创伤后关节炎
创伤后关节炎（PTA）是关节损伤后骨关节炎的一种形式。目录
1 分类
1.1 创伤后骨关节炎
1.2 创伤后炎症性关节炎
2 症状和体征
3 风险因素
4 发病机制和病因
4.1 速发期
4.2 急性期
4.3 慢性期
5 诊断
6 管理和预防
6.1 生活
6.2 治疗措施
6.3 药物治疗
6.4 手术
7 流行病学
8 参考
分类
创伤后关节炎是骨关节炎的一种形式，前者可以在后者之后发生。 然而，创伤后关节炎也可在慢性炎性关节炎发展后发生。
通常，创伤后关节炎分为两类：创伤后骨关节炎和创伤后炎性关节炎。
创伤后骨关节炎
创伤后骨关节炎是创伤后关节炎的最常见变异。在所有骨关节炎病例中，20％至50％之前是创伤后关节炎。患有创伤后骨关节炎的患者通常比没有任何先前身体伤害的骨关节炎患者年轻。
创伤后炎症性关节炎
不常见的是创伤后炎症性关节炎，占所有创伤后关节炎病例的2％至25％。有报道称先前的身体损伤与炎症性关节炎之间存在联系，例如类风湿性关节炎或银屑病性关节炎。
体征和症状
创伤后关节炎的症状与骨关节炎的症状相似。一般症状是受伤关节的僵硬，肿胀，滑膜渗出，疼痛，发红，压痛，磨削，不稳定和关节内出血。
由于这种症状，创伤后关节炎常伴随着能力丧失。
风险因素
由于创伤后关节炎通常在关节受伤后发生，因此在这种损伤后患有创伤后关节炎的风险显著更高。^增加创伤后关节炎危险的风险因素是超重和身体活动。在做大量工作和过度使用受伤关节时，创伤后关节炎的患病率要高得多。检查还显示，体重指数（BMI）增加5个单位导致创伤后关节炎的风险增加35％。
据报道，遗传学确实对创伤后关节炎的患病率有影响。根据较新的检查，患者的性别也可能对创伤后关节炎产生影响，因为女性比男性更容易受到创伤后关节炎的影响。
发病机制和病因
创伤后关节炎的过程可分为三个阶段：即时，急性和慢性。
速发期
这个阶段通常在受伤后几秒钟开始;其特征是细胞坏死，胶原破裂，软骨肿胀，关节积血和糖胺聚糖（GAGs）的丧失。
急性期
在这个阶段，出现急性创伤后关节病。可发生基质降解，白细胞浸润，炎症介质，缺乏润滑剂和细胞凋亡。通常，急性期在受伤后数小时。
慢性期
慢性期在创伤后数月或数年发生。典型的症状是关节疼痛和功能障碍。
诊断
创伤后关节炎是在患者病史的帮助下诊断出来的。另外，射线照相成像可以帮助诊断创伤后关节炎。
管理和预防
为了预防慢性创伤后关节炎，不可能治愈急性创伤后关节炎。管理慢性创伤后关节炎有许多不同的选择。
生活方式
由于超重是创伤后关节炎的风险因素，因此有助于控制体重的生活方式改变对于治疗和预防病症非常重要。生活方式的改变和减肥通常涉及教育受影响的人如何实践健康的生活方式。
治疗措施
物理治疗可能有助于减轻创伤后关节炎的疼痛和其他症状。按摩疗法和手动疗法的疗效尚未得到证实。
药物治疗
用非甾体抗炎药（NSAID）对症后治疗创伤后关节炎。对于更温和的症状，也使用扑热息痛。另一种医学治疗方法是将可的松或皮质类固醇注射到受影响的关节中。
手术
如果药物，生活方式改变和物理治疗不足以减轻症状，特别是疼痛，手术和其他此类干预措施可用于治疗创伤后关节炎。在许多情况下，建议进行关节置换或软骨表面置换。如临床研究所证明的，这种手术方法可以有效地减轻症状性疼痛和与病症管理相关的成本。
流行病学
在美国，约12％的所有骨关节炎病例被归类为创伤后骨关节炎。 这意味着仅在美国有超过560万人受到创伤后骨关节炎的影响。 女性比男性更容易受到影响。
创伤后关节炎每年使美国医疗保健系统花费大约30.6亿美元（0.15％）的医疗保健费用。
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