一项针对髌股关节炎、以膝关节疼痛和骨髓损伤为目标的支具随机试验。
A randomised trial of a brace for patellofemoral osteoarthritis targeting knee pain and bone marrow lesions.
作者信息
Callaghan Michael J, Parkes Matthew J, Hutchinson Charles E, Gait Andrew D, Forsythe Laura M, Marjanovic Elizabeth J, Lunt Mark, Felson David T
机构信息
Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK Manchester Academic Health Science Centre, Manchester, UK.
Department of Imaging Sciences, University of Manchester, Manchester, UK Department of Health Sciences, University of Warwick, UK.
出版信息
Ann Rheum Dis. 2015 Jun;74(6):1164-70. doi: 10.1136/annrheumdis-2014-206376. Epub 2015 Jan 16.
OBJECTIVE
Braces used to treat (PF) osteoarthritis (OA) may reduce contact stress across the PF joint. We hypothesised that in PF OA, braces would decrease knee pain and shrink PF bone marrow lesions (BMLs).
METHODS
Eligible subjects had painful PF OA. Subjects were randomly allocated to brace or no brace for 6 weeks. Knee MRIs were acquired at baseline and 6 weeks. We measured BMLs on post-contrast fat suppressed sagittal and proton density weighted axial images. The primary symptom outcome was change in pain at 6 weeks during a preselected painful activity, and the primary structural outcome was BML volume change in the PF joint. Analyses used multiple linear regression.
RESULTS
We randomised 126 subjects aged 40-70 years (mean age 55.5 years; 72 females (57.1%)). Mean nominated visual analogue scale (0-10 cm) pain score at baseline was 6.5 cm. 94 knees (75%) had PF BMLs at baseline. Subjects wore the brace for a mean of 7.4 h/day. 6 subjects withdrew during the trial. After accounting for baseline values, the brace group had lower knee pain than the control group at 6 weeks (difference between groups -1.3 cm, 95% CI -2.0 to -0.7; p<0.001) and reduced PF BML volume (difference -490.6 mm(3), 95% CI -929.5 to -51.7; p=0.03) but not tibiofemoral volume (difference -53.9 mm(3), 95% CI -625.9 to 518.2; p=0.85).
CONCLUSIONS
A PF brace reduces BML volume in the targeted compartment of the knee, and relieves knee pain.
TRIAL REGISTRATION NUMBER
UK. ISRCTN50380458.
目的
用于治疗髌股（PF）骨关节炎（OA）的支具可能会降低髌股关节的接触应力。我们假设，在PF OA中，支具会减轻膝关节疼痛并缩小PF骨髓损伤（BML）。
方法
符合条件的受试者患有疼痛性PF OA。受试者被随机分配到佩戴支具组或不佩戴支具组，为期6周。在基线和6周时进行膝关节MRI检查。我们在增强后脂肪抑制矢状位和质子密度加权轴位图像上测量BML。主要症状结局是在预先选定的疼痛活动中6周时疼痛的变化，主要结构结局是PF关节中BML体积的变化。分析采用多元线性回归。
结果
我们将126名年龄在40 - 70岁（平均年龄55.5岁；72名女性（57.1%））的受试者进行了随机分组。基线时平均指定视觉模拟量表（0 - 10厘米）疼痛评分为6.5厘米。94个膝关节（75%）在基线时有PF BML。受试者平均每天佩戴支具7.4小时。6名受试者在试验期间退出。在考虑基线值后，支具组在6周时的膝关节疼痛低于对照组（组间差异 -1.3厘米，95%可信区间 -2.0至 -0.7；p<0.001），且PF BML体积减小（差异 -490.6立方毫米，95%可信区间 -929.5至 -51.7；p = 0.03），但胫股体积无变化（差异 -53.9立方毫米，95%可信区间 -625.9至518.2；p = 0.85）。
结论
PF支具可减少膝关节目标区域的BML体积，并缓解膝关节疼痛。
试验注册号
英国。ISRCTN50380458。
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