健康儿童在不同坡度上行走时的步态分析

目的探讨健康儿童在0°和10°运动平板上行走时的步态特征。方法选取2015年2月-2016年6月在四川省某医院体检的50名健康儿童为研究对象,采用荷兰进口的计算机辅助康复系统(CAREN)收集所有研究对象在0°和10°运动平板上步行的步态数据,并比较儿童在0°和10°运动平板上行走时的3个时空参数和12个运动学参数。结果儿童在10°运动平板上行走时的速度低于在0°运动平板上行走时的速度,差异有统计学意义(P0.05);儿童在10°运动平板上行走时的跨步长长于在0°运动平板上行走时,差异有统计学意义(P0.05);儿童在10°运动平板上行走时的步宽短于在0°的运动平板上行走时,差异有统计学意义(P0.05)。儿童在10°运动平板上行走时的躯干最大前倾角度、骨盆前倾角度、髋关节最大屈曲角度、髋关节最大伸展角度、首次触地时髋关节角度、膝关节承重期最大屈曲角度、膝关节最大伸展角度、首次触地时膝关节角度、踝关节最大背曲角度均大于在0°运动平板上行走时,差异均有统计学意义(P0.05);儿童在10°运动平板上行走时的首次触地时踝关节角度均小于在0°的运动平板上行走时,差异均有统计学意义(P0.05);儿童在10°运动平板上行走时的膝关节摆动期最大屈曲角度及踝关节最大跖曲角度与在0°运动平板上行走时比较,差异均无统计学意义(P0.05)。结论儿童通过调节下肢运动模式,能较好地适应坡度行走。但如果膝关节长期处于过度屈曲状态则会加重膝关节的负荷,导致膝关节疼痛。因此,坡度行走应用于康复训练或日常身体锻炼时,必须关注膝关节在站立期的改变。     

黑龙江省哈尔滨市社区中老年人骨关节炎流行病学调查

目的 了解黑龙江省哈尔滨市社区年龄≥40岁中老年人群膝骨关节炎的患病情况.方法 采用多阶段整群随机抽样方法,对所选取的社区中416名常住居民进行问卷调查和体格检查.结果 膝骨关节炎男女患病率分别为7.23％和10.09％,女性患病率随年龄的增加而逐渐增高(x2=8.12,P=0.012).膝骨关节炎患者的体质指数(body mass index,BMI)与未患膝骨关节炎者的差异有统计学意义(t=1.07,P=0.038).经Kendall相关分析,年龄与影像学分级之间呈现正相关关系(r =0.19,P=0.037).日常慢跑可能是膝骨关节炎发病的保护因素(OR =0.67,95％ CI:0.33～0.79).结论 2013年该地区40岁及以上中老年人群膝骨关节炎患病率相比2005年有所下降,女性患病率仍然高于男性.合理适度的运动对膝骨关节炎的预防有重要意义.     

玻璃酸钠结合中药治疗膝骨关节炎观察分析

目的 探讨玻璃酸钠结合中药治疗膝骨关节炎的临床疗效.方法 将我院2008年12月至2009年12月收治的180例膝骨关节炎患者随机分为观察组和对照组,对照组单纯采用膝关节注射玻璃酸钠治疗,观察组在对照组的基础上采用中药内治、外治等综合疗法,2组均以5周为1个疗程.采用Lysholm膝关节综合评分标准对两组治疗前后膝骨关节炎积分情况进行评价.结果 2组患者的膝关节综合评分均较治疗前有显著提高,但观察组的改善显著优于对照组,P＜0.05.观察组优50例,良35例,优良率为94.4%(85/90)显著高于对照组84.4%(76/90),P＜0.05.结论 玻璃酸钠结合中药治疗膝骨关节炎疗效较好,能显著改善患者症状,促进膝关节功能恢复.     

持续被动活动结合健康教育对膝骨关节炎术后患者疼痛及膝关节功能的影响

目的 探讨持续被动活动结合健康教育在膝骨关节炎术后患者中的应用价值。方法 选择在本院行手术治疗的65例膝骨关节炎患者,依据随机数字表法分为研究组(n=33)和对照组(n=32)。对照组采用常规护理,研究组予以健康教育联合持续被动活动干预,持续干预1个月。采用t检验比较2组膝关节功能、疼痛程度,采用χ2检验比较2组依从性。结果 干预1个月后,研究组Lysholm评分为(80.12±6.27)分,高于对照组的(69.16±6.68)分(t=6.828,P<0.01),均高于干预前(P<0.01)。与干预前比较,2组干预后VAS评分均降低(P<0.01),且研究组为(1.62±0.57)分,低于对照组的(2.85±0.71)分(t=7.714,P<0.01)。干预后,研究组总依从率为96.97%,高于对照组的75.00%(χ2=4.861,P=0.028)。结论 持续被动活动结合健康教育可减轻膝骨关节炎术后患者疼痛程度,提高锻炼依从性,利于患者膝关节功能改善。     

