膝关节负荷改变对关节软骨的影响

目的:观察一侧膝关节固定的条件下对侧膝关节软骨的影响。方法:6月龄,体质量2.5kg新西兰白兔10只,分实验组和对照组。实验组分a,b两部分,a组3只、b组5只。用石膏固定一侧膝关节5.5周。a组去除固定后即刻取对侧膝关节软骨标本。b组去除固定4周后取对侧膝关节软骨标本。通过光镜及扫描电镜观察膝关节负荷改变对关节软骨的影响。对照组2只,膝关节不做任何处理。结果:兔一侧膝关节固定5.5周,对侧膝关节由于承重增加,在去除固定后即刻,对侧膝关节软骨即出现退行性改变。去除固定4周,对侧膝关节软骨尚未恢复正常。结论:①一侧膝关节固定,对侧膝关节由于负荷的增加可导致退行性变化。②在相同时间段,关节固定对软骨的影响大于负荷改变对软骨的影响。     

膝关节负荷改变对关节软骨的影响

目的：观察一侧膝关节固定的条件下对侧膝关节软骨的影响。方法：6月龄，体质量2．5kg新西兰白兔lO只，分实验组和对照组。实验组分a，b两部分，a组3只、b组5只。用石膏固定一侧膝关节5．5周。a组去除固定后即刻取对侧膝关节软骨标本。b组去除固定4周后取对侧膝关节软骨标本。通过光镜及扫描电镜观察膝关节负荷改变对关节软骨的影响。对照组2只，膝关节不做任何处理。结果：兔一侧膝关节固定5．5周，对侧膝关节由于承重增加，在去除固定后即刻，对侧膝关节软骨即出现退行性改变。去除固定4周，对侧膝关节软骨尚未恢复正常。结论：①一侧膝关节固定，对侧膝关节由于负荷的增加可导致退行性变化。②在相同时间段，关节固定对软骨的影响大于负荷改变对软骨的影响。     

高频超声对膝关节结核的诊断价值

目的探讨膝关节结核的高频超声表现及超声对膝关节结核的诊断价值。方法对32例经手术及病理证实的膝关节结核声像图,进行回顾性分析总结。结果 32例膝关节结核高频超声表现为不同程度的滑膜增厚32例、膝关节积液32例、软骨病变及骨质破坏23例。结论高频超声可显示膝关节结核的滑膜厚度、积液程度、软骨及骨质破坏程度,对诊断膝关节结核具有重要诊断价值。     

CT对膝关节周围滑膜囊积液的定位诊断价值

目的探讨CT对膝关节周围滑膜囊积液的定位诊断价值。方法对15例膝关节囊和/或周围滑膜囊积液进行分析。结果膝关节CT能很好地显示膝关节周围的肌肉、肌腱及骨骼等解剖结构,可准确定位周围滑膜囊积液。结论膝关节CT对膝关节周围滑膜囊积液的定位诊断具有重要的价值。     

护膝对跑步过程中膝关节外翻幅度的影响

目的:探索佩戴膝关节护具和不同种类的膝关节护具对普通男大学生膝关节外翻幅度的影响。方法:本研究选取首都体育学院18~22岁的男大学生20例,使用三维红外摄像系统监测20例受试者佩戴两种不同款式的常用膝关节护具在相同跑步速度下的下肢膝关节外翻幅度。结果:佩戴膝关节护具可有效减少膝关节外翻幅度。佩戴膝关节护具1,膝关节外翻...     

早期康复训练对人工膝关节置换术后功能恢复的影响

目的:探讨人工膝关节置换术后早期康复训练对膝关节功能恢复的影响.方法:对60例人工膝关节置换术患者给予整体康复训练指导,即术前护理、术后康复训练及出院指导.结果:本组60例术后膝关节功能明显改善.结论:人工膝关节置换术后早期康复训练可最大限度地改善假体膝关节功能,是提高术后疗效的有效方法.     

