The effect of bracing on varus gonarthrosis
The effect of bracing on varus gonarthrosis
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DOI：
10.2106/00004623-199904000-00012
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发表时间：
1999-04-01
影响因子：
5.3
通讯作者：
Fowler, P
中科院分区：
文献类型：
--
作者：
Kirkley, A;Webster-Bogaert, S;Fowler, P
背景本研究的目的是比较定制的外翻功能性膝关节（卸载器）支架，氯丁橡胶套管，仅用于医疗（对照组）关于他们改善疾病特异性生活质量和膝关节内翻畸形相关骨关节炎患者功能状态的能力方法：研究设计为前瞻性、平行组、随机临床试验。对膝内翻关节病患者进行资格筛选。排除标准包括：除骨关节炎以外的关节炎;过去6个月内膝关节手术;髋关节、踝关节或足的症状性疾病;胫骨或股骨骨折;病态肥胖（体重指数超过35公斤/平方米）;皮肤病;外周血管疾病或静脉曲张，无法使用支具;严重的心血管缺陷;失明;英语能力差;由于身体限制，如手部关节炎或不能弯曲而不能使用支具。治疗分配基于计算机生成的随机分组方法，使用密封信封。根据年龄（小于50岁或至少50岁）、畸形（机械轴内翻小于5度或内翻至少5度）和前交叉韧带状态（撕裂或完整）对患者进行分层。患者被随机分配到三个治疗组之一：仅接受医疗（对照组），药物治疗和使用氯丁橡胶套，或药物治疗和使用卸荷器支具。使用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和麦克马斯特-多伦多关节炎患者偏好残疾问卷（MACTAR）测量疾病特异性生活质量，采用6分钟步行试验和30秒爬楼梯试验评价功能。主要结果的措施包括基线和6个月evaluations.Results之间的分数变化的协方差分析：119例患者进行了随机化。对照组包括40名患者（31名男性和9名女性;平均年龄，60.9岁）;氯丁橡胶袖套组包括38名患者（27名男性和11名女性;平均年龄，58.2岁）;以及卸载支架组包括41名患者（28名男性和13名女性;平均年龄，59.5岁）。9名患者退出研究。在6个月的随访评价中，与对照组相比，氯丁橡胶袖套组和卸载器支具组的疾病特异性生活质量（p = 0.001）和功能（p小于或等于0.001）均显著改善。在6分钟步行试验后，减压支具组和氯丁橡胶袖套组的疼痛有显著差异（p 0.021）和第32次爬楼梯试验（p 0.016），在WOMAC聚合物的变化方面，卸荷器支具组和氯丁橡胶袖套组之间存在显著差异的强烈趋势（p = 0.062）和WOMAC身体功能评分（p = 0.081），结论：结果表明，膝内翻关节病患者除了标准的药物治疗外，还可以从使用膝关节支具中获益。平均而言，卸荷器支架比氯丁橡胶套管更有效。每一种支撑方案的理想候选方案仍有待确定。
Background The purpose of this study was to compare a custom-made valgus-producing functional knee (unloader) brace, a neoprene sleeve, and medical treatment only (control group) with regard to their ability to improve the disease-specific quality of life and the functional status of patients who had osteoarthritis in association with a varus deformity of the knee (varus gonarthrosis),Methods: The study design was a prospective, parallel-group, randomized clinical trial. Patients who had varus gonarthrosis were screened for eligibility. The criteria for exclusion included arthritides other than osteoarthritis; an operation on the knee within the previous six months; symptomatic disease of the hip, ankle, or foot; a previous fracture of the tibia or femur; morbid obesity (a body-mass index of more than thirty-five kilograms per square meter); skin dis; ease; peripheral vascular disease or varicose veins that would preclude use of a brace; a severe cardiovascular deficit; blindness; poor English-language skills; and an inability to apply a brace because of physical limitations such as arthritis in the hand or an inability to bend over.Treatment was assigned on the basis of a computer-generated block method of randomization,vith use of sealed envelopes. The patients were stratified according to age (less than fifty years or at least fifty years), deformity (the mechanical axis in less than 5 degrees of varus or in at least 5 degrees of varus), and the status of the anterior cruciate ligament (torn or intact). The patients were randomly assigned to one of three treatment groups: medical treatment only (control group), medical treatment and use of a neoprene sleeve, or medical treatment and use of an unloader brace, The disease-specific quality of life was measured with use of the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the McMaster-Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR), and function was assessed,vith use of the six-minute walking and thirty-second stair-climbing tests. The primary outcome measure consisted of an analysis of covariance of the change in scores between the baseline and six-month evaluations.Results: One hundred and nineteen patients were randomized. The control group consisted of forty patients (thirty-one men and nine women; mean age, 60.9 years); the neoprene-sleeve group, of thirty-eight patients (twenty-seven men and eleven women; mean age, 58.2 years); and the unloader-brace group, of forty-one patients (twenty-eight men and thirteen women; mean age, 59.5 years). Nine patients withdrew from the study. At the six-month follow-up evaluation, there was a significant improvement in the disease-specific quality of life (p = 0.001) and in function (p less than or equal to 0.001) in both the neoprene-sleeve group and the unloader-brace group compared with the control group. There was a significant difference between the unloader-brace group and the neoprene-sleeve group,vith regard to pain after both the six-minute walking test (p 0.021) and the thirty-second stair-climbing test (p 0.016), There was a strong trend toward a significant difference between the unloader-brace group and the neoprene-sleeve group with regard to the change in the WOMAC aggregate (p = 0.062) and WOMAC physical function scores (p = 0.081),Conclusions: The results indicate that patients who have varus gonarthrosis may benefit significantly from use of a knee brace in addition to standard medical treatment. The unloader brace was, on the average, more effective than the neoprene sleeve. The ideal candidates for each of these bracing options remain to be identified.