同期双侧全膝关节置换与选择性单侧膝关节置换术后早期功能康复临床观察

目的：评价同期双侧全膝关节置换与选择性单侧膝关节置换术后早期功能康复情况的差异。方法：将符合条件的60例患者按照置换方案进行分组,双膝组（n=26,52膝）行同期双侧全膝关节置换,单膝组（n=34,34膝）行单侧全膝关节置换。分别对两组患者置换前后的关节活动度、屈曲挛缩度、疼痛评分及HSS评分进行比较分析,并记录并发症的发生率。结果：置换术后1年随访,置换后关节活动度比较差异无统计学意义（P=0．146）;置换后屈曲挛缩度、疼痛评分,双膝组显著低于单膝组（P=0．039,0．04）;同时双膝组置换后HSS评分优于单膝组（P=0．023）。结论：同期双侧全膝关节置换患者在屈曲挛缩度、疼痛症状评分及HSS评分方面优于单侧全膝关节置换术,早期功能效果更好。     

电针联合功能锻炼和中药外敷治疗膝骨关节炎的临床疗效

目的探讨电针联合功能锻炼和中药外敷治疗膝骨关节炎的临床疗效。方法选取2018年1月-2020年1月重庆市某医院收治的100例膝骨关节炎患者,随机分为观察组和对照组,每组50例。对照组患者给予电针联合膝关节功能锻炼治疗,观察组患者在对照组基础上给予膝关节局部中药外敷治疗。比较2组患者治疗前后西安大略和麦克马斯特大学骨关节炎指数量表(WOMAC)评分、Lysholm膝关节评分量表(LKSS)评分和Lequesne指数、膝关节活动度及2组临床疗效。结果治疗前,2组患者WOMAC各项症状评分及总分比较,差异均无统计学意义(P0.05);治疗后,2组患者WOMAC膝关节疼痛、僵硬、膝关节功能评分及总分均低于治疗前,且观察组低于对照组,差异均有统计学意义(P0.05)。治疗前,2组患者膝关节活动度比较,差异无统计学意义(P0.05);治疗后,2组患者膝关节活动度大于治疗前,且观察组大于对照组,差异均有统计学意义(P0.05)。治疗前,2组患者LKSS评分和Lequesne指数比较,差异无统计学意义(P0.05);治疗后,2组患者膝关节LKSS评分高于治疗前且观察组高于对照组,而Lequesne指数低于治疗前且观察组低于对照组,差异均有统计学意义(P0.05)。观察组患者治疗总有效率为96.00%,高于对照组的82.00%,差异有统计学意义(P0.05)。结论电针联合功能锻炼和中药外敷治疗膝骨关节炎,可明显缓解患者局部疼痛,改善患者膝关节活动功能。     

正常范围血清尿酸水平与膝骨关节炎症状及结构改变的相关性

  目的  探讨膝骨关节炎(osteoarthritis,OA)患者正常范围血清尿酸(uric acid,UA)水平与膝关节症状、结构改变之间的相关性。  方法  收集205例膝OA患者,根据纳入及排除标准,最终122例OA患者纳入研究,调查患者一般情况,WOMAC骨关节炎指数(western ontario and mcMaster universities osteoarthritis index,WOMAC)评分评估膝关节症状严重程度,Kellgren-Lawrenc(K-L)分级评估膝关节放射学严重程度,在磁共振成像(magnetic resonance imaging,MRI)上利用Osirix软件测量关节结构改变,过氧化物酶法测定血清UA水平,选取正常范围UA纳入研究,分析UA水平与膝关节症状、结构改变之间的关系。  结果  研究发现,以UA中位数(263 μmol/L)分组进行组间比较,与UA ≥ 263 μmol/L组相比,UA < 263 μmol/L组患者的身高、体重较小,女性较多,而K-L分级≥ 2的比例较低;调整性别、年龄及体质指数后,UA水平与WOMAC总分(β=-16.15,P=0.018)、WOMAC疼痛(β=-3.15,P=0.037)、WOMAC僵硬(β=-1.65,P=0.025)呈负相关;但UA水平与膝关节结构改变无明显相关性。  结论  在膝OA患者中,正常UA水平与关节症状严重程度呈负相关,提示正常水平UA可能对OA关节症状具有保护作用。     

