两种膝关节牵引装置的临床疗效和机械特性比较及对临床实践的启示

IF 2.7 4区 医学 Q1 ORTHOPEDICS CARTILAGE Pub Date : 2024-12-01 Epub Date: 2024-03-04 DOI:10.1177/19476035231226418
T Struik, M P Jansen, R G P Lafeber, F P J G Lafeber, S C Mastbergen
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引用次数: 0

摘要

目的:对 65 岁以下的严重骨关节炎患者进行牵引治疗可成功推迟关节置换术的时间。大多数患者都采用普通外固定器或专门用于膝关节牵引的装置进行治疗。本研究比较了这两种装置的临床疗效及其机械特性:设计:使用膝关节牵引治疗严重膝关节骨性关节炎患者的回顾性数据对治疗后 2 年的临床疗效进行比较;63 例患者使用 Dynamic Monotube(史赛克公司,瑞士),65 例患者使用 KneeReviver(ArthroSave BV,荷兰)。对治疗期间西安大略和麦克马斯特大学骨关节炎指数(WOMAC)的疼痛、僵硬度和功能、总体健康状况(SF-36)、通过X光关节间隙增宽测量的软骨厚度以及不良事件的变化进行了评估。通过对 Dynamic Monotube triax 系统和 KneeReviver 进行台架测试,评估了临床上可行配置的轴向硬度:结果:两种设备的临床疗效、机械特性和不良反应均无差异。虽然差异较大,但都显示出了临床相关的改善。在机械测试中,两种设备都能在生理负荷下观察到关节面之间的接触。应用配置的刚度差异很大,主要取决于骨针的长度:结论:使用一般预期用途装置或特定牵引装置治疗的患者都获得了临床和结构疗效,但患者之间存在显著差异。后者可能是由于装置的临床配置和实际加载的不同而导致的不同机械特性的结果。在牵引治疗过程中,关节完全/部分机械卸载的确切作用仍不清楚。
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Comparison of Clinical Efficacy and Mechanical Characteristics of Two Knee Distraction Devices With Relevance for Clinical Practice.

Objective: Distraction treatment for severe osteoarthritis below the age of 65 successfully postpones arthroplasty. Most patients have been treated with a general external fixator or a device specifically intended for knee distraction. This study compares clinical efficacy of both devices in retrospect and their mechanical characteristics.

Design: Clinical efficacy 2 years posttreatment was compared using retrospective data from patients with severe knee osteoarthritis treated with knee distraction; 63 with the Dynamic Monotube (Stryker GmbH, Switzerland) and 65 with the KneeReviver (ArthroSave BV, the Netherlands). Changes in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and function, general well-being (SF-36), cartilage thickness by radiographic joint space widening, and adverse events during treatment were assessed. Axial stiffness of clinically feasible configurations was assessed by bench testing for the Dynamic Monotube triax system and the KneeReviver.

Results: No differences were observed in clinical efficacy, nor in mechanical characteristics and adverse events between the two devices. Although with large variation, both showed a clinically relevant improvement. In mechanical testing, contact between articular surfaces was observed for both devices at physiological loading. Stiffness of applied configurations strongly varied and primarily depended on bone pin length.

Conclusions: Patients treated with a general intended-use device or a distraction-specific device both experienced clinical and structural efficacy although with significant variation between patients. The latter may be the result of varying mechanical characteristics resulting from differences in clinical configurations of the devices and actual loading. The exact role of full/partial mechanical unloading of the joint during distraction treatment remains unclear.

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来源期刊
CARTILAGE
CARTILAGE ORTHOPEDICS-
CiteScore
6.90
自引率
7.10%
发文量
80
期刊介绍: CARTILAGE publishes articles related to the musculoskeletal system with particular attention to cartilage repair, development, function, degeneration, transplantation, and rehabilitation. The journal is a forum for the exchange of ideas for the many types of researchers and clinicians involved in cartilage biology and repair. A primary objective of CARTILAGE is to foster the cross-fertilization of the findings between clinical and basic sciences throughout the various disciplines involved in cartilage repair. The journal publishes full length original manuscripts on all types of cartilage including articular, nasal, auricular, tracheal/bronchial, and intervertebral disc fibrocartilage. Manuscripts on clinical and laboratory research are welcome. Review articles, editorials, and letters are also encouraged. The ICRS envisages CARTILAGE as a forum for the exchange of knowledge among clinicians, scientists, patients, and researchers. The International Cartilage Repair Society (ICRS) is dedicated to promotion, encouragement, and distribution of fundamental and applied research of cartilage in order to permit a better knowledge of function and dysfunction of articular cartilage and its repair.
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