不同相对分子质量玻璃酸钠对膝关节镜术后关节功能恢复的作用比较

目的:观察关节腔内留置不同相对分子质量玻璃酸钠对膝关节镜术后早期疼痛及功能恢复的影响。方法:于2005-11/2006-05选择北京大学人民医院骨关节科收治的行膝关节镜手术患者60例。关节镜手术中根据不同诊断分别行半月板成形术、游离体取出术以及软骨成形术。60例患者按随机数字表法分为3个实验组,分别为Mr1.5×106～2.5×106玻璃酸钠组,Mr3×106玻璃酸钠组,Mr6×106玻璃酸钠组。术后关节腔内注入不同相对分子质量玻璃酸钠2.0～2.5mL,并被动屈伸膝关节20次,使玻璃酸钠均匀分布于关节内。术后第1天开始股四头肌力量锻炼,坐在床边屈膝活动,并可下床。术后1周拆除缝线,术后6周门诊复查。分别于术前、术后1,2,3d,1,6周采用同一评分量表进行自觉疼痛程度、日常生活活动能力、膝关节屈曲角度测评,评分越高,功能恢复越好。结果:纳入患者60例,均进入结果分析。①自觉疼痛程度测定:术后6周Mr1.5×106～2.5×106,3×106,6×106玻璃酸钠组自觉疼痛程度评分均高于术前[分别为(8.5±1.3),(7.3±2.2)分;(8.5±1.3),(7.3±2.2)分;(8.5±1.3),(7.3±2.2)分]。②日常生活活动能力测定:术后6周Mr1.5×106～2.5×106,3×106,6×106玻璃酸钠组日常生活活动能力评分均高于术前[分别为(60.5±8.4),(59.3±7.0)分;(63.4±8.2),(59.4±8.3)分;(66.9±3.8),(53.8±19.0)分]。③膝关节屈曲角度评分:术后6周Mr1.5×106～2.5×106,3×106,6×106玻璃酸钠组膝关节屈曲角度评分均高于术前[分别为(9.1±1.4),(5.8±2.7)分;(8.1±3.1),(7.2±3.5)分;(6.3±3.8),(5.5±3.1)分]。④综合评分:术后6周Mr1.5×106～2.5×106,3×106,6×106玻璃酸钠组综合评分均高于术前[分别为(88.1±7.7),(79.8±11.1)分;(91.4±6.8),(84.9±13.7)分;(91.2±10.7),(73.5±23.7)分]。关节腔内留置3种不同相对分子质量玻璃酸钠在膝关节镜术后近期各项评分差异均无显著性意义(P>0.05)。结论:关节腔内留置不同相对分子质量玻璃酸钠在膝关节镜术后近期康复中具有相似的效果。     

膝关节镜术后患者205例的护理

目的：探讨关节镜治疗膝关节疾病的术后护理。方法：回顾性分析205例患者术前、术后护理方法，包括：心理护理、术前准备、术后护理、康复护理。结果：本组随访平均12个月，术后膝关节功能恢复良好，平均治愈率为93％。结论：关节镜已成为膝关节疾病诊断和治疗的重要手段，高质量的关节镜术前准备及正确合理的术后康复护理是保证手术成功的重要环节。     

关节镜下半月板切除术的护理与康复指导

总结了56例关节镜下半月板切除术患者的术前、术后护理与功能康复。包括有效的心理护理、精心的术前准备、密切观察病情，加强营养等术后护理及康复指导。认为精心的护理对术后疗效有重要意义。     

关节镜下半月板成形术对膝关节半月板损伤患者膝关节功能的影响

目的 分析关节镜下半月板成形术治疗膝关节半月板损伤,对患者疾病相关指标与膝关节功能Lysholm评分、国际膝关节文献委员会膝关节评估表(IKDC)及日常生活活动能力量表(ADL)评分的影响.方法 按照随机数字表法将云南省文山壮族苗族自治州人民医院2018年11月至2020年9月收治的86例膝关节半月板损伤患者分为两组,...     

早期康复护理对膝关节镜下膝关节术后患者患肢功能恢复的影响

目的探讨早期康复护理对膝关节镜下膝关节术后患肢功能恢复的促进效果,为临床实践提供依据。方法将64例行膝关节镜下膝关节术患者随机分为早期康复训练组和对照组各32例,对照组进行常规康复锻炼,早期康复训练组术后12h即详细指导患者开始进行系统的功能锻炼。术后两周统计两组并发症发生率,术后6个月应用HSS功能评分标准对膝关节功能进行评分,比较两组之间的功能康复效果。结果术后2周早期康复训练组优于对照组。结论术后早期康复护理可降低膝关节镜下膝关节术后并发症发生率,促进患肢功能恢复。     

关节镜半月板成形术治疗膝关节半月板损伤的效果及对膝关节功能的影响

目的 探讨关节镜半月板成形术对膝关节半月板损伤患者的治疗效果。方法 选取2013年6月至2020年2月在平煤神马医疗集团总医院治疗的膝关节半月板损伤患者50例,根据治疗方案分为观察组和对照组,观察组28例,对照组22例。其中观察组患者采用关节镜半月板成形术治疗,对照组患者采用非手术保守治疗。观察两组的治疗效果、手术前后患者的膝关节功能评分(Lysholm)和膝关节屈伸情况。结果 术后,观察组的手术优良率为92. 86%(26/28),高于对照组(68. 18%,15/22,P 0. 05)。两组患者的膝关节屈曲范围、Lysholm评分在关节镜术后均有提高(P 0. 05),且观察组术后的上述参数评分高于对照组(P 0. 05)。两组患者的伸直活动范围都有降低(P 0. 05),且观察组术后的伸直活动范围低于对照组(P 0. 05)。结论 关节镜半月板成形术治疗膝关节半月板损伤的效果好于保守治疗,值得在临床治疗中推广。     