蠲痹汤联合关节腔内注射玻璃酸钠治疗老年膝骨关节炎效果分析

目的观察蠲痹汤联合关节腔内注射玻璃酸钠在老年膝骨关节炎患者中的临床治疗效果。方法取2015年3月~2016年8月医院收治老年膝骨关节炎患者90例,采用随机数字法分为对照组(n=45)和观察组(n=45)。对照组采用关节腔内注射玻璃酸钠治疗,观察组在对照组基础上联合蠲痹汤治疗,比较2组临床疗效。结果 2组治疗前骨关节炎指数、VAS评分比较差异无统计学意义(P﹥0.05);观察组治疗后骨关节炎指数、VAS评分,低于对照组(P﹤0.05);2组不良反应发生率比较差异有统计学意义(P﹤0.05)。结论老年膝骨关节炎患者在关节腔内注射玻璃酸钠基础上联合蠲痹汤治疗效果理想,值得推广应用。     

推拿结合膝关节外固定可调支具治疗48例老年膝骨关节炎的疗效观察

目的观察推拿结合膝关节外固定可调支具治疗老年膝骨关节炎的疗效,并与单纯采用膝关节外固定可调支具治疗做比较分析。方法将96例老年膝骨关节炎患者随机分为两组,对照组采用膝关节外固定可调支具治疗的方法,治疗组在对照组的基础上,采用推拿手法进行治疗。采用骨关节炎指数(WOMAC)量表分别在治疗前、治疗后2周、4周,对患者膝关节的疼痛、僵硬、功能是否丧失及总分等方面进行疗效评定。结果两组患者WOMAC各项指标评分与治疗时间相关,各时间点之间差异有统计学意义(P<0.01)。两组WOMAC各项指标评分比较差异亦有统计学意义(P<0.05或P<0.01)。结论相较于单纯使用膝关节外固定可调支具治疗老年膝骨关节炎,推拿结合膝关节外固定可调支具疗法在治疗老年膝骨关节炎过程中,缓解疼痛的作用更为显著。     

人工膝关节置换术后早期功能锻炼的康复护理体会分析

目的:分析人工膝关节置换术后患者实行早期功能锻炼康复护理的价值与意义。方法:选取2017年3月至2018年4月本院收治的65例人工膝关节置换患者,随机的分为对照组和观察组,对照组32例,观察33例,对照组给予早期功能锻炼常规护理,观察组给予早期功能锻炼康护护理。对比两组术后4天、2周及1个月膝关节伸直度和患膝屈曲度。结果:观察组术后膝关节伸直度和患膝屈曲度均优于对照组,数据差异明显(p 0.05)。结论:人工膝关节置换术后在患者早期功能锻炼时给予康护护理效果更佳,可有效起到改善膝关节功能的作用,促进患者身体康复。     

关节镜微创技术对膝关节骨性关节炎患者的临床疗效

目的探讨关节镜微创技术治疗膝关节骨J生关节炎的临床效果。方法选择120例膝关节骨性关节炎患者,按随机数字表法分为治疗组和对照组,每组60例,分别行关节镜微创技术治疗以及常规治疗。比较两组手术前后膝关节活动度和膝关节综合评价情况。结果平均随访18个月。治疗组膝关节活动度术前为（62．5±5．5）°,对照组术前为（64．5±6。5）°,两组比较差异无统计学意义（P〉0．05）;治疗组膝关节活动度术后为（92．5±4．2）°,对照组为（70．5±4．5）°,治疗组术后明显优于术前和对照组术后,差异有统计学意义（P〈0．05）。治疗组膝关节综合评价优良率96．7％（58／60）,明显高于对照组的73．3％（44／60）,差异有统计学意义（P〈0．05）。结论关节镜微创技术操作简便,术后患者恢复快,明显改善膝关节骨性关节炎患者临床症状。     

Factors associated with osteoarthritis of the hip and knee in Hong Kong Chinese: obesity, joint injury, and occupational activities

