血流限制训练在膝关节骨性关节炎治疗中的研究进展

膝关节骨性关节炎是老年人常见的一种退行性膝关节疾病,其发病和进展与股四头肌无力密切相关。受关节疼痛和肿胀等因素的影响,高负荷阻力训练可能会加重关节病变,引起疼痛,从而降低病人的依从性。为了降低疾病风险和增强身体功能,需要一种有效加强股四头肌,同时减轻疼痛和关节负荷的方法。血流限制训练采用限制动脉血流的方式,通过与低强度抗阻训练结合,可以获得类似于高强度抗阻训练的效果,从而促进肌肉力量的提高和关节功能的改善。本文从血流限制训练的作用机制、对膝关节骨性关节炎的影响、训练方案的选择等3个方面对此技术在膝关节骨性关节炎中的应用进行综述,以期为膝关节骨性关节炎病人安全、有效地应用血流限制训练提供科学指导。     

股内侧肌下入路与髌旁内侧入路行TKA治疗膝关节骨性关节炎对比观察

目的 比较股内侧肌下入路（SVA）与髌旁内侧入路（MPA）行全膝关节置换术（TKA）治疗膝关节骨性关节炎（KOA）的临床效果。方法 选择KOA患者89例,其中经SVA行TKA 46例（SVA组）、经MPA行TKA 43例（MPA组）。比较两组术前及术后1、3、6个月视觉模拟评分（VAS）、膝关节活动度（ROM）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分及Berg平衡量表（BBS）评分,手术前后股骨与胫骨机械轴夹角（mFTA）,术前及术后6个月起立-行走计时（TUG）测试、被动活动察觉阈值（TDPM）以及患膝术后初次主动直腿抬高（SLR）时间。结果 术后1、3、6个月,两组VAS、ROM、WOMAC评分和BBS评分（除MPA组术后1个月BBS评分外）均较术前显著改善（P均<0.05）;除术后6个月BBS评分外,SVA组术后各时间VAS、ROM、WOMAC评分和BBS评分均优于MPA组同期（P均<0.05）。两组术后6个月mFTA、TUG测试、TDPM均显著低于术前（P均<0.05）,且SVA组术后6个月TUG测试、TDPM优于MPA组（P均<0.05...     

髌骨旁内侧与股内侧肌下入路行全膝关节置换术的临床疗效比较

目的探讨髌骨旁内侧与股内侧肌下入路行全膝关节置换术的临床效果。方法选择兰考第一医院2014-02~2015-03收治的需全膝关节置换术的骨关节炎患者60例,根据手术方式的不同分为两组,各30例。对照组实施髌骨旁内侧入路全膝关节置换术,观察组实施股内侧肌下入路全膝关节置换术。比较两组各项手术指标和膝关节功能情况。结果观察组置换时间较对照组长,但切口长度、下床活动时间与对照组相比有明显缩短,差异有统计学意义(P0.01)。术前、术后1年两组患者膝关节功能对比,差异无统计学意义(P0.05),但术后3个月观察组膝关节功能评分明显高于对照组,差异有统计学意义(P0.05)。结论与髌骨旁内侧入路方式相比,实施股内侧肌下入路全膝关节置换术效果更好,能减少对患者的创伤,减轻患者病痛,短期内膝关节功能恢复更优。     

针刺配合肌力训练治疗老年性膝关节骨性关节炎的疗效研究

膝关节骨性关节炎（osteoarthritis，OA）又称退行性关节炎，是发生于中老年的常见病与多发病，我国人群中膝OA的患病率为9．56％，症状多出现在40岁以后，女性发病率高于男性，≥60岁者达78．5％00，随着老龄化社会的到来，膝OA已成为影响老年人生活质量的主要疾病之一。我们自2004年5月至2007年4月采用针刺配合多点等长肌力训练治疗老年性膝OA，     

术前访视对中老年骨性关节炎患者膝关节内侧间室关节镜内侧松解术后生理应激反应的影响

<正>膝关节骨性关节炎多以膝关节疼痛和运动功能障碍为主要临床表现,给患者带来较大的痛苦,影响其生活质量〔1〕。目前多以用保守和手术治疗为主,然而保守治疗存在起效慢、疗效有限、病情易反复等弊端,手术治疗虽效果明显,但创伤大、疼痛较剧烈〔2〕。关节镜以其疗效肯定、并发症少而广泛应用于膝关节骨性关节炎的治疗,然而由于老年患者的生理、心理特殊性,以致于在术前如何更好地进行沟通已成为影响手术效果     

