复方杜仲健骨颗粒改善膝关节骨性关节炎患者膝关节功能400例分析

背景根据国家药品监督管理局批文精神,进行复方杜仲健骨颗粒(伯司庄)治疗膝关节骨性关节炎临床试验.目的评价复方杜仲健骨颗粒改善膝骨关节炎患者膝关节功能及治疗的安全性.设计以壮骨关节丸为对照药,双盲双模拟随机方法.单位福建省中医药研究院、中国中医研究院广安门医院、中国中医研究院骨伤科研究所和北京中医医院.对象自1999-09/12,进行Ⅱ期临床试验,观察膝关节骨性关节炎患者200例,其中复方杜仲健骨颗粒组100例,壮骨关节丸组100例;自1999-12/2000-03,进行Ⅲ期临床试验,观察膝关节骨性关节炎患者400例,其中复方杜仲健骨颗粒组300例,壮骨关节丸组100例.所有患者均经X射线检查确诊;中医证见肝肾不足,筋脉瘀滞证;患者均知情同意.方法复方杜仲健骨颗粒组复方杜仲健骨颗粒(1包/次,3次/d)+壮骨关节丸模拟剂;壮骨关节丸组复方杜仲健骨颗粒模拟剂+壮骨关节丸(1包/次,2次/d).双盲双模拟随机对照,治疗1个月,观察临床疗效.主要观察指标患者经治疗后的关节功能、临床疗效、中医证侯积分和不良反应.结果参选的600例患者全部完成数据采集,无脱落者.①复方杜仲健骨颗粒组总有效率明显优于壮骨关节丸组(92%,82%).②与壮骨关节丸组比较,复方杜仲健骨颗粒组关节功能明显优于壮骨关节丸组.③复方杜仲健骨颗粒在改善中医证侯方面优于壮骨关节丸组(积分下降值分别为7.03±3.38,5.43±3.16).④试验过程中未见明显不良反应.结论复方杜仲健骨颗粒能有效改善膝骨关节症状,应用安全、有效.     

中药治疗膝关节骨性关节炎临床观察

目的观察中药健骨舒膝汤内服结合膝痛洗剂外用对膝关节骨性关节炎的临床疗效.方法将膝关节骨性关节炎患者70例分为治疗组和对照组各35例,治疗组口服健骨舒膝汤并结合膝痛洗剂外洗,每日1剂;对照组口服氨糖美辛0.1 g,3次/d.结果治疗2周后,治疗组总有效率为91.4%,对照组为71.4%（P＜0.05）.结论健骨舒膝汤结合膝痛洗剂对膝关节骨性关节炎有较好疗效.     

火疗在膝关节骨性关节炎中应用观察

目的:观察火疗治疗膝关节骨性关节炎的临床疗效。方法:选择60例膝关节骨性关节炎患者随机分为实验组30例和对照组30例,对照组给予常规的药物镇痛、针灸、按摩等治疗,实施膝关节骨性关节炎中医护理方案;实验组在对照组常规治疗护理的基础上予以火疗,在治疗前后采用疼痛视觉模拟量表VAS对2组患者关节疼痛进行评价,观察2组临床治疗效果,比较其结果。结果:2组治疗后VAS评分较治疗前均有降低,实验组优于对照组(P0.05);实验组临床疗效与对照组比较差异有统计学意义(P0.05)。结论:应用火疗可有效减轻膝关节骨性关节炎患者关节疼痛、改善关节僵硬症状,提高患者关节运动能力,疗效确切,已纳入本院膝关节骨性关节炎中医护理方案的优化项目。     

比较全膝关节置换术与单髁置换术治疗老年单侧间室膝关节骨性关节炎的效果

目的：探讨患有单侧间室膝关节骨性关节炎的老年患者在治疗时选用全膝关节置换术和单髁置换术的区别,并比较两者的治疗效果。方法：选取2018年1月~2019年12月收治的51例老年单侧间室膝关节骨性关节炎患者作为研究对象,利用信封法分为对照组26例、观察组25例,对照组采用全膝关节置换术治疗,观察组采用单髁置换术治疗,比较两组治疗效果。结果：观察组手术耗时、住院时间、屈曲至90°用时短于对照组,术中出血量少于对照组（P＜0.05）;两组关节僵硬发生率比较无显著差异（P＞0.05）;术后3个月,两组膝关节活动度及美国特种外科医院评分均较治疗前升高,WOMAC骨性关节炎指数评分表评分均较术前降低（P＜0.05）,观察组各指标改善幅度大于对照组（P＜0.05）。结论：老年单侧间室膝关节骨性关节炎患者选用单髁置换术治疗,可以缩短手术耗时、住院时间,减少术中出血量,减低关节僵硬发生率,促进关节功能恢复。     

