关节松动术配合肌力训练治疗膝关节骨性关节炎68例

膝关节骨性关节炎是以关节骨及软骨的退行性改变为主的疾病,多见于中老年人,且随年龄增长而症状逐渐加重。膝关节骨性关节炎最显著的症状是疼痛,并伴有不同程度的功能障碍。目前研究表明,膝关节骨性关节炎患步态、关节的柔韧性及肌肉力量均有不同程度的改变,其中肌力改变在膝关节骨性关节炎病程中有重要意义[1]。我科在物理疗法的基础上,应用关节松动技术配合肌力训练治疗膝关节骨性关节炎68例,效果满意,现介绍如下。1 资料与方法1.1 资料68例中,男21例,女47例,年龄46～83岁,单膝发病52例,双膝发病16例,病程半年～25年。1.2 …     

关节清理加钻孔减压术治疗膝骨性关节炎的观察

骨性关节炎主要发生在负重关节，而膝关节居第一位，其特征是关节软骨发生原发性或继发性退行性变，并在关节边缘有骨赘形成。门诊的膝痛多数是骨性关节炎，该病治疗方法多，但疗效不尽人意，尤其是远期疗效，难以满意，我院从1995年～2004年采用关节清理术加钻孔减压术治疗膝关节骨性关节炎，取得了较好的疗效，现报告如下：     

关节清理术结合透明质酸钠治疗膝骨性关节炎的临床研究

目的比较应用膝关节清理术、关节腔内注射透明质酸钠、两者结合应用三种方法治疗膝部骨性关节炎疗效。方法 150例膝骨性关节炎患者随机分为3组：A组采用关节腔内注射透明质酸钠,每周一次,连续注射5次;B组采用关节镜下关节清理术;C组行关节清理术后1周开始,每周注射透明质酸钠一次,共5次。在6个月后比较三种方法的治疗效果。结果关节清理术结合透明质酸钠治疗膝骨性关节炎的疗效与单独应用关节清理术或关节腔内注射透明质酸钠治疗膝骨性关节炎的疗效差异有统计学意义（t分别=15.12、16.64,P均〈0.05）,而单独应用关节清理术和单独应用关节腔注射透明质酸钠两者之间的疗效差异无统计学意义（t=1.22,P〉0.05）。结论关节清理术结合透明质酸钠治疗膝骨性关节炎的疗效优于单独应用关节清理术或关节腔内注射透明质酸钠治疗膝骨性关节炎的疗效,是治疗膝骨性关节炎的一种较好的方法 。     

关节镜下有限化关节清理术治疗膝骨性关节炎

目的：探讨关节镜下有限化关节清理术治疗膝骨性关节炎的经验和影响疗效的因素。方法；对93例（152个膝关节）进行关节镜检依据膝痛部位和关节受限的原因行选择性、有限化关节清理术治疗。结果：该组术后关节肿胀及疼痛迅速缓解，膝关节活动改善。随访1－6年 ，优良率78％。结论：关节镜下选择性、有限化关节清理术可提高手术疗效，具有创伤小，患者症状恢复快，并发症少等优点。依据膝痛部位和关节受限的原因，决定清理的范围和程度。有限的滑膜清理、有限的手术时间及有限的其它致创因素下行关节清理，辅以良好的止血措施，必要的髌骨外侧支持带松解，是取得良好疗效的关键。     

关节清理术与综合疗法治疗膝骨性关节炎

目的：探讨膝骨性关节炎的治疗方法与效果。方法：自1998年5月至2001年10月采用关节清理术，关节内注射透明质酸钠配合关节持续被动活动(CPM)及主动股四头肌功能锻炼治疗膝骨性关节炎患者46例(58膝)，随访1—4年。结果：本组病人46例(58膝)，术后疼痛明显减轻，随访1年优良率89％。2年后优良率78％。结论：关节清理术综合疗法治疗膝骨性关节炎可有效缓解病人的疼痛，改善和恢复膝关节的功能，延缓了关节退变。     

关节松动术治疗颈椎病疗效观察

1资料与方法1.1一般资料96例均为我院门诊于1998年—2001年6月收治的患者,按就诊先后随机分为观察组与对照组。其中观察组50例,男23例,女27例;年龄21—68岁,平均39岁;病程1个月—13年,平均3.5年。对照组46例,男20例,女26例;年龄23—73岁,平均41岁;病程15天—11年,平均3年。1.2诊断标准根据康复医学对颈椎病的诊断标准[1],排除其它疾病,确诊96例患者。1.3治疗方法观察组采用关节松动术治疗。采用Maitland的Ⅳ分级方法,根据患者的具体情况施术。首先做颈椎Ⅰ—Ⅱ级分离牵引1—2次,针对神经根型、混合型、交感神经型中的疼痛、麻木等症状,施颈…     