骨性关节炎对膝关节干骺端松质骨力学性质影响的实验研究

目的 研究正常国人新鲜尸体膝关节干骺端松质骨和老年骨性关节炎病膝关节干骺端松质骨的生物力学性质,为临床提供生物力学参数.方法 取正常和病态膝关节干骺端松质骨在Shimadzu AUTOGRAPH电子万能试验机上进行压缩和弯曲实验.结果 得出了其最大载荷、应力、应变、弹性模量等数据.结论 病态组各项力学性质指标均显著低于正常组.     

电针穴位刺激对膝骨性关节炎患者的疗效观察

目的探讨电针穴位刺激对轻中度膝关节骨性关节炎的治疗效果,为今后膝关节骨性关节炎保守治疗提供一定的临床基础。方法选取2019年1月至2020年1月来自国家体育总局运动医学研究所体育医院运动创伤骨科和康复科的轻中度膝关节骨性关节炎患者,随机分为对照组(常规康复训练)和试验组(电针穴位刺激加常规康复训练),2个月后行Lequesne评分和等速肌力测试,比较两组治疗效果。结果治疗2个月后,两组Lequesne评分无统计学差异(P>0.05);等速肌力测试中,两组相对峰力矩(60°/s和240°/s)和耐力比较,电针穴位刺激加常规康复训练组均较单纯行康复治疗组效果好,治疗后60°/s的伸屈肌群PT/TW:试验组屈肌(1.33±0.21),伸肌(2.55±0.41);240°/s伸屈肌群PT/TW:试验组屈肌(0.96±0.11),伸肌(1.41±0.41);伸屈肌群耐力(ER):试验组屈肌(0.77±0.09),伸肌(0.82±0.11),与对照组相比存在统计学差异(P<0.01)。结论电针穴位刺激联合康复训练能够很好地恢复膝关节功能,并能恢复膝关节肌肉力量,是一种针对轻中度骨性关节炎有效的治疗方式。     

不同强度的电疗对膝骨性关节炎患者功能恢复的影响

目的 探讨不同强度的电疗对膝骨关节炎患者功能恢复的影响。方法 选取我院门诊就诊的膝骨关节炎患者127例,随机分为3组,采用等幅中频电疗法(A组)、干扰电疗法(B组)与调制中频电疗法(C组)三种不同频率的中频电疗法电磁波对膝骨性关节炎患者进行治疗,20min/次,1次/天,5天/周,共治疗4周。三组其他康复项目均相同。选用VAS疼痛评分、time up and go测试与平衡能力变化对康复治疗效果进行评估。结果 三组治疗后的效果与治疗前对比均有显著改善。三组之间进行比较,B组的治疗效果要优于A组与C组,A组与C组之间的治疗效果没有明显差异。结论 干扰电的电流作用深度较大,而且“内生”低频调制中频电兼有低、中频的优点,从而能够达到以中频电流通过皮肤高电阻、在人体深部获得低、中频的电流效应。     

社区与家庭联合康复治疗对老年膝关节骨性关节炎患者生活质量的影响

<正>老年膝关节骨性关节炎是一种因膝关节软骨退行性变化引起的以骨质增生为主要表现的伴有骨膜炎症的关节病变,主要临床表现为膝关节疼痛、压痛、肿胀、关节积液。关节软骨损伤和不同程度的功能障碍,严重影响老年人群的生活质量〔1〕。本文将主要调查社区与家庭联合康复治疗对老年膝关节骨性关节炎生活质量的影响。1资料与方法1.1一般资料将2012年7月至2013年3月在吉林油田总     

