Bauer G C
Rev Chir Orthop Reparatrice Appar Mot. 1981;67(3):329-35.
The natural history of arthrosis is worse for the knee than for the hip. The majority of knee patients become socially isolated because of deficient walking ability associated with increasing instability and pain, usually not remedied by non-operative treatment. In most early cases of varus arthrosis, slight over-correction by osteotomy will provide permanent freedom from pain and retained motion. In advanced stages and in most cases of valgus arthrosis, osteotomy is unreliable. Provided the contralateral compartment is preserved, a unicompartmental arthroplasty is then indicated. However, in the worst cases with severe bone loss and ligamentous instability, a bicondylar or total endoprosthesis should be used. The diagnostic and therapeutic recommendations proposed here are based on experience over a 20-year period including long-term prospective studies, notably a Swedish multi-center study involving 5000 knee arthroplasties. In a general sense, the treatment of gonarthrosis now has a rational basis which in each individual case requires exact roentgenographic analysis, careful choice of operative method and, not least, surgical precision. In the majority of cases an early precise osteotomy should prevent the need for major arthroplasty later in life.
关节病在膝关节的自然病程比在髋关节更严重。大多数膝关节患者由于与日益增加的不稳定和疼痛相关的行走能力不足而在社交上变得孤立，这种情况通常无法通过非手术治疗得到改善。在大多数内翻关节病的早期病例中，截骨术进行轻微过度矫正可使患者永久摆脱疼痛并保留活动能力。在晚期以及大多数外翻关节病病例中，截骨术并不可靠。如果对侧关节腔得以保留，则应进行单髁关节置换术。然而，在伴有严重骨质流失和韧带不稳定的最严重病例中，应使用双髁或全膝关节假体。此处提出的诊断和治疗建议基于20年的经验，包括长期前瞻性研究，特别是一项涉及5000例膝关节置换术的瑞典多中心研究。一般来说，膝关节炎的治疗现在有了合理的依据，在每个具体病例中都需要精确的X线分析、仔细选择手术方法，尤其是手术精度。在大多数情况下，早期精确的截骨术应可避免日后进行大型关节置换术。
