双侧膝骨性关节炎动态足底受力时间分布规律研究

目的:分析双膝骨性关节炎(osteoarthritis,OA)患者在步行周期中支撑相时足底各区域压力变化与正常健康人的差异,为疾病状态下的足底压力变化特征提供量化依据。方法:选取2016年1月—2018年12月于河北省沧州中西医结合医院就诊的30例双侧膝关节炎的患者以及30例健康正常人为研究对象,采用Foot Scan测量系统采集患者及正常人足底7个区域的数据,选择各区域开始触地时刻、结束触地时刻,以及触地(受力)时间比作为主要参数进行统计分析。结果:正常健康组相较于双KOA组,开始触地时刻左足足底M1区(P0.01)、M2区(P0.05)较晚,右足足底M1区、M2区、M3区、M4区(P0.01)较晚;结束触地时刻,左足足底M3区(P0.05)、M4区、M5区、HM区、HL区(P0.01)较早,右足足底M3区、M4区较早(P0.05)、HM区、HL区较早(P0.01);触地时间比,左足足底M2区、M3区、M4区、M5区、HM区、HL区较短(P0.01),右足足底M1区、M2区、M3区、M4区、HM区、HL区较短(P0.01)。双KOA患者左右足比较,开始接触地面时刻无差异,左足结束触地时刻M4、M5区较右足晚(P0.05),触地时间百分比M5区较右足高(P0.01)。结论:①双KOA患者左右足受力不均衡,主要表现在M4、M5结束触地时刻左足较右足晚。②双KOA患者足底各区域受力时间分布具有特征性,足底各区域触地(受力)时间百分比左右足高于正常健康人群,M3、M4区触地(受力)时间延时最长。     

正常人足底压力分布及其影响因素分析

目的　检测中国正常成人足底压力分布及其影响因素 ,为足底压力在各领域的应用提供基线数据。方法　使用自行研制的足底压力测量仪 ,检测 15 8例正常人静态和动态足底峰值压力和各部位最大压力。结果　正常人平均动态和静态足底峰值压力分别为 ( 2 .96± 0 .66)kg/cm2 和 ( 1.2 8± 0 .3 3 )kg/cm2 ;除足弓区域静态最大压力右足 [( 0 .3 8± 0 .17)kg/cm2 ]略大于左足 [( 0 .3 5± 0 .13 )kg/cm2 ]外 ,双足各部位动态和静态最大压力无明显差异 ;男性、女性动态 [( 2 .87± 0 .5 8)kg/cm2 和 ( 3 .0 7± 0 .77)kg/cm2 ]和静态 [( 1.2 7± 0 .3 4)kg/cm2 和 ( 1.2 8± 0 .3 2 )kg/cm2 ]最大峰值足底压力无明显统计学差异 ;静态峰值足压与体重指数 (BMI)弱正相关 ,r =0 .185 (P =0 .0 3 ) ;动态峰值足压与年龄、体重和BMI弱正相关 ,相关系数分别为 0 .175 (P =0 .0 3 )、0 .2 1(P =0 .0 0 9)、0 .2 45 (P =0 .0 0 2 )。结论　正常人静态和动态足底压力分布不同 ,双足压力分布对称 ,动态和静态峰值足压与年龄、性别、身高、体重相关性较弱。     

膝关节骨性关节炎非手术治疗的研究进展

膝关节骨性关节炎(KOA)是一种最常见的膝关节相关的疾病,是一种影响软骨、软骨下骨、滑膜关节囊、滑液、韧带、半月板和肌肉等结构的以关节和关节软骨破坏为主的退行性疾病,是与年龄有关的关节病变,多发于中老年人。主要通过物理疗法、运动疗法、健康教育、药物治疗、自噬疗法、自体富含血小板血浆注射及手术治疗等改变这种关节及关节软骨退变。本文主要以KOA的非手术治疗展开综述。     

膝关节骨性关节炎的中西医护理

本文结合临床护理实践,总结膝关节骨性关节炎发生、发展过程中对患者进行生理、心理及康复训练指导为目的的中西医护理经验,以便控制疾病的进一步发展,促进患者康复.     

