膝关节弥漫性色素沉着绒毛结节滑膜炎关节镜手术加中药治疗观察

目的:观察中药对膝关节弥漫性色素沉着绒毛结节滑膜炎关节镜手术治疗后的作用。方法:本组9例,年龄15~58岁,平均39岁。病程15~36个月,平均21个月。采用常规前内上、前外上、前内下、前外下入路,再作后内、后外辅助入路及跨后纵隔入路。必要时辅助关节外小切口,将滑膜全切。所有患者均在术后附加利湿消肿中药口服。术后经过6~36个月随访,了解患膝活动度及功能情况。结果:最后随访膝关节活动度均超过120°,平均136.0°±3.5°,IKDC膝关节功能主观评分(82.9±5.0)分,Lysholm膝关节功能评分为(81.4±3.6)分。结论:在关节镜清理术后应用利湿消肿中药对于患肢疼痛缓解及肿胀消退具有明确疗效。     

Contrast-enhanced triggered harmonic sonography for assessment of periarticular hemodynamic changes in experimental arthritis

Background Objective quantification is critical for assessment of functional sonography in inflammatory arthritis. To create a microbubble contrast-enhanced image of vessels that lie below the resolution of a standard US system, a technique is required that detects preferentially the contrast agent echo, rejecting that from background tissue: harmonic imaging. Objectives To investigate the ability of contrast-enhanced triggered harmonic sonography (CETHS) to evaluate periarticular hemodynamic changes over the course of experimental arthritis and to discriminate presence and absence of arthritis based on measurement values obtained at specific time-points. Materials and methods Arthritis was induced in rabbits knees by intra-articular injection of serum bovine albumin, which acted as an antigen. A total of 11 rabbits (8 with unilateral arthritis and 3 control animals) were imaged at 0, 1, 7, 14, 21 and 28 days of antigen-induced arthritis and euthanized at 28 days. A continuous infusion protocol was performed (triggering times 30.0, 20.0, 10.0, 5.0, 2.0, 1.0, and 0.5 s). Hemodynamic indices of synovial microvasculature (vascular volume, mean velocity and flow rate) were obtained and compared with clinical, laboratory, and histological surrogate markers. Results Although interval CETHS changes were noted for flow rate (P=0.007) and vascular volume (P=0.003) ratios in albumin-injected knees, no significant differences in ratios were identified over time between albumin-injected and non-injected knees for flow rate (P=0.52), vascular volume (P=0.23) and mean velocity (P=0.19). Flow rate most accurately differentiated between presence and absence of arthritis according to clinical measurements in early (day 1) arthritis, and mean velocity in mid-term arthritis (day 14; both P=0.02). Conclusion Although the measurement properties of CETHS indices were poor in the evaluation of hemodynamic differences over time in albumin-injected knees compared with non-injected knees, they enabled discrimination between presence and absence of arthritis at specific time-points in different stages.     