综合康复治疗膝关节骨性关节炎

目的:观察综合康复治疗对膝关节骨性关节炎(KOA)的疗效。方法:112例KOA患者随机分为2组各56例。观察组采用Maitland关节松动术、主动运动、针刺等综合康复治疗,对照组口服安慰剂治疗。治疗4及8周时,采用6min步行距离、骨性关节炎功能、疼痛、僵硬度综合指数评分(WOMAC)进行评价。结果:治疗第4周时,观察组WOMAC评分较治疗前及对照组明显下降(P<0.01),6min步行距离较治疗前及对照组明显提高(P<0.01);治疗8周后,观察组WOMAC评分呈持续下降趋势(P<0.01),6 min步行距离呈持续增加趋势(P<0.01);对照组治疗前后比较差异无统计学意义。结论:综合康复治疗对膝关节骨性关节炎具有显著疗效。     

关节松动术治疗颈椎病

自1994年12月～1997年6月,我们对96例颈椎病患者采用关节松动术加常规治疗并与单纯常现治疗的方法进行比较,其结果如下。1资料与方法1．1一般资料96例颈椎病患者,均经X线及CT检查确诊。随机分为关节松动术加常规治疗组（手法组）48例,男26例,女22例,年龄40～78岁,平均55岁。病程15d～6年。推动脉型18例,神经很型14例,脊髓型1例,混合型15例,采用关节松动术辅以预牵、理疗及药物等治疗;单纯常规治疗组（对照组）48例,男27例,女21例,年龄38～71岁,平均55岁。病程15d～4年。推动脉型17例,神经根型14例,脊髓型1例,混合型16…     

骨性膝关节炎的关节内治疗

骨性关节炎是一种慢性、退行性病变并以关节软骨变性和丢失及关节边缘和软骨下骨质增生为主要特征的疾病,是常见多发疾病,老年人致残的主要疾病之一。骨性关节炎以膝关节为好发部位。对患者生活质量影响较大。现在治疗膝骨性关节炎的方法较多,其中关节内治疗最直接,起效最快,已经在临床得到广泛应用。该文主要对膝骨性关节炎的关节内治疗作一系统的综述,指导临床的治疗。     

超声对类风湿性关节炎患者膝关节软组织病变及关节积液的诊断价值

目的探讨超声在诊断类风湿性关节炎(RA)患者膝关节软组织病变及关节积液的应用价值。方法 RA组患者57例,体检健康者57例为对照组,超声观测两组膝关节软组织病变及关节积液的情况。结果 RA组髌上囊液体深度(0.58±0.29)cm,滑膜厚度(0.41±0.32)cm,均大于对照组;股骨内、外侧髁软骨厚度为(0.76±0.25)mm和(1.12±0.23)mm,均小于对照组,差异均有统计学意义(均P0.05)。RA组中髌上囊积液检出率为84.2%,高于对照组(8.7%);RA组滑膜内血流检出率为80.7%,亦高于对照组(3.5%),差异均有统计学意义(均P0.05)。结论超声对RA患者膝关节软组织病变及关节积液的诊断准确,具有无创、直观及重复性好等优点,值得推广。     

Clean versus sterile technique for common joint injections: a review from the physiatry perspective

Preparation of the skin prior to joint injection varies widely among disciplines and across regional borders. This is likely due to the paucity of literature on the most effective and efficient methods of preparation. There is no standard definition of clean technique prior to joint injection. Review of the available literature suggests that alcohol is effective preparation for the skin prior to most procedures. Surveys of current clinical practice demonstrate that the use of gloves may be favored, but no conclusions can be drawn in regards to whether sterile gloves are required. Clean technique should be defined as use of non-sterile gloves and agents such as alcohol or soap prior to injection. Significant cost savings may be achieved with the consistent use of clean technique for preparation of the skin prior to joint injection. Further study should address the incidence of iatrogenic bacterial arthritis following clean technique versus sterile technique for joint injection.     