膝关节镜联合腓骨近端截骨术治疗老年膝关节骨性关节炎的疗效及对血清炎症因子的影响

目的探讨膝关节镜联合腓骨近端截骨术治疗老年膝关节骨性关节炎(KOA)的疗效及对血清炎症因子的影响。方法老年KOA患者68例。根据随机数表法分为对照组(n=34)与研究组(n=34),对照组行膝关节镜清理治疗,研究组在对照组基础上联合腓骨近端截骨术治疗,比较两组手术时间、住院时间,术前与术后6个月美国特种外科医院(HSS)、美国膝关节协会评分(KSS)评分、视觉模拟疼痛评分(VAS)及炎症因子水平,同时观察并发症发生情况。结果研究组手术时间显著高于对照组(P0.05);两组住院时间比较无统计学差异(P0.05)。两组术后6个月KSS、KSS评分较术前升高,且研究组高于对照组(P0.05);VAS评分较术前降低,且研究组低于对照组(P0.05)。两组患者术后6个月白介素(IL)-6、肿瘤坏死因子(TNF)-α水平均较术前明显降低,且研究组明显低于对照组(P0.05)。两组并发症发生率对比无统计学差异(P0.05)。结论膝关节镜联合腓骨近端截骨术治疗老年KOA患者疗效确切,可改善患者的膝关节功能,同时降低炎症因子水平,并发症发生率较低。     

Morphologic changes in the vastus medialis muscle in patients with osteoarthritis of the knee

OBJECTIVE: To investigate the frequency of structural changes in the vastus medialis muscle in patients with osteoarthritis (OA) of the knee. METHODS: Specimens of vastus medialis muscle from 78 patients with end-stage OA of the knee undergoing total joint arthroplasty were examined histopathologically. Morphologic changes were assessed in relation to clinical features that might have contributed to muscle injury. RESULTS: All muscle specimens exhibited atrophy of type 2 fibers. In 32% of the patients, atrophy of type 1 fibers was also noted. Fiber type grouping of type 1 fiber in 15% of the patients and type 2 fiber in 37%, indicating reinnervation, led to the diagnosis of neurogenic muscular atrophy in 32% of the patients; selective atrophy of type 2 fiber in 68% of the specimens was interpreted as possibly resulting from pain-associated disuse. Signs of muscle degeneration and regeneration were found in 65% and 96% of the samples, respectively. Soft tissue changes indicating long-term disease, such as calcification, fibrosis, and lipomatosis, were frequently observed (in 69%, 71%, and 94% of the patients, respectively). Statistical analysis of clinical and morphologic parameters revealed a significant association between degenerative muscle changes and the presence of a varus deviation of the leg axis. CONCLUSION: Patients with OA of the knee frequently exhibit muscle changes, with probable multifactorial etiology. Selective atrophy of type 2 fibers might reflect pain-related immobilization of a limb. Changes such as neurogenic muscular atrophy, muscle fiber degeneration, and regeneration might contribute as cofactors in the development or progression of OA.     

Increase in vastus medialis cross‐sectional area is associated with reduced pain,cartilage loss,and joint replacement risk in knee osteoarthritis

Objective

Although there is evidence for a beneficial effect of increased quadriceps strength on knee symptoms, the effect on knee structure is unclear. We undertook this study to examine the relationship between change in vastus medialis cross‐sectional area (CSA) and knee pain, tibial cartilage volume, and risk of knee replacement in subjects with symptomatic knee osteoarthritis (OA).

Methods

One hundred seventeen subjects with symptomatic knee OA underwent magnetic resonance imaging of the knee at baseline and at 2 and 4.5 years. Vastus medialis CSA was measured at baseline and at 2 years. Tibial cartilage volume was measured at baseline and at 2 and 4.5 years. Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index at baseline and at 2 years. The frequency of knee joint replacement over 4 years was determined. Regression coefficients (B) and odds ratios were determined along with 95% confidence intervals (95% CIs).

Results

After adjusting for confounders, baseline vastus medialis CSA was inversely associated with current knee pain (r = −0.16, P = 0.04) and with medial tibial cartilage volume loss from baseline to 2 years (B coefficient −10.9 [95% CI −19.5, −2.3]), but not with baseline tibial cartilage volume. In addition, an increase in vastus medialis CSA from baseline to 2 years was associated with reduced knee pain over the same time period (r = 0.24, P = 0.007), reduced medial tibial cartilage loss from 2 to 4.5 years (B coefficient −16.8 [95% CI −28.9, −4.6]), and reduced risk of knee replacement over 4 years (odds ratio 0.61 [95% CI 0.40, 0.94]).

