Chao E Y, Sim F H
Orthopaedic Biomechanics Laboratory, Johns Hopkins University, Baltimore, MD 21205-2196, USA.
Iowa Orthop J. 1995;15:4-18.
It has been demonstrated that osteoarthritis (OA) is activity related and may worsen when joint contact stress becomes excessive due to overloading. Hence, joint alignment and loading are considered to be the key biomechanical determinants for OA. The initiation of pathologic changes in the knee has been described by the mechanism termed, "vicious cycle" in which joint axial malalignment creates excessive stresses to the localized joint cartilage/subchondral bone regions and the surrounding soft tissue which in turn produces more laxity and joint deformity and thus repeats the cyclic degradation mechanism. If this degenerative cycle can be broken with joint alignment surgery such as osteotomy, a procedure to realign the knee joint and thus redistribute joint forces applied to each compartment, performed properly and at the appropriate time, the osteoarthritic disease process can be decelerated and even reversed. The main goals of this paper are to emphasize the importance of accurate preoperative planning for osteotomy in order to properly correct joint alignment, and to justify the application of an existing computer program, OASIS (Osteotomy Analysis and Simulation Software) using plain radiographs to perform appropriate surgical planning. Normal subjects and knee osteotomy patients were studied to establish a database for the purpose of establishing the utility and efficacy of the presently proposed concept. We wish to rationalize knee osteotomy as a preferred and cost-effective treatment for patients with early symptoms of OA in the knee. This paper presents a new concept of preoperative planning for knee osteotomy based on the underlying etiology of the disease and biomechanical viewpoint with strong emphasis on surgical treatment rationales. The established principles in this paper can be applied to other joints of the body and will help implement preventive measures and other non-surgical means to manage patients with axial malalignment or early degenerative changes.
业已证明，骨关节炎（OA）与活动相关，当因负荷过重导致关节接触应力过大时，病情可能会恶化。因此，关节对线和负荷被认为是OA的关键生物力学决定因素。膝关节病理变化的起始已通过一种称为“恶性循环”的机制来描述，即关节轴向排列不齐会给局部关节软骨/软骨下骨区域及周围软组织造成过大压力，进而导致更多的关节松弛和畸形，从而重复这种循环性退变机制。如果能通过诸如截骨术之类的关节对线手术打破这种退变循环，截骨术是一种重新调整膝关节对线从而重新分配施加于每个关节腔的关节力的手术，在适当的时间正确实施，骨关节炎的疾病进程就可以减缓甚至逆转。本文的主要目的是强调准确的术前截骨规划对于正确纠正关节对线的重要性，并论证使用普通X线片应用现有计算机程序OASIS（截骨分析与模拟软件）来进行适当手术规划的合理性。对正常受试者和膝关节截骨患者进行了研究，以建立一个数据库，目的是确定当前提出的概念的实用性和有效性。我们希望将膝关节截骨术合理化为膝关节OA早期症状患者的一种首选且具有成本效益的治疗方法。本文基于疾病的潜在病因和生物力学观点，提出了一种膝关节截骨术前规划的新概念，重点强调了手术治疗原理。本文所确立的原则可应用于身体的其他关节，并将有助于实施预防措施和其他非手术方法来治疗轴向排列不齐或早期退变改变的患者。
