Univerzitet u Novom Sadu, Medicinski fakultet / University of Novi Sad, Faculty of Medicine
Published December 8, 2022 | Version v1
Journal article Open

Posttraumatski osteoartritis skočnog zgloba – naša iskustva

Authors/Creators

  • 1. Univerzitski klnički centar Niš, Klinika za ortopediju, Niš, Srbija
  • 2. ROR icon Univerzitet Privredna akademija u Novom Sadu
  • 3. Univerziteta u Novom Sadu Medicinski Fakultet
  • 4. ROR icon Oncology Institute of Vojvodina
  • 5. Faculty of Medicine, University of Niš
  • 6. Univerzitet u Nišu, Medinski fakultet, Niš, Srbija
  • 7. Opšta bolnica Leskovac

Abstract (Serbian)

Uvod: Posttraumatski osteoartritis (PTOA) se razvija sekundarno u odnosu na traumu skočnog zgloba sa kliničkim znacima bola i disfunkcije koji često zaostaju godinama za početnim povredama. To je progresivna i iscrpljujuća bolest koja stvara društveno i ekonomsko opterećenje i nosi značajne fizičke i psihološke posledice, a pogađa oko 10% svetske populacije. Trauma skočnog zgloba izaziva akutnu povredu, a potom nastaje hronično abnormalno opterećenje zgloba. Akutno mehaničko oštećenje ima veliki efekat na hrskavicu, može izazvati mikrooštećenje, prelom hrskavice ili osteohondralni prelom.

Materijal i metode: Sproveli smo retrospektivnu studiju uključujući sve pacijente operisane na Klinici za ortopediju Univerziteskog kliničkog centra u Nišu za period od januara 2013. do januara 2020. godine, a zbog preloma maleolusa koji su lečeni ORIFom. Sve bolesnike smo pratili posle jedne i više godina od operacije, radili smo Rtg snimak, a stepen osteoartritisa skočnog zgloba smo određivali korišćenjem Kellgren-Lawrenceove skale.

Rezultati: Bilo je 184 bolesnika koji su uključeni u ovu studiju, a za analizu i praćenje, ostalo je 53 (29%) pacijenta. Po Kellgren-Lawrenceovoj skali, stepen 3 je registrovan kod 16, a stepen 4 kod 5 pacijenata. Ova grupa pacijenata imala je prelom medijalnog i posteriornog maleolusa, dislocirani tip B i C po Weberu.

Diskusija: Skočni zglob grade plafon duge tibije i talus, on je kompaktan i mali, pa sila udara može se rasporediti samo na malu zapreminu kosti. Mali volumen i tanka hrskavica talusa su objašnjenje zašto su osteohondralni defekti češći na talarnoj kupoli nego na tibijalnom plafonu. Na talusu nastaju lezije hrskavice ili mikrofrakture u subhondralnoj kosti kada je izložen jakom udaru. Tip preloma skočnog zgloba određuje incidencu osteohondralnih lezija u zglobu. Najlošiju prognozu za razvoj PTOA imaju anterolateralne lezije talusa sa lateralnim maleolusom i lezije medijalnog maleolusa. Hronična promena mehanike skočnog zgloba i neujednačena distribucija kontaktnog stresa sa vremenom dovodi do kumulativnog efekta koji se ogleda u degeneraciji hrskavice i razvoju PTOA.

Zaključak: Mehanički faktori u vidu primarnog udara ili zbog nestabilnosti i nekongruencije su glavni induktori PTOA.

Abstract (English)

Introduction: Posttraumatic osteoarthritis (PTOA) develops secondary to ankle trauma, with clinical signs of pain and dysfunction often lagging years after the initial injury. It is a progressive and debilitating disease that creates a social and economic burden and carries significant physical and psychological consequences, affecting about 10% of the world's population. Trauma to the ankle joint causes an acute injury, followed by chronic abnormal loading of the joint. Acute mechanical damage has a great effect on cartilage, it can cause microdamage, cartilage fracture or osteochondral fracture.

Material and methods: We conducted a retrospective study including all patients operated on at the Clinic for Orthopedics and Traumatology in Niš for the period from January 2013 to January 2020, for malleolus fractures who were treated with ORIF. We followed up all patients after one or more years after the operation, we took an X-ray, and the degree of osteoarthritis of the ankle joint was determined using the Kellgren-Lawrence scale.

Results: There were 184 patients included in this study, and 53 (29%) patients remained for analysis and follow-up. According to the Kellgren-Lawrence scale, grade 3 was registered in 16 and grade 4 in 5 patients. This group of patients had a fracture of the medial and posterior malleolus, dislocated type B and C according to Weber.

Discussion: The ankle joint is built by the long tibia and talus, it is compact and small, so the impact force can be distributed only on a small volume of bone. The small volume and thin cartilage of the talus explain why osteochondral defects are more common in the talar dome than in the tibial ceiling. Cartilage lesions or microfractures in the subchondral bone occur on the talus when it is exposed to a strong impact. The type of ankle fracture determines the incidence of osteochondral lesions in the joint. Anterolateral talus lesions with lateral malleolus and medial malleolus lesions have the worst prognosis for the development of PTOA. Chronic change in ankle mechanics and uneven distribution of contact stress over time leads to a cumulative effect reflected in cartilage degeneration and development of PTOA.

Conclusion: Mechanical factors in the form of primary impact or due to instability and incongruence are the main inducers of PTOA.

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Apollinem Medicum et Aesculapium 2022, vol 20, 4 (171-5).pdf

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Additional details

Dates

Accepted
2022-12-08