Conclusion

In a population of patients with symptomatic knee OA, increased vastus medialis size was associated with reduced knee pain and beneficial structural changes at the knee, suggesting that management of knee pain and optimizing vastus medialis size are important in reducing OA progression and subsequent knee replacement.

     

A comparison of muscle training methods in patients with knee osteoarthritis

This study sought to compare the efficacy of isokinetic and progressive resistive exercise (PRE) programs in patients with knee osteoarthritis (OA). Forty-four patients with bilateral knee OA were included in the study. The patients in Group 1 (n=21) performed isokinetic exercises and the patients in Group 2 (n=18) performed a PRE program. Disease severity, pain, walking time, WOMAC, Lequesne index, AIMS2 and SF36 were compared before and after the treatments. All the patients were evaluated via a Cybex isokinetic device before and after treatment. Disease severity, pain, Lequesne, WOMAC and walking time improved with treatment in both groups. In SF36 and AIMS2 assessments, pain and social evaluation parameters in the PRE group showed better improvement. On isokinetic assessment flexor and extensor peak torque and peak torque body weight values improved significantly in both groups compared to pretreatment measurements. When the assessed parameters were taken into account no statistical significant difference was observed between the two groups. Our conclusions were that isokinetic and PRE programs are efficient in the treatment of knee OA; no statistically significant differences could be found between the two programs; and the PRE program, as it is cheaper, more easily performed and efficient, may be preferable for the treatment of knee OA.Abbreviations OA Osteoarthritis - PRE Progressive resistive exercise - PT Peak torque - PTBW Peak torque body weight - ROM Range of motion - TW Total work - TWBW Total work body weightAn erratum to this article can be found at     

Pilot study of the effects of a heat-retaining knee sleeve on joint pain, stiffness, and function in patients with knee osteoarthritis

OBJECTIVE: To identify changes in joint pain, stiffness, and functional ability in patients with knee osteoarthritis (OA) after use of a knee sleeve that prevents loss of body heat by the joint. METHODS: Subjects with symptomatic knee OA (n = 52) were randomized to 2 treatment groups: verum sleeve (specially fabricated to retain body heat) or placebo sleeve (standard cotton/elastane sleeve). Subjects wore the sleeve over the more painful OA knee for at least 12 hours daily for 4 weeks. Pain, stiffness, and functional impairment (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) in the index knee were measured at baseline and after 4 weeks of wear, after which sleeve use was discontinued. Telephone followup interviews were conducted 2 and 4 weeks later. RESULTS: After 4 weeks of sleeve wear, subjects in the active treatment group reported a 16% decrease in mean WOMAC pain score relative to baseline (P = 0.001). Those who wore the placebo sleeve reported a 9.7% decrease from baseline (P = 0.002). The difference between treatment groups was not statistically significant (P = 0.12). However, it was found that the 12 subjects who believed correctly that they had received the verum sleeve reported a highly significant decrease in WOMAC pain score (-27.5% relative to baseline, P = 0.0001). In comparison, subjects who received the verum sleeve but believed they had received the placebo sleeve exhibited only a marginally significant improvement in pain (-13.0% relative to baseline, P = 0.07). In the placebo group, the modest improvement in pain scores appeared unrelated to the subject's impression of the type of sleeve worn. CONCLUSION: This pilot study was insufficiently powered to be a definitive trial of the heat-retaining sleeve. Given the magnitude of changes in knee pain in the active treatment group, heat retention merits further scientific investigation as a treatment modality for patients with knee OA.     

Cetylated fatty acids improve knee function in patients with osteoarthritis

OBJECTIVE: To determine the benefit of cetylated fatty acids (CFA) on knee range of motion and function in patients with osteoarthritis (OA). METHODS: Sixty-four patients with chronic knee OA were evaluated at baseline and at 30 and 68 days after consuming either placebo (vegetable oil; n = 31) or CFA (Celadrin; n = 33). Evaluations included physician assessment, knee range of motion with goniometry, and the Lequesne Algofunctional Index (LAI). RESULTS: After 68 days, patients treated with CFA exhibited significant (p < 0.001) increase in knee flexion (10.1 degrees) compared to patients given placebo (1.1 degrees). Neither group reported improvement in knee extension. Patient responses to the LAI indicated a significant (p < 0.001) shift towards functional improvement for the CFA group (-5.4 points) after 68 days compared to a modest improvement in the placebo group (-2.1 points). CONCLUSION: Compared to placebo, CFA provides an improvement in knee range of motion and overall function in patients with OA of the knee. CFA may be an alternative to the use of nonsteroidal antiinflammatory drugs for the treatment of OA.     

