综合疗法对老年膝骨关节炎患者本体感觉的影响

目的探讨超声波导入、推拿手法和肌力训练对膝骨关节炎(KOA)患者本体感觉的影响。方法 30例老年KOA患者在给予健康教育指导的基础上,2周内对患膝进行10次双氯芬酸二乙胺乳胶剂经脉冲超声波导入、6次推拿手法治疗和每日1~2次的股四头肌肌力增强训练,并于治疗前后给予西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分、下肢等长肌力测试和本体位置觉测试。结果受试者治疗前后的WOMAC得分、患膝的最大肌力与平均肌力、患膝关节的复位误差平均值之间均存在显著性差异(P<0.05)。结论超声波导入、推拿手法和肌力训练可明显促进KOA患者本体感觉的恢复。     

双氯芬酸二乙胺乳胶剂治疗软组织性腰痛的疗效观察

目的：探讨双氯芬酸二乙胺乳胶剂在治疗软组织性腰痛中的疗效。方法：将67例软组织性腰痛患者随机分为两组,一组于推拿手法治疗时局部涂擦双氯芬酸二乙胺乳胶剂（A组）,另一组只予推拿手法（B组）治疗。治疗1个疗程后观察疗效。结果：A组和B组总有效率分别为94.29%和87.50%,A组优良率明显优于B组。结论：双氯芬酸二乙胺乳胶剂对软组织性腰痛有良好疗效,且使用安全。     

超声波结合股四头肌肌力训练治疗老年膝关节骨关节炎

目的探讨超声波结合股四头肌肌力增强训练对老年膝关节骨关节炎的疗效. 方法将76例老年膝关节骨关节炎患者随机分为实验组和对照组,每组38例.实验组采用超声波结合股四头肌肌力训练,对照组应用综合物理疗法治疗.对患膝治疗前和治疗4周后的日常活动(ADL)能力、疼痛程度及伸直位最大负荷量进行评定. 结果实验组在缓解疼痛、改善膝关节ADL能力方面略优于对照组(P>0.05),但其股四头肌肌力较治疗前及对照组明显增强(P<0.01). 结论超声波结合股四头肌肌力强化训练治疗老年膝关节骨关节炎,可获得较满意的治疗结果.     

超声波结合股四头肌肌力训练治疗老年膝骨关节炎

背景膝关节的疼痛和关节不稳是膝骨关节炎的主要症状表现.目的采用镇痛药物超声波透入疗法减轻局部疼痛症状的同时进行股四头肌肌力训练,并与单纯超声波物理治疗比较对膝关节疼痛及功能状态的改善效果.设计随机对照实验.单位泸州医学院附属医院康复医学科.对象选择2001-08/2004-08泸州医学院附属医院骨科和康复科门诊及住院的膝骨关节炎患者76例,男28例,女48例,共109膝.随机分为实验组和对照组,每组38例.干预①实验组采用绵阳产CZ-01型超声治疗机,声头直径3 cm,以10g/L双氯芬酸乳胶剂(北京诺华制药有限公司生产)作耦合剂涂于患膝关节周围,0.75～1.25 W/cm2,1次/d,8～10 min/次;同时进行膝关节伸直位的静力性等长收缩训练,使用股四头肌等张训练器进行Delorme渐增抵抗运动练习,每日一两次.②对照组超声波疗法同治疗组;超短波应用无热至微热量,患区对置,10～15 min/次;中频电采用CM-518B型电脑中频治疗仪,给予耐受量,20min/次,各种电疗均1次/d.③两组患者均在治疗4周后评定疗效,治疗期间停用其他抗炎镇痛等药物.④应用目测类比评分法对患者患膝平地行走疼痛评分(0分为无痛,10分为极痛,比治疗前缓解40%以上为有效);选择下肢日常活动项目对患者膝关节日常活动能力评分(5个项目,总分10分,分值高为优,低为差);采用悬挂砝码法在股四头肌等张训练器上测定患膝伸直位最大负荷量.主要观察指标①两组患者治疗前后平地行走疼痛评分.②两组患者膝关节日常活动能力评分.③两组患者膝关节伸直位最大负荷量.结果按意向处理分析,76例患者均进入结果分析.①两组患者治疗前后平地行走疼痛评分结果疼痛评分均较治疗前明显减低(P＜0.01),但组间比较无显著差异(P＞0.05).②两组患者治疗前后膝关节日常活动能力比较治疗后均比治疗前明显增加,实验组效果好于对照组(9.61±1.82,8.77±2.28),但组间比较无显著差异(P＞0.05).③两组患者治疗前后膝关节伸直位最大负荷量评价结果治疗后实验组较治疗前及对照组均明显增强[(10.05±2.41)kg比(7.86±1.98)kg及(8.76±1.65)kg,P＜0.01).结论应用双氯芬酸钠乳胶剂作为超声耦合剂对老年膝关节骨关节炎患者进行超声波结合股四头肌肌力强化训练治疗,可以改善患者疼痛提高日常生活能力和增强膝关节伸直位最大负荷量和膝关节的稳定性.其效果好于单纯应用超声波治疗.     