康复训练结合针灸治疗在膝关节骨性关节炎患者中的应用

目的探讨康复训练结合针灸治疗在膝关节骨性关节炎患者中的应用效果。方法采用随机数字表法,将100例早中期膝关节骨性关节炎患者分为治疗组和对照组,每组各50例。对照组患者采用中医针灸加一般功能锻炼指导,治疗组在此基础上采用规范化康复训练,10d为1疗程。3个疗程后,观察两组患者膝关节疼痛、关节功能改善情况和临床疗效。结果治疗后,治疗组患者膝关节疼痛、关节功能改善情况优于治疗前和对照组,组间和组内比较,差异具有统计学意义（均P〈0．05）。治疗组患者疗效优于对照组（P〈0．05）。结论康复训练结合针灸治疗能有效减轻膝关节骨性关节炎患者的疼痛,改善膝关节功能,值得临床推广应用。     

中西医结合治疗膝关节骨性关节炎73例疗效观察

目的为探讨中药内服、熏洗配合玻璃酸钠关节内注射治疗膝关节骨性关节炎的临床疗效。方法将73例膝关节骨性关节炎患者分为两组：治疗组（补益肝肾中药内服、通经活络洗方熏洗配合玻璃酸钠关节内注射）43例,对照组（玻璃酸钠关节内注射）30例,分别观察并比较其临床疗效和改善关节功能的疗效。结果显示治疗组临床疗效及镇痛和改善关节功能的效果均优于对照组（JP〈0．05）。结论表明中药内服外洗配合玻璃酸钠关节内注射治疗膝关节骨性关节炎,具有较好的临床疗效及缓解疼痛和改善关节功能的作用。     

玻璃酸钠联合布洛芬与中药治疗膝关节骨性关节炎临床观察

目的：探讨临床治疗膝关节骨性关节炎的新方法.方法：以玻璃酸钠膝关节内注射,联用布洛芬搽剂外涂与中药＂外科洗剂＂关节周围熏洗治疗膝关节骨性关节炎98例（联用组）,并与单纯关节腔内注射玻璃酸钠者60例（对照组）,进行临床疗效比较.结果：联用组的关节疼痛与功能分级情况都优于对照组（P＜0.05）,综合疗效亦优于对照组（P＜0.05）.结论：玻璃酸钠、布洛芬与中药联用治疗膝关节骨性关节炎疗效满意,值得推广应用.     

藤黄健骨丸联合关节镜手术治疗膝骨性关节炎疗效分析

目的:观察藤黄健骨丸配合关节镜清理术治疗膝骨性关节炎的临床疗效。方法:将120例符合关节镜清理手术指针的膝骨性关节炎患者根据入院顺序随机分为对照组(单纯关节镜手术组A组,n=60)和治疗组(关节镜手术+藤黄健骨丸组B组,n=60)2组,A组单纯给予膝关节镜下清理手术,B组在A组基础上配合中医经验药方服用藤黄健骨丸治疗。比较2组治疗后的临床疗效、症状评分,记录治疗前后膝关节Lysholm评分及VAS评分情况。结果:将120例患者治疗前膝关节Lysholm评分及VAS评分数据统计比较,差异无统计学意义(P0.05);经治疗,2组患者在治疗后第1、4、7周膝关节疼痛的VAS评分分值均明显下降,且B组下降幅度较A组大;而第3、5、7周膝关节的Lysholm评分二者均有上升,且B组提升效果更加明显;治疗组的临床总有效率明显高于对照组。结论:藤黄健骨丸联合关节镜清理术治疗膝骨性关节炎,可以有效的减轻患者的临床症状及促进患膝关节功能改善,值得临床推广。     