Evaluation of vastus lateralis architecture and strength of knee extensors in middle-aged and older individuals with knee osteoarthritis

Clinical Rheumatology - To investigate any differences in muscle architecture (fascicle angle, fascicle length, and muscle thickness) and muscle strength in people of different ages with and...     

Retrospective study of relationship between vastus medialis volume on SPECT-CT and outcome of unilateral total knee arthroplasty

Although the importance of quadriceps femoris function was reported previously, little is known about volume-related factors and their effects on clinical outcomes after total knee arthroplasty (TKA). We sought to determine whether there was a bilateral difference in vastus medialis muscle volume measured on single-photon emission computed tomography–computed tomography (SPECT-CT) in patients who underwent unilateral TKA. We also aimed to determine whether vastus medialis volume was related to osteoarthritis (OA) severity or scintigraphic uptake degree around the knee joint on SPECT-CT. And finally, we attempted to investigate the factors, such as vastus medialis volume and scintigraphic uptake degree, associated with the functional outcomes of TKA.This retrospective study included 50 patients (41 female, 9 male) undergone unilateral TKA due to primary OA. The maximal cross-sectional area of the vastus medialis was measured on axial SPECT-CT images. Scintigraphic uptake degrees and Kellgren-Lawrence (K-L) grade at the tibiofemoral joints were assessed. We compared maximal cross-sectional area of the vastus medialis on SPECT-CT for difference of bilateral lower limbs. We also analyzed the relationship between volume of vastus medialis and scintigraphic uptake measured on SPECT-CT and the severity of OA on conventional radiographs. The clinical outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at baseline and at 1 and 2 years after surgery. The relationship between preoperative muscle volume and scintigraphic uptake on SPECT-CT and WOMAC index was analyzed.The amount of muscle volume measured on SPECT-CT was smaller in operated limb in patients who underwent unilateral TKA. Preoperative vastus medialis muscle volume was not related to preoperative OA severity measured on conventional radiographs and scintigraphic uptake on SPECT-CT. However, a decreased vastus medialis muscle volume was related to worse clinical outcomes after TKA (P = .045), whereas the degree of scintigraphic uptake on SPECT-CT was not associated with postoperative clinical outcomes.Muscle volume of vastus medialis was decreased in the operated knee than in the nonoperated knee, and that was correlated with worse postoperative results. Even if the preoperative volume of vastus medialis were not related to OA severity on conventional radiographs and scintigraphic uptake on SPECT-CT, preservation and improvement of the muscle mass of the knee undergoing TKA is important.     

Evaluation on curative effects of isokinetic muscle strength training for improving muscle function in patients with knee osteoarthritis: A protocol for systematic review and meta-analysis

Background:Knee osteoarthritis (KOA) refers to a chronic deteriorating disease distinguished by degeneration of joint cartilage. Many clinical studies have demonstrated that isokinetic muscle strength training can improve muscle function in patients with KOA. However, although such studies deduce an excellent effect, the results remain controversial. Therefore, the present systematic review seeks to explore the curative effects of isokinetic muscle strength training to establish if it can improve muscle function in patients experiencing KOA.Methods:This review will entail a systematic review and a comprehensive examination to establish all randomized controlled studies covering curative effects of isokinetic muscle strength training to improve muscle function in patients with KOA. We will obtain data from PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure, and WanFang databases from inception to September 2021. In addition, the study will employ the criterion postulated by Cochrane to ascertain a quality evaluation and risk assessment of the studies included for analysis. Also, we will employ relative risk, mean differences, and standardized mean differences with 95% confidence intervals to estimate the effective measures. Also, we will employ Cochran Q test and I² statics to assess heterogeneity among the 2 studies.Results:Overall, this study anticipates providing accurate results and balanced inferences on curative effects of isokinetic muscle strength training for improving muscle function in patients with KOA.Conclusion:The study''s inferences will offer evidence to decide whether isokinetic muscle strength training is an effective measure for improving muscle function in patients with KOA.