体外冲击波与关节松动术治疗肩关节周围炎的临床疗效对比

目的 比较体外冲击波与关节松动术在治疗肩关节周同炎方面的疗效差异，从而为体外冲击波在临床中更广泛的应用提供依据。方法 共选取82例肩关节周围炎患者，将其随机分为治疗组（采用体外冲击波治疗，n=42）与对照组（采用关节松动术治疗，n=40）。体外冲击波频率为60次／min，强度为0．18～0.25ml／mm^2，每次治疗时共冲击1000次，每5天治疗1次，共治疗3次。关节松动术治疗每天1次，每次持续30～40min，共治疗15次。采用视觉模拟评分法（VAS）评定患者治疗前、后的痛觉变化；选用Constant-Murley肩功能评分法（C-M评分）评定患者治疗前、后ADL及ROM的改变情况。结果 2组患者经相应治疗后其疼痛及C-M评分均较治疗前明显改善。差异有统计学意义（P〈0.01），治疗后2组患者上述评分进行比较，差异亦有统计学意义（P〈0．05），且治疗组患者疗效明显优于对照组，差异有统计学意义（P〈0．05）。结论 体外冲击波治疗肩关节周围炎的疗效明显优于关节松动术，值得临床进一步推广、应用。     

超声检查在类风湿关节炎膝关节积液诊断中的应用

目的　探讨超声显像检查在膝关节积液诊断中的应用以及膝关节积液与类风湿关节炎病情的关系。方法　采用超声显像检查 ,对 10 0例正常人膝关节及 10 0例类风湿关节炎患者膝关节进行检查。结果　①正常人双膝关节腔内积液无回声区均小于 0 17± 0 0 5cm ;以 >0 3cm为界 ,关节积液阴性与阳性两组之间差异有显著意义 (P <0 0 1) ;② 10 0例类风湿关节炎患者膝关节积液多为对称性 ,其左侧和右侧积液发生率分别为 5 2 9%和 6 1 4 % ;③类风湿关节炎患者膝关节积液程度与炎性指标ESR相关 (P <0 0 1) ,与RF滴度无相关。结论　①正常人双膝关节腔内积液小于 0 2cm ,超过 0 3cm即可认为有膝关节积液存在 ;②类风湿关节炎患者膝关节积液发生率较高 ,其积液量的变化与ESR相关 ,可作为病情变化的观察指标之一。因此 ,超声显像检查膝关节积液是一种简单、无创、快捷和优于膝浮膑征检查的方法。     

腓骨截骨联合关节镜微骨折术对膝关节骨性关节炎患者关节功能及生活质量的影响

目的研究膝关节骨性关节炎治疗中腓骨截骨联合关节镜微骨折术的应用效果及对患者关节功能及生活质量的影响。方法采用回顾性分析方法,研究对象为2015年1月至2020年1月湖南省中医药研究院附属医院收治入院的65例膝关节骨性关节炎患者,根据不同治疗方式分为两组。对照组(n=32)单用关节镜微骨折术治疗,研究组(n=33)联用腓骨截骨与关节镜微骨折术治疗。比较两组患者手术前后膝关节关节活动度评分、Lysholm膝关节运动功能评分、WOMAC评分、生活质量评分变化与术后并发症(神经损伤、膝关节内黏连、切口感染)发生率。结果两组患者术前膝关节关节活动度评分、Lysholm膝关节运动功能评分、WOMAC评分、生活质量评分比较,差异无统计学意义(P>0.05)。两组患者术后膝关节关节活动度评分、Lysholm膝关节运动功能评分、WOMAC评分、生活质量评分均较术前明显改善,且研究组患者术后各项指标均较同期对照组改善更显著,差异均有统计学意义(P <0.05)。两组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。结论膝关节骨性关节炎治疗中腓骨截骨联合关节镜微骨折术的应用效果显...     

Biomechanical effects of patellar positioning on intraoperative knee joint gap measurement in total knee arthroplasty

Background

Balancing both the lateral/medial and extension/flexion joint gaps is a prerequisite for soft tissue balance in total knee arthroplasty. The purpose of this study was to quantify the effects of patellar positioning and quadriceps load during total knee arthroplasty on knee joint gap measurements.

Methods

Eight fresh-frozen cadaveric knees ranging in age from 65 to 85 years old were used. Using a medial parapatellar approach, posterior cruciate ligament sacrificing total knee arthroplasty was performed. The specimens were mounted on a custom knee testing system that allowed the femur to be locked in position for knee extension or flexion. Patellar positions of eversion, reduction, and following repair of the arthrotomy were examined. The influence of quadriceps muscle load was investigated by varying the quadriceps load from 0 to 125 N. The lateral and medial joint gaps, represented by the distance from the implanted femoral component surface to the cut tibia surface, were measured with 100 N tibial distraction force using a 3D digitizer in both extension (0°) and flexion (90°).