关节内注射富血小板血浆或玻璃酸钠联合等速肌力训练对膝骨性关节炎的影响

目的 观察在等速肌力训练基础上,向关节腔内注射富血小板血浆（PRP）或玻璃酸钠对膝骨性关节炎（KOA）的疗效。 方法 采用随机数字表法将50例KOA患者分为PRP组和玻璃酸钠组,每组25例。PRP组采用5 ml自体PRP进行膝关节腔内注射,每2周1次,连续6周;玻璃酸钠组采用2 ml玻璃酸钠进行膝关节腔内注射,每周1次,连续6周。术后两组均进行等速肌力训练,每周3次,连续6周。治疗前及治疗6周后、3个月、6个月、12个月,对患者进行随访,进行西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评估,采用Biodex System 4型等速肌力测试系统评价患侧膝关节屈、伸肌峰力矩(PT)、总功量(TW)和平均功率(AP)。 结果 治疗前,2组患者WOMAC疼痛、僵硬、关节评分比较,差异无统计学意义（P>0.05）。与组内治疗前比较,2组患者治疗后不同时间点的WOMAC疼痛、僵硬、关节评分均有所改善（P<0.05）。与玻璃酸钠组治疗后同时间点比较,PRP组治疗3个月［（6.44±1.56）分］、6个月［（6.12±2.72）分］、12个月［（7.18±2.19）分］的WOMAC疼痛评分较低（P<0.05）,PRP组治疗6个月［（2.11±1.07）分］、12个月［（2.55±0.77）分］的WOMAC僵硬评分较低（P<0.05）,PRP组治疗6个月［（24.54±7.09）分］、12个月［（25.04±5.72）分］的WOMAC关节功能评分较低（P<0.05）。与组内治疗前比较,2组患者治疗6周后、12个月时在角速度60°/s、90°/s下的屈肌、伸肌PT、TW、AP均有所改善（P<0.05）。与玻璃酸钠组治疗后同时间点、同指标比较,PRP组治疗12个月时在角速度60°/s、90°/s下的屈肌、伸肌PT、TW、AP较为优异,差异有统计学意义（P<0.05）。 结论 关节腔内注射自体PRP或玻璃酸钠联合等速肌力训练均能有效缓解KOA患者的膝关节疼痛及活动受限等临床症状,但PRP疗效更显著,值得临床应用、推广。     

关节镜辅助下应用自体半腱肌腱微创重建膝交叉韧带和加强重建后外侧角韧带

目的探讨膝交叉韧带和后外侧韧带结构损伤的治疗方法 ,评估临床治疗效果。方法 2004年5月～2009年2月,对32例膝交叉韧带合并后外侧韧带结构损伤的患者,在关节镜辅助下应用自体半腱肌腱一期重建交叉韧带和加强重建后外侧角韧带。结果 32例随访1～4年,平均2.3年。所有患者在站立、行走和下楼梯时没有与膝关节后外侧不稳相关的过伸位膝关节不稳感;未发现行走时膝关节内甩者。关节活动度,屈曲110°～130°,平均118°;伸0°～5°。按照IKDC膝关节评分标准,主观评价:正常10例(31%),近似正常16例(50%),不正常6例(19%),无严重异常;客观评价48～95分,平均83分。结论对膝交叉韧带合并后外侧韧带结构损伤,通过应用自体半腱肌腱微创手术重建能够满意恢复膝关节后外侧的稳定性和关节功能。     

基于经筋理论的理筋手法治疗膝骨性关节炎的疗效观察

目的 观察理筋手法对膝骨性关节炎（KOA）患者关节疼痛、活动功能及步态的影响。 方法 采用随机数字表法将61例KOA患者分为观察组（31例）及对照组（30例）。2组患者均给予超声波理疗及运动训练（包括股四头肌训练及提踵训练）,观察组患者在此基础上辅以理筋手法治疗。2组患者均每天治疗1次,每周治疗5 d,连续治疗3周。于治疗前、治疗3周后分别采用视觉模拟评分法（VAS）、西安大略和麦克马斯特大学(WOMAC)骨关节炎指数量表及三维步态分析设备对2组患者膝关节疼痛、运动功能及步态时空参数（如步长、步速、双支撑相占比）进行评测。 结果 与治疗前比较,治疗后2组患者疼痛VAS评分、WOMAC量表关节疼痛、僵硬、功能障碍维度评分及总分均明显降低（P＜0.05）;观察组步长、步速及双支撑相占比均明显改善（P＜0.05）,对照组仅有步速、双支撑相占比明显改善（P＜0.05）。通过组间对比发现,治疗后观察组患者疼痛VAS评分、WOMAC量表各维度评分、总分及步态时空参数（如步长、步速、双支撑相占比）均显著优于同期对照组水平（P＜0.05）。 结论 在常规康复干预基础上辅以理筋手法能进一步缓解KOA患者疼痛,减轻膝关节功能障碍程度,提高步行效率,从而改善患者生活质量。     