人工全膝关节置换术后肌力锻炼对假体膝关节功能的作用

人工全膝关节置换术的目的在于缓解疼痛、矫正畸形、在一定程度上恢复膝关节功能。术后进行正确、有效的功能康复锻炼,可以在最大限度上改善假体膝关节的功能,从而影响着手术的效果。对43例人工全膝关节置换术患者中的骨性关节炎、类风湿性关节炎患者进行术后功能康复锻炼,并对患者手术前及康复锻炼后的膝关节评分变化进行观察。功能康复后膝关节功能评分高于手术前膝关节评分。功能康复锻炼能改善人工全膝关节置换术后假体膝关节功能。     

后稳定型假体TKA术对膝关节骨性关节炎患者膝关节功能的影响

目的:探讨后稳定型假体全膝关节置换术对膝关节骨性关节炎治疗效果及对膝关节功能的影响。方法:选取2017年3月～2019年3月收治的85例膝关节骨性关节炎患者,依据手术方式不同分为PS组43例和PCR组42例。PCR组给予后交叉韧带保留型假体全膝关节置换术治疗,PS组给予后稳定型假体全膝关节置换术治疗,对比两组手术指标及膝关节功能评分。结果:PS组手术时间、术中出血量均低于PCR组(P0.05);术后3个月,PS组疼痛评分、骨关节炎评指数分均低于PCR组,美国膝关节协会评分及膝关节活动度均高于PCR组(P0.05)。结论:后稳定型假体全膝关节置换术对膝关节骨性关节炎患者创伤较小,能有效减轻患者疼痛程度,利于患者膝关节功能的恢复,改善膝关节活动度。     

膝关节生理解剖环境对膝关节生物力学特性的影响

背景:了解膝关节的生物力学特点对理解人工膝关节假体的设计原理和手术操作原则是至关重要的。目的:分析膝关节周围的力学环境及与膝关节生物力学的关系,进一步探索膝关节的稳定性及损伤机制。方法:应用计算机检索CNKI和PubMed数据库中1998-01/2011-08关于膝关节生物力学方面的文章,在标题和摘要中以"膝关节,韧带,半月板,关节软骨,生物力学"或"kneejoints,ligament,meniscus,cartilage,biomechanical"为检索词进行检索。选择文章内容与膝关节生物力学有关者,同一领域文献则选择近期发表或发表在权威杂志文章。初检得到163篇文献,根据纳入标准选择关于膝关节损伤生物力学特性方面的25篇文献进行综述。结果与结论:膝关节的稳定除了依赖膝关节骨以外,还以依赖前后交叉韧带的制约、内外副韧带的平衡、以及伸膝装置与股四头肌及腘绳肌的力量均衡,尤其是内外侧副韧带的平衡和稳定作用。说明膝关节的解剖环境决定了膝关节在负荷、运动及稳定等生物力学特性上的复杂性,因此,了解膝关节生理结构和解剖特点有利于掌握膝关节的生物力学特点,因此此方面的研究对膝关节疼痛、损伤及组织工程研究至关重要。     

彩色多普勒超声对膝关节病变的诊断价值

目的探讨彩色多普勒超声对膝关节及膝关节周围组织病变的诊断价值。方法对75个病变膝关节进行高频超声检查，详细观察病变部位、大小、数目以及声像图改变等情况。结果75个病变膝关节超声检查声像图均有相应异常改变。结论超声具有无创、方便、快捷、重复性强等优点，可作为检查膝关节疾病的一种重要辅助手段。     

全膝关节置换术后关节活动范围的影响因素分析

目的:探讨全膝关节置换术后关节活动范围的影响因素,从而制订相应的康复治疗方案。方法:21例接受全膝关节置换术的患者入组,采用HSS评分法对所有患者进行术前膝关节功能评估,应用关节量角器对膝关节进行关节活动范围测定。采用Pearson相关分析法对术前各因素与术后1、2周及出院时膝关节活动范围进行相关分析。采用独立t检验对术后1、2周及出院时膝关节活动范围进行比较。结果:术前HSS总分、术前关节疼痛、术前膝关节功能、术前膝关节活动和术前屈膝畸形与术后1周膝关节活动范围成正相关,相关系数分别为0.546、0.430、0.423、0.539和0.403,P<0.05。术前所有评估因素除年龄外与术后2周和出院时关节活动度无相关。结论:术前关节疼痛、膝关节功能、膝关节活动和术前屈膝畸形与术后膝关节活动范围相关。     

