI= 1.060~9.967）。 结论：大量吸烟、饮酒以及乙肝感染是壶腹周围癌的危险因素。