Goh En Lin, Lou Winston Choong Ngan, Chidambaram Swathikan, Ma Shaocheng
Oxford University Clinical Academic Graduate School, Medical Sciences Division, University of Oxford , Oxford, UK.
Faculty of Medicine, Imperial College London, London, UK.
Orthop Res Rev. 2019 Aug 7;11:79-92. doi: 10.2147/ORR.S211060. eCollection 2019.
Knee osteoarthritis is a major cause of pain and disability for which joint distraction is a potential treatment to delay the need for knee arthroplasty. This systematic review aims to assess the short- and long-term clinical and structural outcomes following knee joint distraction (KJD).
MEDLINE, EMBASE, Scopus, and Web of Science databases were searched from the date of inception to 26th June 2019. Clinical studies investigating joint distraction for knee osteoarthritis with outcomes including ∆WOMAC index, ∆VAS pain score, and ∆joint space width were included. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) - CRD42018087032.
Nine studies comprising a total of 507 patients were included. There were four randomized controlled trials (RCTs), five open prospective cohort studies, and one case series. Overall, there were significant improvements in WOMAC index, VAS pain score and joint space width following KJD, which persisted up to 9 years. KJD also demonstrated comparable clinical outcomes with high tibial osteotomy and total knee arthroplasty.
There is moderate quality evidence supporting the beneficial outcomes of joint distraction for knee osteoarthritis. Larger RCTs with longer follow-up (>1 year) are necessary to establish the true effect size of this procedure.
膝关节骨关节炎是疼痛和残疾的主要原因，关节撑开术是一种可能延缓膝关节置换需求的治疗方法。本系统评价旨在评估膝关节撑开术（KJD）后的短期和长期临床及结构结局。
检索MEDLINE、EMBASE、Scopus和Web of Science数据库，检索时间从建库至2019年6月26日。纳入研究关节撑开术治疗膝关节骨关节炎且结局包括WOMAC指数变化、视觉模拟评分法（VAS）疼痛评分变化和关节间隙宽度变化的临床研究。本评价方案已在国际前瞻性系统评价注册库（PROSPERO）注册——CRD42018087032。
纳入9项研究，共507例患者。其中有4项随机对照试验（RCT）、5项开放前瞻性队列研究和1项病例系列研究。总体而言，KJD后WOMAC指数、VAS疼痛评分和关节间隙宽度有显著改善，且持续长达9年。KJD的临床结局与高位胫骨截骨术和全膝关节置换术相当。
有中等质量的证据支持关节撑开术治疗膝关节骨关节炎的有益结局。需要开展更大规模、随访时间更长（>1年）的RCT来确定该手术的真实效应量。