超声波结合股四头肌肌力训练治疗老年膝骨关节炎

背景：膝关节的疼痛和关节不稳是膝骨关节炎的主要症状表现。目的：采用镇痛药物超声波透人疗法减轻局部疼痛症状的同时进行股四头肌肌力训练，并与单纯超声波物理治疗比较对膝关节疼痛及功能状态的改善效果。设计：随机对照实验。单位：泸州医学院附属医院康复医学科。对象：选择2001-08／2004—08泸州医学院附属医院骨科和康复科门诊及住院的膝骨关节炎患者76例，男28例，女48例，共109膝。随机分为实验组和对照组，每组38例。干预：①实验组：采用绵阳产CZ-01型超声治疗机，声头直径3cm，以10叽双氯芬酸乳胶剂（北京诺华制药有限公司生产）作耦合剂涂于患膝关节周围，0．75～1．25W／cm^2，1次／d，8～10min／次；同时进行膝关节伸直位的静力性等长收缩训练，使用股四头肌等张训练器进行Delorme渐增抵抗运动练习，每日一两次。②对照组：超声波疗法同治疗组；超短波应用无热至微热量，患区对置，10-15min／次；中频电采用CM-518B型电脑中频治疗仪，给予耐受量，20min／次，各种电疗均1次／d。③两组患者均在治疗4周后评定疗效，治疗期间停用其他抗炎镇痛等药物。④应用目测类比评分法对患者患膝平地行走疼痛评分（0分为无痛，10分为极痛，比治疗前缓解40％以上为有效）；选择下肢日常活动项目对患者膝关节日常活动能力评分（5个项目，总分10分，分值高为优，低为差）；采用悬挂砝码法在股四头肌等张训练器上测定患膝伸直位最大负荷量。主要观察指标：①两组患者治疗前后平地行走疼痛评分。②两组患者膝关节日常活动能力评分。③两组患者膝关节伸直位最大负荷量。结果：按意向处理分析，76例患者均进人结果分析。①两组患者治疗前后平地行走疼痛评分结果：疼痛评分均较治疗前明显减低（P〈0．01），但组间比较无显著差异（P〉0．05）。②两组患者治疗前后膝关节日常活动能力比较：治疗后均比治疗前明显增加，实验组效果好于对照组（9．61&;#177;1．82，8.77&;#177;2．28），但组间比较无显著差异（P〉0．05）。③两组患者治疗前后膝关节伸直位最大负荷量评价结果：治疗后实验组较治疗前及对照组均明显增强[（10．05&;#177;2．41）kg比（7．86&;#177;1．98）kg及（8.76&;#177;1．65）kg，P〈0．01）。结论：应用双氯芬酸钠乳胶剂作为超声耦合剂对老年膝关节骨关节炎患者进行超声波结合股四头肌肌力强化训练治疗，可以改善患者疼痛提高日常生活能力和增强膝关节伸直位最大负荷量和膝关节的稳定性。其效果好于单纯应用超声波治疗。     

5次坐-立试验在膝骨关节炎患者功能评估中的价值

目的明确运动功能测试结果能否反映膝骨关节炎患者的患肢肌力水平。方法对30例经放射影像学确诊且有临床症状的膝骨关节炎患者进行5次坐-立试验、10 m步行速度、计时起立-行走和等速肌力测试。结果5次坐-立试验与10 m步行速度和计时起立-行走之间相关(P<0.001);5次坐-立试验、10 m步行速度、计时起立-行走与患肢伸肌肌力均相关(P<0.05)。结论5次坐-立试验测试既能反映膝骨关节炎患者的行走能力又能反映患肢肌力水平,可以作为评价膝骨关节炎患者下肢功能水平的评估方法。     