佩带膝外翻支具膝骨关节炎患者膝关节的生物力学变化

背景：佩带膝关节外翻矫形器已被证明是一种可以有效减轻内侧间室膝骨关节炎患者疼痛的方法,但是佩带矫形器后的膝关节所产生的运动学以及动力学变化至今尚不明确。目的：观察内侧间室膝骨关节炎患者佩带膝关节矫形器前后的膝关节运动学以及动力学参数变化,便于为将来设计新型膝关节矫形器提供依据。方法：纳入20例内侧间室膝骨关节炎患者,分别通过三维步态分析系统和测力板对其在佩带膝外翻矫形器及不佩带膝外翻矫形器两种情况步行中的运动学及动力学参数进行采集,并进行对比。结果与结论：相比未佩带膝关节外翻支具,佩带膝关节外翻支具后患者在步行过程中膝关节内收力矩明显减小,与此同时膝关节内翻角度明显减小,外翻角度明显增加（P均〈0.05）,膝关节在步行过程中的最大屈曲角度以及时间空间参数差异无显著性意义。提示膝关节外翻矫形器可有效地通过增加内侧间室膝骨关节炎患者膝关节在步行过程中的外翻角度减小内翻角度从而降低膝内侧间室所承受的压力,与此同时纠正膝关节非正常对线。     

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。     

The effect of inturning of the foot on knee kinematics and kinetics in children with treated idiopathic clubfoot

OBJECTIVE: To assess the effect of internal foot progression angle (inturning) on knee dynamics in children with treated clubfeet. DESIGN: Prospective study dividing a population of clubfeet according to the factor inturning. BACKGROUND: Excessive internal or external foot progression angle increases knee flexion by a backward shift of the ground reaction force to the knee joint in children with cerebral palsy. Similarly, inturning in clubfeet was hypothesized to shift the ground reaction force backwards with reference to the knee joint, increasing the external knee flexion moment and the maximal knee flexion at stance. METHODS: Three-dimensional gait analysis was performed on 20 children with surgically treated clubfeet (n=28) to assess alterations of knee dynamics related to inturning (>7 degrees ) and on 13 normal children. RESULTS: Inturning occurred in 46% of the clubfeet and was associated during stance, at maximal knee flexion, to an increase in maximal knee flexion (+7 degrees ), external knee flexion moment (+60%) and related lever arm to the knee (+100%) and at minimal knee flexion, to a reduction in external knee extension moment (-62%) and related lever arm (-58%). Inturning was associated with a more frequent prolongation of internal knee extension moment and of rectus femoris activity exceeding 50% of stance. CONCLUSION: Inturning in clubfeet is associated with knee dynamics alteration, which might contribute to the long-term development of knee osteoarthritis. RELEVANCE: The therapeutic correction of inturning in clubfeet would be of importance if the consecutive knee dynamics alteration is shown by further studies to contribute to long-term degenerative knee pathology.     

佩带膝外翻支具膝骨关节炎患者膝关节的生物力学变化

背景:佩带膝关节外翻矫形器已被证明是一种可以有效减轻内侧间室膝骨关节炎患者疼痛的方法,但是佩带矫形器后的膝关节所产生的运动学以及动力学变化至今尚不明确。目的:观察内侧间室膝骨关节炎患者佩带膝关节矫形器前后的膝关节运动学以及动力学参数变化,便于为将来设计新型膝关节矫形器提供依据。方法:纳入20例内侧间室膝骨关节炎患者,分别通过三维步态分析系统和测力板对其在佩带膝外翻矫形器及不佩带膝外翻矫形器两种情况步行中的运动学及动力学参数进行采集,并进行对比。结果与结论:相比未佩带膝关节外翻支具,佩带膝关节外翻支具后患者在步行过程中膝关节内收力矩明显减小,与此同时膝关节内翻角度明显减小,外翻角度明显增加(P均<0.05),膝关节在步行过程中的最大屈曲角度以及时间空间参数差异无显著性意义。提示膝关节外翻矫形器可有效地通过增加内侧间室膝骨关节炎患者膝关节在步行过程中的外翻角度减小内翻角度从而降低膝内侧间室所承受的压力,与此同时纠正膝关节非正常对线。     