透明质酸钠治疗膝关节骨性关节炎60例分析

目的：观察透明质酸钠关节腔内注射治疗膝关节骨性关节炎的临床疗效。方法：应用透明质酸钠注射液对门诊确诊的60例膝关节骨性关节炎患者进行关节腔内注射治疗,并运用Bristol膝关节评分系统对治疗后患者膝关节疼痛和功能改善情况进行对比分析。结果：除2例无明显好转外,余58例治疗后关节疼痛和功能活动均得到明显改善。结论：透明质酸钠注射液对膝关节骨性关节炎具有较好疗效,无明显不良反应。     

推拿电针治疗膝关节骨性关节炎疗效观察

目的：探讨推拿电针治疗膝关节骨性关节炎的临床疗效。方法：比较推拿、电针和单纯电针两法治疗膝关节骨性关节炎的效果。结果：两组疗效分析：推拿、电针的疗效明显优于单纯电针的疗效。结论：推拿加电针治疗膝关节骨性关节炎具有一定的优越性。     

膝关节骨性关节炎的治疗进展

膝关节骨性关节炎（osteoarthritis,OA）又称膝关节增生性关节炎、退行性关节炎、退行性骨关节病等,是一种以关节软骨变性或丢失及关节边缘和软骨下骨质再生为特征的慢性关节炎症。该病始发部位在软骨,以老年人群最为常见,男女均可发病。60岁以上人群50％X线片有骨性关节炎的表现,其中35％～50％有临床表现;75岁以上者80％有骨性关节炎症状。随着人类寿命的延长,     

复方杜仲健骨颗粒改善膝关节骨性关节炎患者膝关节功能400例分析

背景根据国家药品监督管理局批文精神,进行复方杜仲健骨颗粒(伯司庄)治疗膝关节骨性关节炎临床试验.目的评价复方杜仲健骨颗粒改善膝骨关节炎患者膝关节功能及治疗的安全性.设计以壮骨关节丸为对照药,双盲双模拟随机方法.单位福建省中医药研究院、中国中医研究院广安门医院、中国中医研究院骨伤科研究所和北京中医医院.对象自1999-09/12,进行Ⅱ期临床试验,观察膝关节骨性关节炎患者200例,其中复方杜仲健骨颗粒组100例,壮骨关节丸组100例;自1999-12/2000-03,进行Ⅲ期临床试验,观察膝关节骨性关节炎患者400例,其中复方杜仲健骨颗粒组300例,壮骨关节丸组100例.所有患者均经X射线检查确诊;中医证见肝肾不足,筋脉瘀滞证;患者均知情同意.方法复方杜仲健骨颗粒组复方杜仲健骨颗粒(1包/次,3次/d)+壮骨关节丸模拟剂;壮骨关节丸组复方杜仲健骨颗粒模拟剂+壮骨关节丸(1包/次,2次/d).双盲双模拟随机对照,治疗1个月,观察临床疗效.主要观察指标患者经治疗后的关节功能、临床疗效、中医证侯积分和不良反应.结果参选的600例患者全部完成数据采集,无脱落者.①复方杜仲健骨颗粒组总有效率明显优于壮骨关节丸组(92%,82%).②与壮骨关节丸组比较,复方杜仲健骨颗粒组关节功能明显优于壮骨关节丸组.③复方杜仲健骨颗粒在改善中医证侯方面优于壮骨关节丸组(积分下降值分别为7.03±3.38,5.43±3.16).④试验过程中未见明显不良反应.结论复方杜仲健骨颗粒能有效改善膝骨关节症状,应用安全、有效.     

关节镜治疗老年性膝关节骨性关节炎126例分析

老年性膝关节骨关节炎是由于各种原因致膝关节退行性变关节软骨改变的一种常见病,是严重威胁老年人健康的一种慢性进行性骨关节疾病,中老年患者多见,发病时间长,致残率高。目前治疗老年性骨关节炎方法较多,以理疗、休息应用非甾体类抗炎药物为主,但不能控制病情发展。     

膝骨性关节炎功能评价步态指标研究——足底压力各阶段时间分布及地面垂直反力

目的探讨膝骨性关节炎患者足底压力各阶段时间分布及地面垂直反力。方法选取40例膝骨性关节炎(KOA)患者、10位正常老年人和10位正常年轻人,运用足底压力测量系统测试单足支撑期足底压力各阶段时间分布及地面垂直反力。结果在时间分布上,单侧OA组健、患侧触地初期和前脚掌蹬离期差异无显著性意义(P>0.05),健、患侧之间前脚掌触地及全足支撑期差异有非常高度显著性意义(P<0.001);单侧KOA组健侧与正常老年组相应侧比较,各阶段差异均有显著性意义(P<0.05)。双侧OA组左右侧相比差异无显著性意义(P>0.05),与单侧KOA组健、患侧比较,各阶段差异均有显著性意义(P<0.05)。单侧KOA组健、患侧缓冲时间T0和缓冲力系数K值差异有非常显著性意义(P<0.01),健侧与正常老年人比较差异有显著性意义(P<0.025,P<0.001);双侧KOA组自身比较差异无显著性意义(P>0.05),但小于正常老年组及单侧KOA组健侧(P<0.05)。结论KOA患者单足承重期时间减少,缓冲时间缩短,缓冲力系数降低,这些指标可以作为KOA患者功能评价步态指标和疗效客观依据。     