膝骨关节炎患者动静态跌倒风险测试的临床应用价值

目的探讨膝骨关节炎(KOA)患者的平衡功能状况和动静态跌倒风险测试在KOA患者中的临床应用价值。方法对无膝痛的KOA患者(对照组,n=30)给予静态姿势稳定性(PS)、姿势稳定极限性(LOS)、动态跌倒风险指数(DFI)和静态跌倒风险指数(SFI)测试。对有膝痛的KOA患者(治疗组,n=30)给予10次双氯芬酸二乙胺乳胶剂经脉冲超声波导入和6次推拿手法联合治疗,并于治疗前后给予西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分及上述4种平衡功能测试。结果对照组与治疗组治疗前在PS总分、前后摆动系数、侧向摆动系数存在显著性差异(P<0.05);LOS完成时间、LOS总分和DFI存在非常显著性差异(P<0.01),而SFI无显著性差异(P>0.05)。治疗组治疗前后的WOMAC得分、PS总分、前后摆动系数、LOS完成时间、LOS总分和DFI存在显著性差异(P<0.05);侧向摆动系数、SFI无显著性差异(P>0.05)。结论有膝痛的KOA患者与年龄相匹配的无膝痛KOA受试者相比,平衡功能更差,跌倒风险更大。经有效治疗后,KOA患者的平衡功能明显改善,跌倒风险降低。与SFI测试相比,DFI测试对KOA患者平衡功能改善更加敏感。     

髋关节肌训练治疗膝骨关节炎的短期效果

比较髋关节肌与股四头肌等长肌力训练治疗膝骨关节炎的短期疗效,探讨髋关节肌训练治疗膝骨关节炎的优势。     

分米波理疗结合股四头肌肌力训练治疗老年人膝关节骨关节炎

目的　探讨分米波理疗结合股四头肌肌力强化训练对老年人膝关节骨关节炎的疗效。方法　将76例老年膝关节骨关节炎患者随机分为实验组和对照组 ,每组 38例。实验组采用分米波理疗结合股四头肌肌力训练 ,对照组应用综合物理疗法治疗。对患膝治疗前和治疗 4周后的日常活动 (ADL)能力 ,疼痛程度及伸直位最大负荷量进行评定。结果　实验组在缓解疼痛 ,改善膝关节ADL能力方面较对照组明显增强 (P <0 0 1)。结论　分米波理疗结合股四头肌肌力强化训练治疗老年膝关节骨关节炎 ,可获得较满意的治疗效果。     

短期与长期股四头肌训练对1例膝骨关节炎的疗效比较

<正> 本文研究目的;①比较短期与长期股四头肌等长肌力训练,治疗膝骨关节炎(OA)的效果;②评价停止治疗对肌力的影响。 资料与方法 受试者是1名58岁健康家庭妇女,主诉步行时左膝关节疼痛,上楼梯很困难,不足     

膝关节骨性关节炎肌力训练疗效的临床研究

目的观察以股四头肌及腘绳肌肌力训练疗法为主的综合康复方法治疗膝关节骨关节炎的疗效。方法将我院60例膝关节骨关节炎者随机分为治疗组和对照组各30例。对照组采用超短波、超声中频治疗,治疗组在以上治疗基础上增加股四头肌及腘绳肌肌力训练疗法。结果两组患者经治疗后,视觉模拟评分法(治疗组2.10±0.95,对照组4.18±1.05)和美国Lysholm外科学全膝关节评分法(治疗组85.50±13.52,对照组73.40±12.80)。总分级间差异有统计学意义(治疗组优良率83.3%,对照组优良率50.0%,P<0.05),治疗组的临床疗效明显优于对比组(P<0.01)。结论以股四头肌及腘绳肌肌力训练为主的康复治疗对膝关节骨关节炎具有显著疗效。     

Short-term effectiveness of ultrasound therapy in knee osteoarthritis

This randomized, placebo-controlled, double-blind study was designed to investigate the short-term efficacy of ultrasound therapy in 90 patients with knee osteoarthritis (OA). Patients were randomly assigned to three groups: group 1 received continuous ultrasound, group 2 received pulsed ultrasound, and group 3 received a 'sham' (placebo) ultrasound for 5 min each session. All treatments were applied once a day for 5 days a week for 2 weeks, i.e. a total treatment duration of 10 days. Compared with baseline, significant improvements were observed in the visual analogue scale pain scores and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores in all three groups. The reductions in pain and WOMAC scores were significantly higher in patients treated with pulsed ultrasound than in the placebo group. In conclusion, pulsed ultrasound therapy is a safe and effective treatment modality in patients with knee OA. Further research is required to investigate the long-term efficacy of pulsed ultrasound therapy in knee OA.     