以屈膝肌群训练为主的康复训练对膝骨性关节炎的疗效

目的：探讨针对膝关节屈肌群训练为主的综合康复治疗对膝骨性关节炎（KOA ）的临床效果。方法：KOA患者97例,分为屈膝组33例、伸膝组33例和药物组31例。屈膝组、伸膝组均给予肌力训练、针刺、中频等综合康复治疗,屈膝组治疗以屈膝肌群部位为主,伸膝组治疗以伸膝肌群部位为主;药物组给予双氯酚钠缓释片口服及双氯酚酸二乙胺乳胶剂外用。结果：治疗1个疗程后,3组患者西部安大略湖与麦克马斯特骨性关节炎指数（W O M-AC）中3项评分、体征检查及综合评价评分均较治疗前明显下降（P＜0．01）,且屈膝组与伸膝组评分均更低于药物组（P＜0．01,0．05）,屈膝组WOMAC中的疼痛、身体功能评分较伸膝组降低更显著（P＜0．05）。屈膝组、伸膝组总有效率均高于药物组（P＜0．05）,复发率低于药物组（P＜0．05）,屈膝组与伸膝组比较差异无统计学意义。结论：膝关节屈肌群在膝关节功能中有重要作用,在治疗时可给予一定程度重视,加强膝关节功能的整体性治疗。     

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.     

Sex comparison of extensibility, passive, and active stiffness of the knee flexors

OBJECTIVE: To compare extensibility, and passive and active stiffness of the knee flexors between males and females. DESIGN: An experimental design utilized 15 males and 15 females to identify sex differences in active extensibility, and active and passive stiffness of the knee flexors. BACKGROUND: Muscle stiffness appears to contribute to joint stability from both mechanical and neuromuscular perspectives. Differences in knee flexor stiffness may partially explain higher female anterior cruciate ligament injury rates. METHODS: Active knee flexor extensibility was assessed as subjects extend the knee from a fixed hip position, measuring the final knee position. Passive knee flexor stiffness was calculated as the slope of the moment-angle curve resulting from controlled passive knee extension. Active knee flexor stiffness was assessed by loading the lower extremity with 10% total body mass, and measuring the damping effect of the knee flexors on imposed vibratory motion about the knee joint. RESULTS: Females displayed greater active extensibility (P<0.05), while males displayed greater active (P<0.05) and passive (P<0.05) knee flexor stiffness. Sex differences in active and passive knee flexor stiffness were not significant following normalization to anthropometric characteristics. CONCLUSIONS: The knee flexor musculature in males is less extensible and displays greater active and passive stiffness compared to females. However, these differences may be functions of greater mass and height in males.     

Effect of resisted knee flexion on knee extension torque

We tested the principle of "reversal of antagonists" by measuring the effect of resisted knee flexion on subsequent peak knee extension torque at velocities of 60 degrees/sec and 120 degrees/sec using an isokinetic dynamometer. We determined peak knee extension torques from torque curves produced during knee extension that was performed reciprocally with either passive or maximum voluntary resisted knee flexion. We used a crossover design so that all 18 healthy adult subjects performed knee extension reciprocally with both passive and resisted knee flexion. Paired means t tests revealed no statistically significant difference between the peak knee extension torques produced under the two knee flexion conditions either at 60 degrees/sec or 120 degrees/sec. We, therefore, concluded that resisted knee flexion does not augment peak knee extension torque under our conditions of testing. The concept of reversal of antagonists was not supported. Antagonistic muscle functioning, therefore, may be irrelevant to agonist isokinetic testing and training in neurologically healthy persons.     

Patients with total knee arthroplasty do not use all of their available range of knee flexion during functional activities

BackgroundRecent research designed to improve outcome from total knee arthroplasty has included focus on strategies that increase the range of post-operative knee flexion. Patients with knee arthroplasty can now expect > 100° of knee flexion following surgery, but it is not clear whether this improved range of motion facilitates outcome or whether patients take advantage of this range when completing daily functional activities. The aim of this study was to investigate the knee flexion angles used during daily functional activities that specifically required high degrees of knee flexion. It was hypothesised that patients with greater range of passive knee flexion would achieve higher degrees of knee flexion during functional activities.MethodsMotion analysis was used to assess the maximum knee flexion of 40 patients with total knee arthroplasty and 40 control participants as they performed maximum flexion squatting and lunging activities.FindingsPatients with knee arthroplasty used between 80.8 and 91.4° of knee flexion to complete these activities, which was 20 to 30% less than that used by the control participants. Patients with greater ranges of passive knee flexion had greater maximum knee flexion during functional activities. However, they used only between 68% and 77% of their full passive range when lunging and squatting.InterpretationThe development of rehabilitation strategies that aim to increase weightbearing knee flexion capacity may be warranted to improve functional performance following total knee arthroplasty.