Research Progress on the Prevention of Ankle Osteoarthritis
Objective: To summarize the research progress on the prevention of ankle arthritis (OA) over the past decade. By optimizing the diagnosis and treatment of ankle injuries through these preventive strategies, the incidence of ankle OA can be reduced. Methods: We searched for randomized controlled trials, cohort studies, case-control studies, and systematic reviews on the prevention of ankle osteoarthritis from 2004 to 2024 in the Embase, PubMed, and Web of Science databases, with no language restrictions. The search terms included “ankle arthritis” and “prevention”, along with their synonyms and related terms, to ensure the comprehensiveness of the literature search. Additionally, we manually reviewed the reference lists of relevant articles to identify important studies that might have been missed by the database search. Studies that could effectively prevent the development of ankle osteoarthritis were included. Studies with duplicate publications and those with poor quality due to unreasonable design, incomplete data, or erroneous statistical methods were excluded. Results: Studies have shown that preventive strategies for ankle osteoarthritis cover multiple aspects, including health management, conservative treatment, surgical intervention, bioactive agents, and the application of imaging techniques. Adhering to a healthy lifestyle or implementing exercise-based preventive programs, using emerging imaging technologies to guide early preventive treatment after ankle trauma, adopting conservative treatment or arthroscopic ligament reconstruction for ankle ligament injuries, performing autologous osteochondral grafting for large osteochondral defects in the ankle joint, and using open reduction and internal fixation for displaced intra-articular ankle fractures can all effectively prevent the development of ankle OA. Bioactive agents have demonstrated promising applications in disease prevention, but the assessment of their clinical translation and long-term therapeutic effects remains a significant challenge. Conclusion: Health management, conservative treatment, surgical intervention, bioactive agents, and the application of imaging techniques are all effective in preventing the development of ankle osteoarthritis. However, the long-term effects of certain interventions, such as the use of bioactive agents, require further investigation through prospective clinical trials.
Ankle Osteoarthritis
众所周知,踝关节很少发生原发性骨关节炎
踝关节OA患病率在50岁以上的普通人群中约为3.4%
已知吸烟、较高的体质指数和其他出现疼痛、酸痛或僵硬的关节(如肩、肘、腕、手、髋、膝、足等)的数目增多是导致踝关节OA发生的非创伤性可调节风险因素
大约85%的踝关节损伤为外侧踝关节扭伤
当保守治疗对慢性踝关节不稳定无效且韧带变得松弛时,可考虑手术治疗
踝关节扭伤可导致骨软骨病变的发生率升高
除了外踝扭伤,关节内骨折同样是诱导PTOA发生的重要病因,可导致软骨损伤和韧带不稳定
许多涉及PTOA发展的机制已被提出作为潜在的治疗靶点,例如针对踝关节中具有独特活性的IL-1和TNF等促炎细胞因子使用其受体的靶向拮抗剂
富含血小板的血浆(Platelet Rich Plasma, PRP)在运动相关损伤的治疗应用中越来越广泛,被认为可以刺激组织愈合
目前临床评估踝关节对齐及监测踝关节OA涉及连续获取负重X线片,并采用Kellgren和Lawrence (KL)分级进行评分
此外,双平面荧光透视是一种涉及两台校准的荧光透视仪捕捉动态视频以评估日常活动中各个骨骼三维运动学的技术,因其高度精确的体内骨骼运动学追踪特性,它能够检测到踝关节创伤后细微的功能差异(即退行性关节疾病早期标志),非常适合研究PTOA随时间的发展
本文综述了踝关节OA的多方面预防策略,不仅涵盖了从生活方式调整到手术干预的多种手段,还突出了针对踝关节损伤后的早期诊断和精准治疗的重要性。未来的研究应聚焦于开发更精准的影像学工具以实现踝关节损伤后的早期诊断和个性化干预、进一步探索各类生物制剂在踝关节损伤修复和骨关节炎预防中的长期治疗效果、不断优化手术技术和完善术后康复训练方案,以加快患者踝关节的功能恢复。此外,开展国际多中心研究以进一步验证不同预防策略在不同人群中的有效性和适用性是必要的,这样做能够为全球范围内的临床实践提供更可靠的科学依据。
*通讯作者。