中药结合股四头肌训练治疗膝骨性关节炎疗效观察

目的观察中药配合股四头肌训练治疗膝骨性关节炎(KOA)的临床康复效果。方法70例门诊KOA患者随机分为中药组和对照组,各35例。中药组以"身痛逐瘀汤"加味汤剂口服,2次/d;对照组应用舒林酸片0.2 g/次,2次/d。两组同时配合股四头肌训练,10次/疗程,共3个疗程,每疗程间隔3 d。应用足底压力步态分析检查和改良的日本骨科协会(JOA)评分法评价疗效。结果治疗后,中药组的效果优于对照组(P<0.05),在治疗结束12周后依然如此;中药组患者患肢的最大负重、时间积分、负重积分比例治疗后均明显改善(P<0.01),而对照组仅负重积分比例有改善(P<0.05)。结论采用中药配合股四头肌训练对KOA的疼痛和功能障碍均有较好的疗效。     

Effects of combined application of progressive resistance training and Russian electrical stimulation on quadriceps femoris muscle strength in elderly women with knee osteoarthritis

[Purpose] The aim of this study was to investigate the effects of combined application of progressive resistance training and Russian electrical stimulation on quadriceps femoris muscle strength in elderly women with osteoarthritis of the knee. [Subjects] Thirty women over 65 years of age diagnosed with knee osteoarthritis participated in the present study. The subjects were randomly assigned to a control group (n=10), a progressive resistance training group (n=10), or a Russian electrical stimulation group (n=10). [Methods] Each group was treated 3 times weekly for 8 weeks, and each session lasted 45 minutes. Muscle strength was assessed by measuring the peak torque of the quadriceps femoris muscle. Outcome measurements were performed at baseline and at the fourth and eighth weeks of the treatment period. [Results] All groups showed significant intragroup differences in the quadriceps femoris muscle peak torque after the treatment intervention. There were significant intergroup differences between the Russian electrical stimulation group and the other groups. [Conclusion] The results of this study suggest that combined application of progressive resistance training and Russian electrical stimulation can be effective in strengthening the quadriceps femoris muscle in elderly women with knee osteoarthritis.Key words: Knee osteoarthritis, Progressive resistance training, Russian electrical stimulation     

不同频率振动训练对膝骨关节炎老年人下肢肌力和症状的影响

目的 探讨不同频率振动训练对膝骨关节炎(KOA)老年人下肢关节肌力和症状的影响。方法 2019年7月至10月,82例KOA老年人随机分成对照组(n = 20)、低频组(n = 20)、中频组(n = 21)和高频组(n = 21)。低频组、中频组和高频组进行振幅3 mm,频率分别为15 Hz、30 Hz和45 Hz的振动训练,每次15 min,每周3次,共16周。训练前后进行双侧下肢关节屈伸等速肌力测试,角速度为60°/s和180°/s;采用西安大略和麦克马斯特大学骨关节炎指数(WOMAC)进行评定。结果 训练后,中频组60°/s和180°/s下膝关节伸肌峰力矩均增加(|t| > 2.162, P < 0.05),高频组膝和踝关节伸肌峰力矩均增加(| t| > 2.227, P < 0.05);高频组髋和膝关节伸肌耐力均增加(| t| > 1.997, P < 0.05),WOMAC疼痛得分显著减少( t = 16.901, P < 0.001)。训练后,高频组60°/s下膝和踝关节伸肌峰力矩,髋和膝关节伸肌耐力值大于低频组和中频组( P< 0.05);高频组180°/s下髋、膝和踝关节伸肌峰力矩大于低频组(P< 0.05);高频组WOMAC疼痛得分小于其他三组(P< 0.05)。结论 45 Hz振动训练能提高KOA老年人膝和踝关节伸肌绝对力和爆发力,髋和膝关节伸肌耐力,减轻疼痛症状。     

Quadriceps-strengthening exercise and quadriceps and knee biomechanics during walking in knee osteoarthritis: A two-centre randomized controlled trial

ObjectiveTo assess the effect of quadriceps strengthening on quadriceps muscle force, power, and work and tibio-femoral compressive loads during walking in adults with knee osteoarthritis.MethodsStudy design: Two-center, randomized, controlled trial. Intervention: Patients with knee osteoarthritis were randomly allocated to quadriceps strengthening program (3 times weekly) or no attention control group. Main outcome measures: Primary outcome was change from baseline in peak quadriceps force during walking at 12 weeks. Secondary outcomes included quadriceps power and work, knee compression forces during walking estimated with musculoskeletal modeling, muscle strength and pain and function. Outcomes were measured at baseline and 12 weeks.Results30 patients were randomized to receive either training (n = 15) or no attention (n = 15). At follow-up, there were no statistical differences between groups for maximum quadriceps force, quadriceps positive power, negative work, and positive work, and knee compressive force. Maximum negative quadriceps power in early stance was statistically significantly increased 36% in the training group compared to the control group which was most likely partially a response to faster walking velocity at follow-up. Muscle strength and patient reported pain and function were improved in the training group compared to the control group.ConclusionsQuadriceps strength training leads to increased muscle strength and improved symptomatic and functional outcomes but does not change quadriceps or knee joint biomechanics during walking. The biomechanical mechanism of improved health with strength training in knee osteoarthritis patients remains unknown.ClinicalTrials.gov Identifier: NCT01538407.