正常膝关节几何学及其参数的测量

目的　建立正常典型的膝关节三维解剖模型 ,并对之进行测量。方法　对正常膝关节进行扫描 ,以数字化的形式输入到计算机中 ,建立典型膝关节三维解剖模型 ,并对其线性、角度等 1 5项指标进行测量。结果　①所建立的膝关节三维解剖模型 ,代表了绝大多数人的膝关节特征 ;②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 ;③角度指标是相对独立的一组指标。结论　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     

新型膝部约束带的设计及应用

临床上为了防止谵妄、昏迷、躁动等患者因意识不清或其他原因而发生坠床、撞伤、抓伤等意外变故,或因诊疗、护理需要而限制患者下肢活动时,在征得患者家属知情同意后,常使用约束带对患者膝部实施约束[1].传统的膝部约束带在使用时存在易滑脱、舒适度差、松紧度不好调节等缺点.     

髌韧带移植重建交叉韧带距离及其临床意义

ObjectiveTo study the location and the length of cruciate ligament transposed from patellar ligament and the clinical significance.MethodsThe location of the reconstructed cruciate ligament and the bone-patellar ligament-bone (B-PL-B) were measured on 18 knees of fresh cadavers.ResultsThe lengths of reconstructed anterior and posterior cruciate ligaments and of the bone-patellar-bone were 22.5±0.9 mm,29.0±2.5 mm and 41.0±4.0 mm respectively.ConslusionsThe length of the patellar ligament is enough for the reconstruction of the cruciate ligaments.The locations and the lengths of the reconstructed ligaments play an important role in functional recovery and stabilization of the joint.     

Obtaining anatomic motion and laxity characteristics in a total knee design

BackgroundSince the introduction of the first total knee designs, a frequent design goal has been to reproduce normal knee motion. However, studies of many currently used total knee designs, have shown that this goal has not been achieved. We proposed that Guided Motion total knee designs, could achieve more anatomic motion than present standard designs.MethodsSeveral Guided Motion knees for application without cruciate ligaments were designed using a computer method where the bearing surfaces were generated by the motion required. A knee testing machine was constructed where physiological forces including compressive, shear and torque were applied during knee flexion. The neutral path of motion and the laxity about the neutral path were measured. This evaluation method was a modification of the ASTM standard Constraint Test.ResultsThe motions of the Guided Motion knees and a standard PS knee were compared with the anatomic motion of knee specimens determined in an earlier study The Guided Motion knees showed motion patterns which were closer to anatomic than the PS knee.ConclusionsThe results provided justification for carrying out further evaluations of functional conditions, using either knee simulators or computer modelling. If anatomic motions could be reproduced in vivo, it is possible that clinical outcomes could be improved.     

电针对膝关节骨关节炎患者血清IL-1β及TNF-α水平的影响

目的:探讨电针治疗对膝关节骨关节炎(osteoarthritis,OA)的疗效及其对血清白细胞介素(IL-1β)、肿瘤坏死因子(TNF-α)水平的影响.方法:43例膝OA患者予电针治疗,穴取梁丘、血海、阴陵泉等,观察治疗前后患膝疼痛程度、下肢日常活动能力以及IL-1β、TNF-α水平的变化.结果:经电针治疗后,OA患者的患膝疼痛目测类比定级法(VAS)评分治疗后(32.50±10.79)较治疗前(64.22±14.55)明显降低,下肢功能评分治疗后(9.05±1.89)较治疗前(7.38±2.01)明显增加,即患者的疼痛症状及下肢功能均有显著改善(均P<0.01);同时,血清中IL-1β、TNF-α水平均明显降低(均P<0.05).结论:电针治疗对膝OA患者的短期疗效较好,其治疗作用可能与抑制IL-1β及TNF-α的活性有关.