超氧化物歧化酶在膝骨关节炎患者血清中的变化及相关因素分析

目的研究膝骨关节炎(KOA)患者血清超氧化物歧化酶(SOD)的变化及其影响因素。方法比色法测定62例KOA患者血清SOD,并与年龄、症状积分、性别、病程、膝关节功能影响指数(Lequesne MG)及红细胞沉降率(ESR)、超敏C反蛋白(CRP)等实验室指标进行相关性分析。结果 62例KOA患者血清SOD值与正常参考值比较,下降的有36例,下降异常率达58%;轻、中、重度组血清SOD比较,重度组低于中度组,中度组低于轻度组(P<0.05);相关性分析显示,SOD与病程、Lequesne MG、中医症候积分、ESR、CRP、免疫球蛋白M(IGM)呈负相关,与C3、C4呈正相关(P<0.05),而与年龄、性别、白细胞(WBC)、红细胞(RBC)、血红蛋白(HGB)、血小板(PLT)、免疫球蛋白G(IGG)、免疫球蛋白A(IGA)无相关性(P>0.05)。结论 KOA患者血清SOD显著降低,其表达失调参与了KOA发病。     

Effect of magnetic knee wrap on quadriceps strength in patients with symptomatic knee osteoarthritis

Chen C-Y, Chen C-L, Hsu SC-C, Chou S-W, Wang K-C. Effect of magnetic knee wrap on quadriceps strength in patients with symptomatic knee osteoarthritis.

Objective

To determine the effects of magnetic knee wrap on isokinetic quadriceps strength in patients with painful knee osteoarthritis (OA).

Design

Randomized, double-blinded, placebo-controlled and before-after trial.

Setting

Rehabilitation clinic in a tertiary hospital.

Participants

Eligible patients (N=50) (mean age ± SD, 66.0±8.6y) with mild to moderate knee OA were recruited from the outpatient department and 37 (74%) completed the trial. Only 3 (6%) withdrew due to study-related adverse effects.

Interventions

Wearing the active (n=24) or sham (n=26) magnetic knee wrap for 12 weeks.

Main Outcome Measures

The primary outcome measure was isokinetic quadriceps strength. Secondary outcome measures included the Health Assessment Questionnaire Disability Index (HAQ-DI) and the Health Assessment Questionnaire (HAQ) Pain Scale.

Results

Using intention-to-treat analyses, the peak isokinetic quadriceps strength increased significantly in the treated leg at 30°/s (P=.007) and 60°/s (P=.022) after wearing the magnetic knee wrap. Compared with baseline, the median strength increase for the treated leg in the study group significantly exceeded that in the control group at week 4 (.05Nm/kg vs −.09Nm/kg at 60°/s, P=.038) and week 12 (30°/s, .09Nm/kg vs .04Nm/kg, P=.044; 60°/s, .17Nm/kg vs .02Nm/kg, P=.031). The HAQ-DI and HAQ Pain Scales improved significantly in both groups. Compared with baseline, the improvement at week 12 in terms of the HAQ-DI in the study group significantly exceeded that in the control group.

Conclusions

Magnetic knee wrap may significantly facilitate isokinetic quadriceps strength in patients with mild to moderate knee OA.     

推拿结合超短波治疗中老年膝关节骨性关节炎

目的观察推拿结合超短波治疗膝关节骨性关节炎(KOA)的疗效。方法将56名KOA患者,按就诊序号随机分为两组,治疗组30例和对照组26例,治疗组采用推拿及超短波联合疗法,对照组只进行单纯超短波疗法。两组患者分别在治疗前和治疗20 d后采用《中医病证诊断疗效标准》和国际骨关节炎评分标准Lequesne指数对治疗效果和关节功能改善情况进行评定。结果治疗组有效率为90%,对照组有效率为69.2%,经χ2检验,两组差异有统计学意义(P<0.05);两组治疗后Lequesne指数评分均较治疗前有明显改善(P<0.01);治疗后两组患者Lequesne指数评分比较,治疗组优于对照组(P<0.01)。结论推拿及超短波联合治疗KOA具有显著疗效。     

