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。

参考：
Punzi, Leonardo; Galozzi, Paola; Luisetto, Roberto; Favero, Marta; Ramonda, Roberta; Oliviero, Francesca; Scanu, Anna (6 September 2016). "Post-traumatic arthritis: overview on pathogenic mechanisms and role of inflammation". RMD Open. 2 (2). doi:10.1136/rmdopen-2016-000279. PMC 5013366. PMID 27651925.
Brown, Thomas D.; Johnston, Richard C.; Saltzman, Charles L.; Marsh, J. Lawrence; Buckwalter, Joseph A. (November 2006). "Posttraumatic Osteoarthritis: A First Estimate of Incidence, Prevalence, and Burden of Disease". Journal of Orthopaedic Trauma. 20 (10): 739. doi:10.1097/01.bot.0000246468.80635.ef. PMID 17106388.
Muthuri, S.G.; McWilliams, D.F.; Doherty, M.; Zhang, W. (2011-11-01). "History of knee injuries and knee osteoarthritis: a meta-analysis of observational studies". Osteoarthritis and Cartilage. 19 (11): 1286–1293. doi:10.1016/j.joca.2011.07.015. PMID 21884811.
Lohmander, L. Stefan; Englund, P. Martin; Dahl, Ludvig L.; Roos, Ewa M. (October 2007). "The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis". The American Journal of Sports Medicine. 35 (10): 1756–1769. doi:10.1177/0363546507307396. PMID 17761605.
Gelber, A. C.; Hochberg, M. C.; Mead, L. A.; Wang, N. Y.; Wigley, F. M.; Klag, M. J. (2000-09-05). "Joint injury in young adults and risk for subsequent knee and hip osteoarthritis". Annals of Internal Medicine. 133 (5): 321–328. PMID 10979876.
Williams, K A; Scott, J T (November 1967). "Influence of trauma on the development of chronic inflammatory polyarthritis". Annals of the Rheumatic Diseases. 26 (6): 532–537. PMC 1010439. PMID 6066236.
Söderlin, Maria K.; Bergsten, Ulrika; Svensson, Björn; BARFOT Study Group (March 2011). "Patient-reported events preceding the onset of rheumatoid arthritis: possible clues to aetiology". Musculoskeletal Care. 9 (1): 25–31. doi:10.1002/msc.193. PMID 21351367.
Malleson, P (May 1997). "Management of childhood arthritis. Part 1: acute arthritis". Archives of Disease in Childhood. 76 (5): 460–462. PMC 1717186. PMID 9196369.
Olivieri, Ignazio; Padula, Angela; D'Angelo, Salvatore; Scarpa, Raffaele (November 2008). "Role of trauma in psoriatic arthritis". The Journal of Rheumatology. 35 (11): 2085–2087. doi:10.3899/jrheum.080668X. PMID 19004049.
Punzi, L.; Pianon, M.; Bertazzolo, N.; Fagiolo, U.; Rizzi, E.; Rossini, P.; Todesco, S. (May 1998). "Clinical, laboratory and immunogenetic aspects of post-traumatic psoriatic arthritis: a study of 25 patients". Clinical and Experimental Rheumatology. 16 (3): 277–281X. PMID 9631749.
"Post Traumatic Wrist Arthritis | Orthopaedic Surgery | Michigan Medicine | University of Michigan". medicine.umich.edu. Retrieved 2018-03-28.
"What Is Post-Traumatic Arthritis and How Can It Affect My Claim? | Tiano Odell Law". www.westvirginiapersonalinjurylawyer.net. Retrieved 2018-03-28.
Anderson, Donald D.; Chubinskaya, Susan; Guilak, Farshid; Martin, James A.; Oegema, Theodore R.; Olson, Steven A.; Buckwalter, Joseph A. (2011-06-01). "Post-traumatic osteoarthritis: Improved understanding and opportunities for early intervention". Journal of Orthopaedic Research. 29 (6): 802–809. doi:10.1002/jor.21359. PMC 3082940. PMID 21520254.
Jiang L, Tian W, Wang Y, Rong J, Bao C, Liu Y, Zhao Y, Wang C (May 2012). "Body mass index and susceptibility to knee osteoarthritis: a systematic review and meta-analysis". Joint, Bone, Spine : Revue Du Rhumatisme. 79 (3): 291–7. doi:10.1016/j.jbspin.2011.05.015. PMID 21803633.
Valdes, Ana M; Doherty, Sally A; Muir, Kenneth R; Wheeler, Margaret; Maciewicz, Rose A; Zhang, Weiya; Doherty, Michael. "The genetic contribution to severe post-traumatic osteoarthritis". Annals of the Rheumatic Diseases. 72 (10): 1687–1690. doi:10.1136/annrheumdis-2012-202562. PMC 3786638. PMID 23355107.
Spector TD, MacGregor AJ (2004). "Risk factors for osteoarthritis: genetics". Osteoarthritis and Cartilage. 12 Suppl A: S39–44. doi:10.1016/j.joca.2003.09.005. PMID 14698640.
Zhang Y, Jordan JM (August 2010). "Epidemiology of osteoarthritis". Clinics in Geriatric Medicine. 26 (3): 355–69. doi:10.1016/j.cger.2010.03.001. PMC 2920533. PMID 20699159.