In 1998, a case-control study was conducted in Hong Kong on hospital patients with osteoarthritis of the hip (n = 138) and osteoarthritis of the knee (n = 658). Age- and sex-matched controls were recruited consecutively from general practice clinics in the same region. The following three risk factors were found to be associated with osteoarthritis of both the hip and the knee: first, a history of joint injury: for osteoarthritis of the hip, the odds ratio = 25.1 (95% confidence interval (CI): 3.5, 181) in men and 43.3 (95% CI: 11.7, 161) in women; for osteoarthritis of the knee, the odds ratio = 12.1 (95% CI: 3.4, 42.5) in men and 7.6 (95% CI: 3.8, 15.2) in women; second, climbing stairs frequently: for osteoarthritis of the hip, the odds ratio = 12.5 (95% CI: 1.5, 104.3) in men and 2.3 (95% CI: 0.6, 8.1) in women; for osteoarthritis of the knee, the odds ratio = 2.5 (95% CI: 1.0, 6.4) in men and 5.1 (95% CI: 2.5, 10.2) in women; third, lifting heavy weight frequently: for osteoarthritis of the hip, the odds ratio = 3.1 (95% CI: 0.7, 14.3) in men and 2.4 (95% CI: 1.1, 5.3) in women; for osteoarthritis of the knee, the odds ratio = 5.4 (95% CI: 2.4, 12.4) in men and 2.0 (95% CI: 1.2, 3.1) in women. In addition, subjects whose height and weight were in the highest quartile were at increased risk of osteoarthritis of the hip and knee, respectively (p < 0.05).     

Performance-based physical functioning in African-American and Caucasian women at midlife: considering body composition, quadriceps strength, and knee osteoarthritis

In 2000, body composition, x-ray-defined knee osteoarthritis, and self-reported knee pain information from a cross-sectional, community-based study of 211 African-American and 669 Caucasian women in southeast Michigan (mean age, 47 years) was related to performance-based physical functioning measures to characterize development of functional limitations. Body composition was assessed with bioelectrical impedance. Functioning measures were gait assessment, timed walk, timed stair climb with and without videography, and isometric quadriceps strength. Knee osteoarthritis was determined by Kellgren-Lawrence score from radiography, whereas knee pain was self-reported. Almost 31% of mid-aged women walked at functionally inadequate speeds, and over 12% walked at speeds considered typical of frailty in older women. Ten percent of women had skeletal muscle mass levels less than a proposed cutpoint for increased physical disability risk in older adults. Gait measures correlates included increasing age, increasing fat mass (in kilograms), knee joint pain, and reduced quadriceps strength. Stair climbing correlates included skeletal muscle mass (in kilograms) and its change, painful knee osteoarthritis, and reduced quadriceps strength. Race differences in walking measures and stair climbing time diminished when the authors accounted for other factors. Compromised physical functioning began earlier than expected, with indications that approximately 12-31% of women might benefit from interventions to forestall future decline.     

超重肥胖对儿童跑步时膝关节生物力学的影响

  目的  探讨超重肥胖对儿童跑步时膝关节生物力学的影响，为超重肥胖儿童科学制定运动处方并降低运动损伤风险提供理论支持。  方法  2020年6—8月，选取江苏省徐州市某小学7~11岁正常体重(健康组)和超重肥胖(超重肥胖组)儿童各15名。受试者以[3.5×(1-5%)~3.5×(1+5%)]m/s的速度跑过测力平台，利用Simi Motion动作捕捉系统和Kistler三维测力平台同步采集膝关节运动学与动力学数据，采用外周定量计算机断层扫描测定胫骨平台表面积和密度。对比两组膝关节角度以及基于胫骨平台维度的冲击力学与膝关节力矩的差异。  结果  超重肥胖组跑步时支撑相膝关节外展峰值角度[(6.14±4.16)°]高于健康组[(2.57±1.36)°](t=-3.16，P < 0.01)；基于胫骨平台密度标准化后，超重肥胖组的冲击力学(垂直地面反作用力峰值、冲击峰值、最大负载率及平均负载率)与膝关节力矩(膝关节屈膝力、伸展力、内收力矩峰值)均高于健康组(t值分别为-4.26，-4.52，-2.97，-2.74；-2.17，-4.27，-3.70，P值均 < 0.05)。  结论  超重肥胖儿童表现出异常的跑步力学和膝关节负荷模式，跑步时支撑相膝关节承受较大负荷，可能增加前交叉韧带损伤或骨关节炎的发生风险。     

汽疗、膝关节松动术、肌力训练综合治疗老年膝关节骨关节炎疗效分析

目的 观察汽疗、膝关节松动术、肌力训练综合治疗老年膝关节骨关节炎的疗效。方法 将60例膝关节骨关节炎的患者随机分为治疗组与对照组，每组30例，治疗组采用汽疗、膝关节松动术、肌力训练治疗；对照组采用汽疗、微波、电脑中频疗法。结果 治疗组疗效明显优于对照组。结论 汽疗、膝关节松动术、肌力训练综合治疗老年膝关节骨关节炎可获得满意的治疗效果。     

Physical activity and self-reported, physician-diagnosed osteoarthritis: is physical activity a risk factor?