人工全膝关节置换术治疗严重膝骨性关节炎

目的评价人工全膝关节置换术治疗严重膝骨性关节炎的效果。方法对13例应用全膝关节置换术治疗的严重膝骨性关节炎患者的临床资料进行临床分析和总结。结果根据Tohn．N．Insall评分标准,手术优良率达92．3％,术后在疼痛、关节功能及活动度等方面均有明显的改善。结论人工全膝关节置换术是治疗严重膝骨性关节炎的切实有效方法,但应注意适应证的选择及胫骨假体的正确放置以减少胫骨假体的松动,而且其远期疗效尚待进一步观察。     

系统性康复护理指导对膝关节骨性关节炎患者康复效果的影响

目的观察系统性康复护理指导对膝关节骨性关节炎患者康复效果的影响。方法将78例膝关节骨性关节炎患者利用随机数字表随机分为康复组和对照组各39例,两组均给予高频热疗、中频脉冲及蜡疗治疗,并给予常规健康教育。康复组在以上物理因子治疗基础上给予早期、系统化的康复护理指导。两组患者分别于治疗前和治疗3个疗程后进行日常生活活动能力（ADL）及膝关节功能评定。结果治疗前两组患者ADL能力及膝关节功能比较差异无统计学意义（P〉0．05）;治疗3个疗程后,康复组患者ADL评分与膝关节功能评分分别为（9．52±0．46）分,（68．82±0．74）分,对照组患者分别为（8．71±0．66）分,（62．06±1．25）分,两组患者ADL能力及膝关节功能恢复均有明显改善,且康复组改善程度优于对照组,组间差异有统计学意义（t=7．200,P=0．015;t=13．800,P=0．044）。对于两组治疗效果,康复组优良率（89．7％）高于对照组（58．9％）,组间差异有统计学意义（x2=11．631,P=0．009）。结论系统性康复护理指导联合物理因子治疗能明显改善膝关节骨性关节炎患者的膝关节功能及ADL能力。     

膝关节表面置换术治疗骨关节炎64例疗效分析

目的探究对骨关节炎患者用膝关节表面置换手术进行治疗的效果。方法对在永煤集团总医院进行骨关节炎治疗的患者用膝关节表面置换术进行治疗,并对患者治疗前后的功能进行评分比较。结果用膝关节表面置换术对骨关节炎患者进行治疗之后效果明显。结论用膝关节表面置换术对骨关节炎患者进行治疗能够明显改善患者症状,值得在以后的治疗中推广。     

An application of computerised adaptive testing for measuring health status in patients with knee osteoarthritis

Purpose.?The aim of this study was to explore the potential of computerised adaptive testing (CAT) for measuring health status in knee osteoarthritis.

Method.?Three hundred and fifty-one patients with knee osteoarthritis (OA) answered 118 questions from a range of widely used questionnaires. Three dimensions relevant to knee OA were identified by expert opinion as ‘pain, mental and emotional status’; ‘self-care and household activities’ and ‘mobility and social activities’. Confirmatory factor analysis (CFA) was used to test the relationship between the items and their dimensions. After CFA, these dimensions were subjected to Rasch analysis to calibrate the items onto an interval scale. A CAT was developed for each dimension, and the results checked against simulated applications from 10,000 simulees.

Results.?After CFA and Rasch analysis, 14, 22 and 23 items remained in the first, second and third dimensions, respectively. Items were mostly free of differential item functioning for age, gender and duration of disease. Reliability exceeded 0.87 for each dimension. The health status levels generated using item banks and those obtained from the simulated CAT application were highly correlated (i.e. >0.91 for each dimension). On average, 8, 10 and 10 items were used to estimate the health status levels using the CAT for the first, second and third dimensions respectively.

Conclusions.?Using a combination approach of CFA and Rasch analysis, this study has shown that it is possible to calibrate items onto a single metric in a way that can be used to provide the basis of a CAT application.     

Short-term effects of a dedicated knee orthosis on knee adduction moment, pain, and function in patients with osteoarthritis

Fantini Pagani CH, Böhle C, Potthast W, Brüggemann G-P. Short-term effects of a dedicated knee orthosis on knee adduction moment, pain, and function in patients with osteoarthritis.

Objective

To analyze knee joint loading, subjective pain relief, and improvements in function in patients with osteoarthritis (OA) with the use of 2 orthosis adjustments.

Design

Patients were tested under 3 different conditions (without orthosis, orthosis at 4° valgus, and a neutral very flexible adjustment) in a crossover trial.

Setting

University gait analysis laboratory with 3-dimensional motion analysis and force platforms.