Lieberthal, Jason; Sambamurthy, Nisha; Scanzello, Carla R. "Inflammation in Joint Injury and Post-Traumatic Osteoarthritis". Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. 23 (11): 1825–1834. doi:10.1016/j.joca.2015.08.015. PMC 4630675. PMID 26521728.
Swärd, P.; Frobell, R.; Englund, M.; Roos, H.; Struglics, A. (November 2012). "Cartilage and bone markers and inflammatory cytokines are increased in synovial fluid in the acute phase of knee injury (hemarthrosis)—a cross-sectional analysis". Osteoarthritis and Cartilage. 20 (11): 1302–1308. doi:10.1016/j.joca.2012.07.021. PMID 22874525.
Heard, B. J.; Solbak, N. M.; Achari, Y.; Chung, M.; Hart, D. A.; Shrive, N. G.; Frank, C. B. (December 2013). "Changes of early post-traumatic osteoarthritis in an ovine model of simulated ACL reconstruction are associated with transient acute post-injury synovial inflammation and tissue catabolism". Osteoarthritis and Cartilage. 21 (12): 1942–1949. doi:10.1016/j.joca.2013.08.019. PMID 24012772.
Bierma-Zeinstra, Sita M. A.; Oster, J. Dorinde; Bernsen, Roos M. D.; Verhaar, Jan A. N.; Ginai, Abida Z.; Bohnen, Arthur M. (August 2002). "Joint space narrowing and relationship with symptoms and signs in adults consulting for hip pain in primary care". The Journal of Rheumatology. 29 (8): 1713–1718X. PMID 12180735.
Cibulka, Michael T.; White, Douglas M.; Woehrle, Judith; Harris-Hayes, Marcie; Enseki, Keelan; Fagerson, Timothy L.; Slover, James; Godges, Joseph J. "Hip Pain and Mobility Deficits – Hip Osteoarthritis". The Journal of orthopaedic and sports physical therapy. 39 (4): A1–25. doi:10.2519/jospt.2009.0301. PMC 3963282. PMID 19352008.
Wang, Shi-Yi; Olson-Kellogg, Becky; Shamliyan, Tatyana A.; Choi, Jae-Young; Ramakrishnan, Rema; Kane, Robert L. (2012-11-06). "Physical Therapy Interventions for Knee Pain Secondary to Osteoarthritis: A Systematic Review". Annals of Internal Medicine. 157 (9). doi:10.7326/0003-4819-157-9-201211060-00007. PMID 23128863.
De Luigi, Arthur Jason (May 2012). "Complementary and alternative medicine in osteoarthritis 1". PM & R: the journal of injury, function, and rehabilitation. 4 (5 Suppl): S122–133. doi:10.1016/j.pmrj.2012.01.012. PMID 22632691.
French, H. P.; Brennan, A.; White, B.; Cusack, T. (April 2011). "Manual therapy for osteoarthritis of the hip or knee – A systematic review". Manual Therapy. 16 (2): 109–117. doi:10.1016/j.math.2010.10.011. PMID 21146444.
Flood J (March 2010). "The role of acetaminophen in the treatment of osteoarthritis". The American Journal of Managed Care. 16 Suppl Management: S48–54. PMID 20297877.
Zhang, W.; Moskowitz, R. W.; Nuki, G.; Abramson, S.; Altman, R. D.; Arden, N.; Bierma-Zeinstra, S.; Brandt, K. D.; Croft, P. (September 2007). "OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence". Osteoarthritis and Cartilage. 15 (9): 981–1000. doi:10.1016/j.joca.2007.06.014. PMID 17719803.
Arroll, Bruce; Goodyear-Smith, Felicity (2004-04-10). "Corticosteroid injections for osteoarthritis of the knee: meta-analysis". BMJ. 328 (7444): 869. doi:10.1136/bmj.38039.573970.7C. PMID 15039276.
Santaguida, Pasqualina L.; Hawker, Gillian A.; Hudak, Pamela L.; Glazier, Richard; Mahomed, Nizar N.; Kreder†, Hans J.; Coyte, Peter C.; Wright, James G. "Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review". Canadian Journal of Surgery. 51 (6): 428–436X. PMC 2592576. PMID 19057730.
Carr, Andrew J; Robertsson, Otto; Graves, Stephen; Price, Andrew J; Arden, Nigel K; Judge, Andrew; Beard, David J (2012-04-07). "Knee replacement". The Lancet. 379 (9823). doi:10.1016/S0140-6736(11)60752-6. PMID 22398175.
Jenkins, P. J.; Clement, N. D.; Hamilton, D. F.; Gaston, P.; Patton, J. T.; Howie, C. R. (January 2013). "Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis". The Bone & Joint Journal. 95-B (1): 115–121. doi:10.1302/0301-620X.95B1.29835. PMID 23307684.
Daigle, Meghan E.; Weinstein, Alexander M.; Katz, Jeffrey N.; Losina, Elena. "The cost-effectiveness of total joint arthroplasty: a systematic review of published literature". Best practice & research. Clinical rheumatology. 26 (5). doi:10.1016/j.berh.2012.07.013. PMC 3879923. PMID 23218429.