运动训练结合玻璃酸钠治疗膝关节骨性关节炎患者关节功能改善分析

目的：评价膝关节功能训练联合玻璃酸钠注射液（施沛特）对膝关节骨性关节炎患者关节功能改善的状况。方法：选择92例膝关节骨性关节炎患者,随机分为2组,一组接受玻璃酸钠注射液膝关节内注射治疗,每周1次,连续5次为1疗程。另一组同样完成1疗程的玻璃酸钠注射液膝关节内注射治疗,但在完成第2次玻璃酸钠注射液关节内注射时开始膝关节功能训练,功能训练持续6个月,评价两组患者膝关节功能改善的差异。结果：膝关节内注射玻璃酸钠注射液联合膝关节功能训练组在改善膝关节功能方面优于单纯膝关节内注射玻璃酸钠注射液组。结论：膝关节内注射玻璃酸钠注射液联合膝关节功能训练能够对膝关节骨性关节炎起到温和持久的关节功能改善作用。     

膝关节骨性关节炎的治疗进展

膝关节骨性关节炎（osteoarthritis,OA）又称膝关节增生性关节炎、退行性关节炎、退行性骨关节病等,是一种以关节软骨变性或丢失及关节边缘和软骨下骨质再生为特征的慢性关节炎症。该病始发部位在软骨,以老年人群最为常见,男女均可发病。60岁以上人群50％X线片有骨性关节炎的表现,其中35％～50％有临床表现;75岁以上者80％有骨性关节炎症状。随着人类寿命的延长,     

The role of knee joint moments and knee impairments on self-reported knee pain during gait in patients with knee osteoarthritis

BackgroundThe association between high mechanical knee joint loading during gait with onset and progression of knee osteoarthritis has been extensively studied. However, less attention has been given to risk factors related to increased pain during gait. The purpose of this study was to evaluate knee joint moments and clinical characteristics that may be associated with gait-related knee pain in patients with knee osteoarthritis.MethodsSixty-seven participants with knee osteoarthritis were stratified into three groups of no pain (n = 18), mild pain (n = 27), or moderate/severe pain (n = 22) based on their self-reported symptoms during gait. All participants underwent three-dimensional gait analysis. Quadriceps strength, knee extension range of motion, radiographic knee alignment and self-reported measures of global pain and function were also quantified.FindingsThe moderate/severe pain group demonstrated worse global pain (P < 0.01) and physical function scores (P < 0.01) compared to the no pain and the mild pain groups. The moderate/severe pain group also walked with greater knee flexion moments during the midstance phase of gait compared to the no pain group (P = 0.02). Additionally, the moderate/severe pain group demonstrated greater varus knee malalignment (P = 0.009), which was associated with higher weight acceptance peak knee adduction moments (P = 0.003) and worse global pain (P = 0.003) and physical function scores (P = 0.006).InterpretationGreater knee flexion moment is present during the midstance phase of gait in patients with knee osteoarthritis and moderate/severe pain during gait. Additionally, greater varus malalignment may be a sign of increased global knee joint dysfunction that can influence many activities of daily living beyond gait.     

Comparison of peak knee adduction moment and knee adduction moment impulse in distinguishing between severities of knee osteoarthritis

Background

The peak knee adduction moment is a valid proxy for medial knee joint loading. However as it only measures load at one instance of stance, knee adduction moment impulse, a measure that takes into account both the magnitude and duration of the stance phase, may provide more comprehensive information. This study directly compared the abilities of peak knee adduction moment and knee adduction moment impulse to distinguish between knee osteoarthritis severities.

Methods

169 participants with medial knee osteoarthritis completed radiographic and magnetic resonance imaging, the Western Ontario and McMaster Universities Arthritis Index to assess pain and a three-dimensional gait analysis. Participants were classified using four dichotomous classifications: Kellgren–Lawrence grading, alignment, medial tibiofemoral bone marrow lesions, and pain.

Findings

When using Kellgren–Lawrence grade and alignment classifications, the area under the receiver operator curves were significantly greater for knee adduction moment impulse than for peak knee adduction moment. Based on analysis of covariance, knee adduction moment impulse was significantly different between Kellgren–Lawrence grade and alignment groups while peak knee adduction moment was not significantly different. Both peak knee adduction moment and knee adduction moment impulse distinguished between bone marrow lesion severities while neither measure was significantly different between pain severity groups.

