Abu-Abeid Subhi, Wishnitzer Nurit, Szold Amir, Liebergall Meir, Manor Orly
Endoscopic Surgery Service, Surgery B, Tel Aviv Sourasky Medical Center, Tel Aviv, Jerusalem, Israel.
Obes Surg. 2005 Nov-Dec;15(10):1437-42. doi: 10.1381/096089205774859281.
The causal relationship between obesity and osteoarthritis (OA) of the knee is generally accepted. Weight loss has been shown to reduce the development of OA and improve the radiological parameters of existing disease. However, inducing weight reduction is difficult, and thus the number of patients studied has been small. We wished to determine the effects of surgically-induced weight loss on objective, radiological evidence of OA in the knee joint.
64 consecutive patients that were referred to the Bariatric Surgical Unit were enrolled in the study. The only exclusion criterion was the prior diagnosis of OA. Knee pain alone did not exclude patients from the study. The study was performed in a prospective manner as a before-after trial. Radiographic data was evaluated by an independent radiologist not involved in the patient care or follow-up. Upright film of the knee was taken prior to surgery and 3 months following surgery. Minimal medial joint space width (JSW) was measured by a digital image computer. In addition, patients were clinically assessed using the American Knee Society Score (AKSS) at these times.
59 of 64 patients were available for followup. BMI decreased from 43.4 to 36.9 (P<0.01). The medial joint space increased from 4.6 mm to 5.25 mm (P<0.001). The AKSS improved from 78.5 points (perfect function = 100 points) to 90.69 points (P<0.01).
Surgically-induced weight loss is an effective, rapid and dependable means of reversing the radiological signs of early changes associated with OA.
肥胖与膝关节骨关节炎（OA）之间的因果关系已被普遍认可。体重减轻已被证明可减少OA的发展，并改善现有疾病的放射学参数。然而，诱导体重减轻很困难，因此所研究的患者数量较少。我们希望确定手术诱导的体重减轻对膝关节OA客观放射学证据的影响。
连续64例转诊至减肥手术科的患者纳入本研究。唯一的排除标准是先前诊断为OA。仅膝关节疼痛并不排除患者参与研究。本研究以前瞻性前后对照试验的方式进行。放射学数据由一名不参与患者护理或随访的独立放射科医生评估。术前及术后3个月拍摄膝关节正位片。通过数字图像计算机测量最小内侧关节间隙宽度（JSW）。此外，在这些时间点使用美国膝关节协会评分（AKSS）对患者进行临床评估。
64例患者中有59例可进行随访。体重指数从43.4降至36.9（P<0.01）。内侧关节间隙从4.6毫米增加到5.25毫米（P<0.001）。AKSS从78.5分（完美功能=100分）提高到90.69分（P<0.01）。
手术诱导的体重减轻是一种有效、快速且可靠的方法，可逆转与OA相关的早期变化的放射学征象。
