Ploegmakers J J W, van Roermund P M, van Melkebeek J, Lammens J, Bijlsma J W J, Lafeber F P J G, Marijnissen A C A
Rheumatology & Clinical Immunology, University Medical Center Utrecht, The Netherlands.
Osteoarthritis Cartilage. 2005 Jul;13(7):582-8. doi: 10.1016/j.joca.2005.03.002.
Osteoarthritis (OA) is a degenerative disabling joint disease affecting more than 10% of the adult population. No validated disease-modifying treatment is available. Joint distraction is a relatively new approach to the treatment of severe ankle OA. Short-term (3 years) clinical benefit has been proven, but long-term effects remain to be evaluated.
Patients with severe OA of the tibio-talar joint, who had been treated with Ilizarov joint distraction more than 7 years previously, were included. Pre-treatment data were obtained by retrospective analysis using questionnaires and patients' charts. Post-treatment assessments were undertaken using the same questionnaires and by physical examination. Three approaches were used and results were compared: the van Valburg score, the Ankle Osteoarthritis Scale (AOS), and a patient satisfaction questionnaire. Retrospectively and prospectively obtained data were available from eight patients for comparison.
Twenty-five out of 27 patients with severe ankle OA treated with Ilizarov joint distraction could be traced. Appropriate retrospective data could not be obtained from three patients. Six out of the 22 patients (27%) were failures. In 16 patients (73%), significant improvement in all clinical parameters was observed using each of the three approaches. Good correlations were found between the results of the three methods of assessment and retrospectively obtained pre-treatment values were very similar to the prospective data.
In 73% of the patients, significant clinical benefit from joint distraction of severe OA ankles was maintained for at least 7 years. There is, however, a need for further research to try and predict which patients will not respond to this unconventional form of major surgical intervention.
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。目前尚无经过验证的改善病情的治疗方法。关节牵张术是治疗重度踝关节OA的一种相对较新的方法。短期（3年）临床获益已得到证实，但长期效果仍有待评估。
纳入7年多以前接受过伊里扎洛夫关节牵张术治疗的重度胫距关节OA患者。通过问卷调查和患者病历进行回顾性分析获取治疗前数据。使用相同问卷并通过体格检查进行治疗后评估。采用三种方法并比较结果：范瓦尔堡评分、踝关节骨关节炎量表（AOS）和患者满意度问卷。回顾性和前瞻性获取的数据来自8名患者以供比较。
27例接受伊里扎洛夫关节牵张术治疗的重度踝关节OA患者中，25例可追踪到。3例患者无法获得合适的回顾性数据。22例患者中有6例（27%）治疗失败。16例患者（73%）使用三种方法中的每一种评估均观察到所有临床参数有显著改善。三种评估方法的结果之间相关性良好，回顾性获得的治疗前值与前瞻性数据非常相似。
73%的患者中，重度OA踝关节的关节牵张术至少7年维持了显著的临床获益。然而，需要进一步研究以尝试预测哪些患者对这种非常规的重大手术干预无反应。