Interpretations

Findings suggest knee adduction moment impulse is more sensitive at distinguishing between disease severities and may provide more comprehensive information on medial knee joint loading. Future studies investigating biomechanics of knee osteoarthritis should include knee adduction moment impulse in conjunction with peak knee adduction moment.     

旋转平台膝关节假体置入治疗膝关节病62例

目的:观察采用旋转平台膝关节假体行人工膝关节置换治疗膝关节疾病的疗效.方法:回顾性分析2005-01/2009-01山东大学附属省立医院收治的行人工膝关节置换患者62例(74膝),男36例(41膝),女26例(33膝);年龄52～79岁,平均61.5岁;左侧28例,右侧22例,双侧12例.其中骨性关节炎34例,类风湿性关节炎21例,创伤性关节炎7例.所有患者均选用旋转平台膝关节假体进行置换,且为首次置换,未置换髌骨.采用HSS膝关节评分标准对置换前后膝关节功能进行评估.结果:62例(74膝)患者均进行了随访,时间3~48个月,平均22个月.病例刀口均一期愈合,未出现感染和明显关节血肿.2例术后3d出现下肢肿胀,经超声多普勒检查确诊轻度下肢深静脉血栓形成,给予低分子肝素钠和拜阿司匹林等药物治疗,10d后肿胀消退.62例患者术后疼痛解除,功能明显改善.置换前HSS评分为34～58分,平均44.99分;置换后69～98分,平均88.78分,其中优45例(55膝),良16例(18膝),可1例,优良率98%.X射线平片未发现存在假体周围的X射线透亮区,亦未发现假体脱位征象.结论:选用旋转平台膝关节假体行人工膝关节置换治疗膝关节病手术简便,术后恢复好,并发症少,短期临床效果满意.     

Deluxe-ps膝关节假体在一期双膝关节置换过程中的应用

背景：Deluxe-PS 型人工膝关节假体是根据中国人膝关节解剖特点尤其是股骨髁的形态特征而设计的,其膝关节假体股骨髁内外侧距（M-L）较进口假体少3.5 mm。 目的：探讨Deluxe-ps膝关节假体行一期双膝关节置换中的近期疗效。 方法：纳入使用Deluxe-ps型膝关节假体行一期双侧膝关节置换的膝关节炎患者15例（30膝）设为实验组,对照组为同期采用P.F.C.Sigma膝关节假体行一期双侧膝关节置换的20例患者（40膝）。采用KSS评分和关节功能HSS评分、膝关节关节活动度评估两组手术前、后膝关节功能,对比两组手术时间、及术中输血量。 结果与结论：两组患者置换后均得到12-24个月随访,平均16个月。置换后患者膝关节疼痛均缓解,关节功能恢复满意。两组膝关节置换后与置换前 KSS 评分、HSS 评分及膝关节关节活动度比较,差异均有显著性意义（P〈0.05）。置换后,两组间KSS评分和HSS评分及膝关节关节活动度,差异均无显著性意义（P〉0.05）,两组间置换过程中出血量比较,差异均无显著性意义（P〉0.05）,手术时间比较,差异有显著性意义（P〈0.05）。说明采用Deluxe-ps膝关节假体行一期双膝关节置换近期疗效满意。     

膝关节镜术后肌力强化训练对膝关节骨性关节炎患者膝关节功能的影响

目的 探讨膝关节骨性关节炎(KOA)患者膝关节镜术后肌力强化训练的临床疗效,并分析其对膝关节功能的影响.方法 选择2018年12月至2020年12月于我院行膝关节镜手术治疗的86例KOA患者为研究对象,根据术后康复方案的不同将其分为对照组和观察组,每组43例.对照组术后进行常规康复训练,观察组在对照组基础上增加肌力强化...     

