Marijnissen Anne C A, Van Roermund Peter M, Van Melkebeek Jan, Schenk Willem, Verbout Abraham J, Bijlsma Johannes W J, Lafeber Floris P J G
University Medical Center Utrecht, Utrecht, The Netherlands.
Arthritis Rheum. 2002 Nov;46(11):2893-902. doi: 10.1002/art.10612.
Osteoarthritis (OA) is a degenerative, disabling joint disease that affects >10% of the adult population. No effective disease-modifying treatment is available. In the present study, we used joint distraction, a relatively new treatment in which mechanical contact between the articular surfaces is avoided while intraarticular intermittent fluid pressure is maintained, to treat patients with severe OA of the ankle.
Patients with severe ankle OA (n = 57) who were being considered for joint fusion (arthrodesis) were treated with joint distraction in an open prospective study. In addition, a randomized trial was performed in 17 patients to determine whether joint distraction had a better outcome than debridement. A standardized evaluation protocol (physical examination, assessment of pain, mobility, and functional ability) was used, and changes in radiographic joint space width and subchondral sclerosis were measured. Thirty-eight patients in the open study have been followed up for >1 year, with up to 5 years of followup in 7 of them (mean +/- SD followup 2.8 +/- 0.3 years). Patients in the randomized study have been followed up for 1 year.
Significant clinical benefit was found in three-fourths of the 57 patients in the open prospective study. Most interestingly, the improvement increased over time. Radiographic evaluation showed increased joint space width and decreased subchondral sclerosis. Moreover, joint distraction showed significantly better results than debridement.
The clinical benefit of joint distraction in the treatment of severe OA is proof of the concept. Although the followup remains relatively short and effects over time remain unpredictable, our study creates possibilities for the treatment of severe OA in general. Considering the high prevalence of OA and the lack of a cure for it, joint distraction as a treatment of severe OA may have great medical, social, and economic impact.
骨关节炎（OA）是一种退行性、致残性关节疾病，影响超过10%的成年人口。目前尚无有效的疾病改善治疗方法。在本研究中，我们采用关节撑开术，这是一种相对较新的治疗方法，在维持关节内间歇性流体压力的同时避免关节面之间的机械接触，用于治疗重度踝关节OA患者。
在一项开放性前瞻性研究中，对57例被考虑进行关节融合术（关节固定术）的重度踝关节OA患者采用关节撑开术进行治疗。此外，对17例患者进行了随机试验，以确定关节撑开术是否比清创术有更好的疗效。使用标准化评估方案（体格检查、疼痛、活动度和功能能力评估），并测量影像学上关节间隙宽度和软骨下硬化的变化。开放性研究中的38例患者已随访超过1年，其中7例随访长达5年（平均±标准差随访2.8±0.3年）。随机研究中的患者已随访1年。
在开放性前瞻性研究的57例患者中，四分之三发现有显著的临床益处。最有趣的是，改善情况随时间增加。影像学评估显示关节间隙宽度增加，软骨下硬化减少。此外，关节撑开术的效果明显优于清创术。
关节撑开术治疗重度OA的临床益处证明了这一概念。尽管随访时间相对较短，且长期效果仍不可预测，但我们的研究总体上为重度OA的治疗创造了可能性。考虑到OA的高患病率以及缺乏治愈方法，关节撑开术作为重度OA的一种治疗方法可能具有重大的医学、社会和经济影响。
