膝骨性关节炎关节周围肌肉功能改善的治疗评价

背景：膝骨性关节炎患者存在膝关节周围肌肉萎软无力，综合治疗辅助膝关节周围肌力训练，可以明显缓解症状，恢复膝关节周围肌肉力量。 目的：用等速肌力测试膝骨性关节炎患者综合治疗前后膝关节周围肌肉的功能变化与膝关节功能的相关性，探讨膝骨性关节炎的病理机制，为临床康复及治疗提供依据。 方法：筛选Ⅱ期及Ⅲ期30例单侧膝骨性关节炎患者，用美国特种外科医院膝关节评分系统判定膝关节的功能情况，标准目测类比量表评分评定患者疼痛情况；测定治疗前膝骨性关节炎患者膝关节周围肌肉功能状况；对Ⅱ期及Ⅲ期膝骨性关节炎患者进行最少1个月的主动股四头肌等长性肌肉收缩运动及口服塞来昔布并关节腔内注射透明质酸钠的综合治疗，测定治疗后的膝关节肌肉功能状况，随访评价美国特种外科医院膝关节评分及标准目测类比量表评分。 结果与结论：与健侧相比，Ⅱ期及Ⅲ期膝骨关节炎患者屈伸肌峰力矩与作功量在60 (°)/s测试及180 (°)/s测试时，患侧肌力明显下降(P < 0.05)。经综合治疗后，膝骨性关节炎患者美国特种外科医院膝关节评分明显增加(P < 0.05)，而标准目测类比量表疼痛评分明显下降(P < 0.05)，患侧肌力明显增强(P < 0.05)；且治疗后膝骨关节炎患者患侧肌力与健侧的差异无显著性意义(P > 0.05)，但综合治疗前后膝骨性关节炎患者患侧膝腘绳肌股四头肌峰力矩比值在60 (°)/s测试中差异无显著性意义(P > 0.05)，而在180 (°)/s测试测试中差异有显著性意义(P < 0.05)。提示膝骨性关节炎患者存在膝关节周围肌力下降，通过肌肉功能锻练配合有效的止痛、营养关节药物的综合治疗，可以明显缓解症状，提高肌肉力量，恢复患者膝关节功能。

Knee muscle function recovery of patients with knee osteoarthritis: Treatment and evaluation

BACKGROUND:Muscle atrophy and weakness exist around the knee joint of patients with knee osteoarthritis, comprehensive treatment combined with training muscle power around knee joint can obviously relieve symptoms and restore muscle power around the knee joint. OBJECTIVE:To test the relationship between muscle function around the knee joint and the knee joint function with isokinetic muscle strength test before and after comprehensive treatment of knee osteoarthritis, and to investigate the pathological mechanisms of knee osteoarthritis in order to provide basis for the clinical rehabilitation and treatment.  METHODS:We screened out 30 subjects with unilateral knee osteoarthritis (stage Ⅱ and Ⅲ). Hospital for Special Surgery was used to evaluate the knee function, and visual analogue scale score was used to assess the patient pain. The knee muscle function of knee osteoarthritis patients was measured before treatment; the patients with knee osteoarthritis at stage Ⅱ and Ⅲ received comprehensive treatment for at least 1 month (active quadriceps isometric muscle strengthening exercises, oral celecoxib capsules combined with intra-articular injection of sodium hyaluronate), and knee muscle function was measured after treatment. Hospital for Special Surgery and the visual analogue scale score were evaluated during follow-up period. RESULTS AND CONCLUSION:Compared with the healthy side, the muscle power of the affected side of the patients with knee osteoarthritis was decreased when the flexion and extension muscle peak torque and work volume tested at 60 (°)/s and 180 (°)/s (P < 0.05). After comprehensive treatment, the Hospital for Special Surgery scores of the knee osteoarthritis patients were increased significantly (P < 0.05), while the visual analogue scale scores were decreased (P < 0.05), and the muscle power of the affected side was increased significantly (P < 0.05); there was no significant difference in the muscle power between affected side and healthy side after treatment (P > 0.05). There was no significant difference in the peak torque ratio of quadriceps and hamstring measured at 60 (°)/s in the knee osteoarthritis patients before and after treatment (P > 0.05), and there was significant difference measured at 180 (°)/s (P < 0.05). Knee osteoarthritis patients have decreased muscle strength around the knee joint, and the comprehensive treatment of muscle functional training combined with effective pain relief and nutrition joint drugs can significantly relieve symptoms, improve muscle strength and restore knee function