全膝关节置换治疗重度膝关节畸形术后的个体化康复方案

目的:探讨严重畸形膝关节置换围手术期康复方法。方法:①对象:选择2005-09/2007-02呼伦贝尔市医院骨科收治的严重风湿病下肢关节畸形施行膝关节置换术患者20例24膝。②干预:对膝内翻患者主要以训练关节活动度和增强肌力为主;对膝外翻患者,主要以增强肌力为主,必要时用支具保护;骨质疏松者康复锻炼以被动活动缓慢过渡到主动活动、由小量短时间逐渐加大运动量并延长康复周期的方法;残余屈曲挛缩畸形主要以手法按压为主。③评估:于手术前、术后2周、1个月及3个月,对患者膝关节平均HSS(纽约特种外科医院)评分及平均活动度进行对比观察,并对术后疼痛、患肢功能及主观满意度进行评估。结果:除1例1膝失访,19例患者顺利度过围手术期康复治疗。①患者膝关节活动度术前平均的35.2°,术后2周提高到92.5°。②HSS评分术前39.1分,术后2周提高到94.1分;平均股四头肌肌力较术前提高1.3级。③患者术后疼痛症状明显缓解,出院时所有患者不扶拐行走距离均超过100m。1个月、3个月随访结果满意,无并发症发生。结论:严重膝关节畸形关节置换的围手术期康复应根据术前关节畸形状态、骨质条件、术中软组织松解范围及截骨情况术后针对性的进行康复锻炼。康复应采取个体化、循序渐进及随时调整的原则进行。     

Correction for gravity in isokinetic dynamometry of knee extensors in below knee amputees

In isokinetic dynamometry of the knee extensors the influence of gravity on the lower limb is often neglected. The aim of this study was to assess the shape, the quantity and reproducibility of the gravity correction curve (GCC). Eight amputees participated in this study. The GCC was produced on an isokinetic dynamometer (QD) throughout the range of motion on the amputated side with prosthesis and on the non-amputated side. The results were compared with the GCC calculated according to the Cybex data reduction computer procedure. The isokinetic torque registration of the QD is, in a mathematical way, a straight line (Pearson correlation coefficient greater than 0.99). The other GCC is shaped like a cosinus curve. The intra-individual reproducibility is high, the inter-individual variability substantial. An explanation for the difference between the two methods is discussed. For an ideal measurement of the muscular torque, one should not only correct for the effect of gravity but for all factors counteracting the effect of the knee extensors. In that case an individual GCC should be made directly with the dynamometer.     

膝关节形态学测量在人工膝关节置换领域的价值及意义

背景:对人工膝关节假体形态尺寸进行观察及测量,并对相关测量统计数据进行人工膝关节形态设计,有利于促进膝关节假体植入后的稳定性和组织相容性。目的:结合文献探讨形态学测量在临床上膝关节置换中的重要性。方法:以"膝关节;假体;测量;设计;置换"为中文关键词,以"artificial knee joint;prosthesis;measure;design;replacement"为英文关键词。采用计算机检索1998-01/2011-12有关人工膝关节假体设计、测量及膝关节假体植入后相容性的文章。结果与结论:膝关节的形态学测量即膝关节的三维有限元模型、相关参数及角度、生物力学研究与膝关节假体选择及设计有着重要相关性。膝关节的形态测量有二维和三维测量,以三维测量法精确。膝关节线性尺寸之间、身高与线性尺寸之间均有很好的相关性,所测量的数据在临床上均有应用意义。典型的膝关节三维解剖模型,能为膝关节参数的测量提供一种可靠的方法,提高手术的成功。     

膝关节形态学测量在人工膝关节置换领域的价值及意义

背景：对人工膝关节假体形态尺寸进行观察及测量,并对相关测量统计数据进行人工膝关节形态设计,有利于促进膝关节假体植入后的稳定性和组织相容性。目的：结合文献探讨形态学测量在临床上膝关节置换中的重要性。方法：以＂膝关节;假体;测量;设计;置换＂为中文关键词,以＂artificial knee joint;prosthesis;measure;design;replacement＂为英文关键词。采用计算机检索1998-01/2011-12有关人工膝关节假体设计、测量及膝关节假体植入后相容性的文章。结果与结论：膝关节的形态学测量即膝关节的三维有限元模型、相关参数及角度、生物力学研究与膝关节假体选择及设计有着重要相关性。膝关节的形态测量有二维和三维测量,以三维测量法精确。膝关节线性尺寸之间、身高与线性尺寸之间均有很好的相关性,所测量的数据在临床上均有应用意义。典型的膝关节三维解剖模型,能为膝关节参数的测量提供一种可靠的方法,提高手术的成功。