Participants

Patients (N=11) with a clinical and radiographic diagnosis of unilateral OA in the medial knee compartment.

Interventions

Patients wore a knee orthosis designed to unload the medial knee compartment for 4 weeks in 2 different adjustments (2 weeks in each adjustment).

Main Outcome Measures

Net knee adduction moment and net knee adduction angular impulse during the stance phase were analyzed by using inverse dynamics. Subjective pain relief, stiffness, and function improvement were evaluated using a questionnaire (Western Ontario and McMaster Universities Osteoarthritis Index). A 6-minute walk test and stair-climbing test also were performed.

Results

Both orthosis adjustments induced subjective pain relief and improvement in function compared with the condition without orthosis. Knee adduction moment was significantly decreased with both adjustments, whereas the decrease observed with the 4° valgus adjustment was significantly greater than the flexible adjustment (25% vs 12.5%). Compared with the condition without orthosis, changes in knee adduction angular impulse of 29% and 15% were found with 4° valgus and the neutral flexible orthosis, respectively. Time required for the stair-climbing activity was significantly decreased using the orthosis in 4° valgus adjustment compared with the condition without orthosis. No significant differences were observed among conditions during the 6-minute walk test.

Conclusions

Both orthosis adjustments were effective in decreasing symptoms; however, a decrease in knee loading was more effective using the 4° valgus adjustment, which could contribute to avoidance of disease progression.     

Management of knee osteoarthritis: knee lavage combined with hylan versus hylan alone

OBJECTIVE: To assess the difference in efficacy between knee lavage plus the standard hylan G-F 20 (a derivative of hyaluronan) protocol and the standard hylan G-F 20 as per standard usage protocol alone for the treatment of knee osteoarthritis (OA). DESIGN: Nonrandomized prospective study in which patients chose their treatment group. Follow-up averaged 1.1 years. SETTING: Faculty practice of a single physician at a major teaching hospital. PARTICIPANTS: Eighty-one patients with documented knee OA on magnetic resonance imaging. INTERVENTIONS: Group 1 (n=44) received a single-needle lavage 1 week before the standard hylan G-F 20 protocol; group 2 (n=37) received the standard hylan G-F 20 protocol alone. MAIN OUTCOME MEASURES: Pre- and posttreatment scores on the Lysholm-II Questionnaire and a visual analog scale (VAS) were documented for each patient. The Wilcoxon signed-rank test was used for statistical analysis. RESULTS: A successful outcome was noted in 79.5% of group 1 patients and in 54% of group 2 patients (P<.05). CONCLUSIONS: In the management of knee OA, the use of knee lavage before viscosupplementation with hylan G-F 20 yields better results than using hylan G-F 20 alone. The presence of radiologic grade IV knee OA or moderate to severe patellofemoral arthritis are negative prognostic factors.     

中医综合护理对骨刺颗粒联合消炎膏治疗膝骨关节炎的效果

目的 探讨中医综合护理在膝骨关节炎(KOA)治疗中的效果.方法 将133例骨科住院KOA患者按照简单随机原则分为观察组和对照组,其中观察组75例,对照组58例.观察组接受中医综合护理(包括内服中药护理、外用中药护理、情志调节、康复指导、饮食护理),对照组接受常规护理措施.治疗前后采用“健康调查简易量表”对两组患者进行评估,治疗后采用《中医病证诊断疗效标准》中“骨痹”的评价标准对患者进行疗效评估.结果 观察组治疗后的体能、精神影响、社会活动、心理健康、体能影响、精力、身体疼痛、一般健康等指标的评分均明显高于对照组[(76.22±11.35)比(67.62±11.53)分,(54.22±11.38)比(48.73 ±9.40)分,(77.49±12.50)比(65.22±10.62)分,(68.33±10.72)比(60.31 ±11.55)分,(42.53 ±6.21)比(37.41 ±8.05)分,(61.61 ±9.54)比(50.27±5.62)分,(70.22±10.08)比(63.72 ±8.58)分,(66.95±9.31)比(59.27 ±8.47)分],差异有统计学意义(T值分别为4.303 5,2.972 0,5.987 8,4.1363,4.141 8,8.0345,3.9309,4.905 2;P＜0.05).两组治疗结束后,根据《中医病证诊断疗效标准》中之“骨痹”疗效标准,观察组的显效率高于对照组(98.67％比93.10％),但两者间差异无统计学意义(P＞0.05).结论 中医综合护理及治疗可明显提高KOA患者的治疗效果,改善患者的生活质量.