膝关节骨关节炎中的卸载支具——对受损软骨有直接影响吗？

Unloader bracing in osteoarthritis of the knee - Is there a direct effect on the damaged cartilage?

作者信息

Beck S, Dittrich F, Busch A, Jäger M, Theysohn J M, Lazik-Palm A, Haubold J

机构信息

Sportsclinic Hellersen, Paulmannshoeher Strasse 17, 58515 Luedenscheid, Germany; Department of Orthopedics and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany.

Department of Orthopedics and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; Gelenkzentrum Bergisch Land, Freiheitsstrasse 203, 42853 Remscheid, Germany.

出版信息

Knee. 2023 Jan;40:16-23. doi: 10.1016/j.knee.2022.11.003. Epub 2022 Nov 17.

DOI:10.1016/j.knee.2022.11.003

PMID:36403395

Abstract

BACKGROUND

Unloading knee braces represent a conservative treatment option for non-pharmalogical management of unicompartmental osteoarthritis of the knee. Though there is consensus on the clinical effectiveness of unloading, the effect mechanism of bracing remains part of a debate. Our study was designed to assess the effect of unloader bracing on damaged cartilage via MRI cartilage mappings.

METHODS

Fourteen patients (7 female, 7 male, mean age 43.1 ± 9.4 years) with unicompartmental cartilage wear in knees with varus or valgus malalignment were enrolled. Clinical scores, radiographs and MR-graphic properties (T2/T2* mapping, T1 Delayed Gadolinium Enhanced MRI of the cartilage (dGEMRIC) mapping, high-resolution PDw sequences) of knee cartilage were recorded before and three months after brace use.

RESULTS

Bracing the knees for a mean of 14.4 ± 2.0 weeks (range 11 to 18 weeks) resulted in significant pain reduction (VAS changed from 5.9 ± 2.0 to 2.0 ± 1.3, p < 0.001) and improvement in knee function (KOOS increased from 42.1 ± 22.7 to 64.8 ± 18.7, p < 0.001). In the affected cartilage regions T2 relaxation times significantly decreased from 56.1 ± 11.4 ms to 46.5 ± 11.2 ms (p < 0.05). No changes in T1-dGEMRIC and T2* relaxation times, thickness or the extent of the damaged cartilage area could be detected.

CONCLUSIONS

Our results suggest, that unloader bracing improves the biochemical properties of the damaged cartilage by increasing collagen and proteoglycan concentration as well as decreasing the cartilage edema.

摘要

背景

卸载式膝关节支具是膝关节单髁骨关节炎非药物治疗的一种保守治疗选择。尽管对于卸载的临床效果已达成共识，但支具的作用机制仍存在争议。我们的研究旨在通过MRI软骨成像评估卸载式支具对受损软骨的影响。

方法

纳入14例（7例女性，7例男性，平均年龄43.1±9.4岁）膝关节单髁软骨磨损伴内翻或外翻畸形的患者。记录使用支具前及使用3个月后的临床评分、X线片以及膝关节软骨的磁共振成像特性（T2/T2*成像、T1延迟钆增强磁共振成像软骨（dGEMRIC）成像、高分辨率质子密度加权序列）。

结果

平均佩戴支具14.4±2.0周（范围11至18周）后，疼痛显著减轻（视觉模拟评分从5.9±2.0降至2.0±1.3，p<0.001），膝关节功能改善（膝关节损伤和骨关节炎疗效评分从42.1±22.7提高到64.8±18.7，p<0.001）。在受影响的软骨区域，T2弛豫时间从56.1±11.4毫秒显著降至46.5±11.2毫秒（p<0.05）。未检测到T1-dGEMRIC和T2*弛豫时间、受损软骨区域的厚度或范围有变化。