Lafeber Floris P J G, Intema Femke, Van Roermund Peter M, Marijnissen Anne C A
Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands.
Curr Opin Rheumatol. 2006 Sep;18(5):519-25. doi: 10.1097/01.bor.0000240366.54960.a1.
Patients are increasingly becoming interested in nonpharmacologic approaches to manage their osteoarthritis. This review examines the recent literature on the potential beneficial effects of unloading joints in the treatment of osteoarthritis, with a focus on joint distraction.
Mechanical factors are involved in the development and progression of osteoarthritis. If "loading" is a major cause in development and progression of osteoarthritis, then "unloading" may be able to prevent progression. There is evidence that unloading may be effective in reducing pain and slowing down structural damage. This review describes unloading by footwear and bracing (nonsurgical), unloading by osteotomy (surgical), and has a focus on unloading by joint distraction. Excellent reviews in all these three fields have been published over the past few years. Recent studies argue for the usefulness of a biomechanical approach to improve function and possibly reduce disease progression in osteoarthritis.
To improve patient function and possibly reduce disease progression, a biomechanical approach should be considered in treating patients with osteoarthritis. Further research (appropriate high-quality clinical trials) and analysis (clinical as well as preclinical and fundamental) are still necessary, however, to understand, validate, and refine the different approaches of unloading to treat osteoarthritis.
患者越来越关注骨关节炎的非药物治疗方法。本综述探讨了近期关于关节卸载在骨关节炎治疗中潜在有益作用的文献，重点是关节牵张。
机械因素参与骨关节炎的发生和发展。如果“负荷”是骨关节炎发生和发展的主要原因，那么“卸载”可能能够阻止其进展。有证据表明卸载在减轻疼痛和减缓结构损伤方面可能有效。本综述描述了通过鞋具和支具进行的卸载（非手术）、通过截骨术进行的卸载（手术），并重点关注通过关节牵张进行的卸载。在过去几年中，这三个领域都发表了优秀的综述。近期研究支持采用生物力学方法来改善骨关节炎患者的功能并可能减缓疾病进展。
为改善患者功能并可能减缓疾病进展，在治疗骨关节炎患者时应考虑采用生物力学方法。然而，仍需要进一步的研究（适当的高质量临床试验）和分析（临床以及临床前和基础研究），以了解、验证和完善不同的卸载方法来治疗骨关节炎。