This prospective study evaluated regular physical activity and self-reported physician-diagnosed osteoarthritis of the knee and/or hip joints among 16,961 people, ages 20-87, examined at the Cooper Clinic between 1970 and 1995. Among those aged 50 years and older, osteoarthritis incidence was higher among women (7.0 per 1000 person-years) than among men (4.9 per 1000 person-years, P = 0.001), while among those under 50 years of age, osteoarthritis incidence was similar between men (2.6) and women (2.7). High levels of physical activity (running 20 or more miles per week) were associated with osteoarthritis among men under age 50 after controlling for body mass index, smoking, and use of alcohol or caffeine (hazard ratio = 2.4, 95% CI: 1.5, 3.9), while no relationship was suggested among women or older men. These findings support the conclusion that high levels of physical activity may be a risk factor for symptomatic osteoarthritis among men under age 50.     

北京地区1858名老年人下蹲与膝关节骨关节炎患病率的回顾性调查

目的研究北京地区老年人下蹲与膝关节骨关节炎(OA)患病率之间的关系。方法随机抽取北京地区年龄≥60岁的老年人,回答有关关节症状的调查问卷,行双侧膝关节X线照相(前后位和冠状位),并回忆其年轻时(25岁±)平均每天的下蹲时间。结果40%的男性和68%的女性年轻时平均每天的下蹲时间≥1 h。随着每天下蹲时间的延长,胫股骨关节OA的患病率增加。与年轻下蹲时间<30 min比较,男性中不同的下蹲时间胫股骨关节OA的OR值分别为:1.1(30- 59 min/d)、1.0(60-119 min/d)、1.7(120-179 min/d)、2.0(≥180 min/d)(P=0.074),女性的OR值相应为1.4、1.3、1.2、2.4(P=0.077)。髌股骨关节OA与下蹲的相关性弱于胫股骨关节OA与下蹲的关系。结论下蹲时间的延长可能是北京地区老年人胫股骨关节OA发生的高危险因素之一。     

黑龙江省不同人群麻疹血清流行病学调查分析

目的了解黑龙江省不同人群麻疹抗体水平。方法采集我省健康人群、麻疹病例和麻疹病例周围人群等不同人群的血清标本．检测麻疹抗体。结果健康人群麻疹抗体水平以15～39岁人群抗体阳性率和几何平均抗体浓度（GMC）均为最低;15～39岁组人群麻疹病例周围人群与健康人群抗体阳性率差异无统计学意义（P=0．249）,但GMC却高于健康人群的抗体水平（P〈0．001）;麻疹病例抗体水平以1～岁组阳性率最低,并有随年龄增长而升高的趋势。结论15—39岁组这部分人群是黑龙江省成人麻疹发病的高危人群,也是今后消除麻疹工作的重点人群,针对这部分人群如何采取免疫策略,控制其发病,将成为消除麻疹面临的新挑战。     

Diagnostic discordance: we cannot agree when to call knee pain 'osteoarthritis'

BACKGROUND: Joint pain is common in community-dwelling older adults. Osteoarthritis is the most likely cause and the most common diagnosis made in this age group by GPs. However, the level of agreement between patients and their GPs in this diagnosis is questionable and may have important implications for clinical care. OBJECTIVES: Our aim was to determine the level of agreement between GP diagnosis of knee osteoarthritis and patients' own attribution of osteoarthritis in older adults consulting their GP with knee pain. METHODS: Forty-five patients aged > or =50 years were recruited retrospectively from consecutive knee pain attenders at two general practices in North Staffordshire. All patients were assessed by trained research physiotherapists using standardized assessment procedures. Patients' attribution was assessed by the open-ended question "What do you think is the matter with your knee now?" Blind to the findings of the assessment, a researcher extracted the most recent knee-related Read code recorded by the patient's GP from the medical records to determine GP diagnosis. The physiotherapists also classified patients as osteoarthritis or non-osteoarthritis according to the American College of Rheumatology's clinical classification criteria. RESULTS: Agreement between GP diagnosis of 'knee osteoarthritis' or 'osteoarthritis NOS' and patient diagnostic attribution of knee 'arthritis' or 'osteoarthritis' was poor [kappa=-0.03; 95% confidence interval (CI) -0.32 to 0.26]. Neither the GP diagnosis nor the patient diagnostic attribution was strongly related to clinical classification using standard criteria (kappa=0.28; 95% CI -0.01 to 0.56; and kappa=-0.39; 95% CI -0.66 to -0.13, respectively). CONCLUSIONS: The level of agreement between a GP diagnostic code of osteoarthritis and patients' use of the term '(osteo)arthritis' is no greater than would be expected by chance alone. Discordance may be high in the use of the label osteoarthritis but is not direct evidence of a lack of shared understanding of this condition.