Findings

Both the medial and lateral joint gaps with patella eversion were significantly smaller than those with patellar reduction and arthrotomy repair (extension: all quadriceps loads, P < 0.0002; flexion: quadriceps loads less than 75 N, P < 0.0002). In patella eversion, quadriceps loading decreased the lateral joint gap more than the medial joint gap in both extension and flexion; however, the effect was greater in knee flexion with significant differences seen at all quadriceps loads, whereas in extension significant differences were only seen for quadriceps loading of 75 N and greater. Patella eversion also caused a lateral-posterior shift and external rotation of the tibia compared to the other conditions (P < 0.005). With patella reduction and repair of the arthrotomy lower quadriceps loading decreased the extension gap significantly more than the flexion gap (P < 0.01). Following repair of the arthrotomy higher quadriceps loading significantly decreased the flexion gap more than the extension gap (P < 0.04).

Interpretation

The patellar positioning and quadriceps muscle loading in total knee arthroplasty have a strong influence on intraoperative joint gap measurements.     

Effect of Pilates Matwork exercises on posterior chain flexibility and trunk mobility in school children: A randomized clinical trial

ObjectiveTo investigate the effects of an exercise program, based on the Pilates Matwork method, on posterior chain flexibility and trunk mobility in healthy school age children.Design and settingThe study was a parallel-group randomized clinical trial. The participants were randomly assigned to groups: Pilates Group (PG) and Control Group (CG). The program was developed at the Early Childhood Education Institute, Londrina-PR.Participants43 children with age between eight to 12 years, no prior knowledge of the Pilates method, and no exercise training in the last six months.InterventionFour months of twice a week 50 min Pilates Matwork exercises were administered.Outcome measuresFlexibility and mobility, assessed using the sit-and-reach test, fingertip-to-floor test and photogrammetry. The assessors were blinded to the allocation of participants.ResultsThree children were excluded before randomization and 40 were randomized (PG n = 20; CG n = 20).12 children were excluded during the protocol (PG n = 7; CG n = 5) and included in the intention to treat analysis. No significant difference between groups was observed for flexibility measures. There was a significant difference in the following outcomes for the PG: distance reached in the sit-and-reach test between pre-test (median 14.25[11.25–28.38]) and post-test (median 20.25[12.00–29.63]) (ES = 0.29, SRM = 0.73); Posterior angle of the knee in the fingertip-to-floor test between pre-test (median 191.60[187.20–191.60]) and post-test (median 189.00[185.90–191.50]) (ES = 0.56, SRM = 0.54).ConclusionThere were no differences in posterior chain flexibility and trunk mobility between school age children who underwent Pilates Matwork exercises and the control. However, children who participated in the exercise program showed improvement in some results of flexibility.Clinical trial registration numberBrazilian Registry of Clinical Trials (REBEC) (N° RBR-8t5p7d).     

北京地区汉族成年人膝关节骨性解剖的研究

目的研究北京地区成年人膝关节骨性解剖。方法对80名成年志愿者（160膝）进行CT扫描,测量股骨、胫骨和髌骨相关参数,并进行比对。结果共采集膝关节相关29个参数,与国外学者针对白种人的研究结果有着明显的差异,与黄种人的研究结果近似。结论进行国人膝关节骨性解剖的研究对设计出符合中国人的膝关节解剖特点的假体具有一定的参考价值。     

无痛病房管理模式在膝骨性关节炎患者中的应用

目的:探讨无痛病房管理模式在膝骨性关节炎患者中的应用效果。方法:将90例膝骨性关节炎患者随机分为对照组和观察组各45例,对照组给予常规护理,观察组在常规护理基础实施无痛病房管理模式,比较两组护理效果。结果:两组护理后疼痛评分低于护理前(P0.05),观察组护理后疼痛评分低于对照组(P0.05);观察组总有效率高于对照组(P0.05)。结论:无痛病房管理模式可减轻膝骨性关节炎患者的疼痛程度,改善治疗效果。     

高频超声在类风湿性关节炎膝关节病变中的应用

目的：应用高频超声观察髌上囊、滑膜、股骨髁软骨及软骨下皮质的情况,评价超声对类风湿性关节炎（RA）膝关节疾病的辅助诊断价值。方法：采用高频超声对RA组与对照组的膝关节髌上囊液体厚度、滑膜及股骨髁软骨厚度及软骨下骨皮质的回声情况进行对比观察。结论：高频超声通过观察关节积液、滑膜、软骨及软骨下骨皮质的病变为临床辅助诊段RA及其疗效评价、鉴别诊段提供依据。