Takahashi Tsuneari, Baboolal Thomas G, Lamb Jonathan, Hamilton Thomas W, Pandit Hemant G
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan.
J Knee Surg. 2019 Aug;32(8):788-795. doi: 10.1055/s-0038-1669447. Epub 2018 Aug 29.
Knee joint distraction (KJD) is a new application of an established technique to regenerate native cartilage using an external fixator. The purpose of this study is to perform a systematic review and meta-analysis of the literature to determine whether KJD is beneficial for knee osteoarthritis and how results compare with established treatments. Studies assessing the outcomes of KJD were retrieved, with three studies (one cohort and two randomized controlled trials), 62 knees, meeting the inclusion criteria. The primary outcome was functional outcome, assessed using a validated outcome score, at 1 year. Secondary outcomes included pain scores, structural assessment of the joint, and adverse events. KJD is associated with improvements in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) from baseline to 1 year as well as reductions in pain scores and improvements in structural parameters assessed radiographically and by magnetic resonance imaging. KJD is not associated with decreased knee flexion, but is associated with a high risk of pin site infection. In patients aged 65 years or under at 1 year, no differences in WOMAC or pain scores was detected between patients managed with KJD compared with high tibial osteotomy or total knee arthroplasty. KJD may represent a potential treatment for knee arthritis, though further trials with longer term follow-up are required to establish its efficacy compared with contemporary treatments. This is a Level I (systematic review and meta-analysis) study.
膝关节牵张术（KJD）是一种利用外固定器再生天然软骨的成熟技术的新应用。本研究的目的是对文献进行系统评价和荟萃分析，以确定KJD对膝关节骨关节炎是否有益，以及其结果与现有治疗方法相比如何。检索了评估KJD结果的研究，有三项研究（一项队列研究和两项随机对照试验）、62个膝关节符合纳入标准。主要结局是1年时使用经过验证的结局评分评估的功能结局。次要结局包括疼痛评分、关节结构评估和不良事件。KJD与从基线到1年时西安大略和麦克马斯特大学骨关节炎指数（WOMAC）的改善相关，以及疼痛评分的降低和通过X线摄影及磁共振成像评估的结构参数的改善。KJD与膝关节屈曲减少无关，但与针道感染的高风险相关。在1年时年龄在65岁及以下的患者中，与高位胫骨截骨术或全膝关节置换术相比，接受KJD治疗的患者在WOMAC或疼痛评分方面未检测到差异。KJD可能是膝关节关节炎的一种潜在治疗方法，不过与当代治疗方法相比，需要进行更长期随访的进一步试验来确定其疗效。这是一项I级（系统评价和荟萃分析）研究。