半月板损伤在MRI与关节镜下表现的比较研究

关节镜检查是诊断膝关节半月板损伤的金标准,磁共振(MRI)以其无创及对组织的高分辨率、对损伤的高敏感性和特异性等特点己成为继关节镜检查后诊断膝关节半月板损伤的又一重要手段,对提高半月板损伤的诊断率,避免不必要的关节镜手术具有重要的临床意义.作者自2006年1月至2009年6月,对在本院同时行MRI检查及关节镜治疗,且至少临床、MRI或关节镜之一诊断为半月板损伤共67例(72膝)患者的资料进行回顾性对照分析.现报道如下.     

关节镜下射频消融治疗膝关节创伤性滑膜炎的疗效观察

目的:观察膝关节创伤性滑膜炎患者采用关节镜下射频消融术治疗的临床效果。方法:选取2018年1～12月收治的膝关节创伤性滑膜炎患者76例作为研究对象,依据随机数字表法分为对照组和观察组,各38例。对照组行常规关节镜手术,观察组行关节镜下射频消融术治疗,对比两组手术相关指标、治疗前后膝关节功能及并发症发生情况。结果:观察组手术时间短于对照组,术中出血量少于对照组,差异有统计学意义(P0.05);患者术后下床活动时间、住院时间均短于对照组,术后膝关节功能评分高于对照组,差异有统计学意义(P0.05);两组术后并发症发生率比较,差异无统计学意义(P0.05)。结论:采用关节镜下射频消融术治疗膝关节创伤性滑膜炎患者效果显著,对机体损伤小,并发症少,有利于患者膝关节功能恢复。     

对膝关节半月板损伤病人行MR检查技术及对诊断符合率影响分析

目的:分析膝关节半月板损伤病人行MR检查技术及对诊断符合率的影响.方法:选取本院2018年1月—2020年10月住院治疗的200例膝关节半月板损伤患者,121例男性、79例女性,分别予以CT、MRI检查,将关节镜检查结果作为本次研究的金标准,比较CT、MRI诊断符合率.结果:CT损伤总符合率(84.00％)显著低于关节...     

膝关节镜下离子冷凝刀对术后关节活动及行走功能的影响

目的：观察关节镜下离子冷凝刀对关节疾病患术后关节功能及行走功能的影响。方法：纳入青岛港口医院骨科2000-03／2004-03膝关节病变患72例。随机分成对照组和试验组，每组36例。对照组在关节镜下全面探察确诊后，应用常规手术器械对病变组织进行剪切、清理和刨削、钻孔减压，试验组在关节镜监视下应用离子冷凝刀必要时结合常规器械，对病变组织进行清理、刨削和钻孔减压的基础上，予以切割和消融，术后均配合早期功能练习等功能训练。结果：经1～3年的有效随访，对照组术后2周关节活动度轻度受限，术后1周可行走距离＜100m，术后第3天关节液血红细胞计数为9～15个／HP。试验组术后2周关节活动度无受限，术后1周可行走距离＞200m，术后第3天关节液血红细胞计数为2-6个／HP。结论：关节镜下离子冷凝刀技术对膝关节疾病患术后关节功能恢复快、并发症较少。     

Recurrent neck pain patients exhibit altered joint motion pattern during cervical flexion and extension movements

BackgroundImpaired sensorimotor ability has been demonstrated in recurrent neck pain patients. It is however not clear if cervical joint motion and pressure pain sensitivity in recurrent neck pain patients are different from asymptomatic controls.MethodsCervical flexion and extension motions were examined by video-fluoroscopy and pressure pain thresholds were assessed bilaterally over C2/C3, C5/C6 facet joints and right tibialis anterior in eighteen recurrent neck pain patients and eighteen healthy subjects. Individual joint motion was analyzed by dividing fluoroscopic videos into 10 epochs. The motion opposite to the primary direction (anti-directional motion) and motion along with the primary direction (pro-directional motion) of each joint were extracted across epochs. Total joint motion was the sum of anti-directional and pro-directional motions. Joint motion variability was represented by the variance of joint motions across epochs.FindingsCompared to controls, recurrent neck pain patients showed: 1) decreased anti-directional motion at C2/C3 and C3/C4 (P < 0.05) and increased anti-directional motion at C5/C6 and C6/C7 (P < 0.05) during extension motion. 2) Increased overall anti-direction motion during flexion motion (P < 0.05). 3) Lower joint motion variability at C3/C4 during extension motion (P < 0.05).InterpretationRecurrent neck pain patients showed a redistribution of anti-directional motion between the middle cervical spine and the lower cervical spine during cervical extension and increased overall anti-directional motion during cervical flexion compared with healthy controls. The anti-directional motion was more sensitive to neck pain compared to other cervical joint motion parameters in the present study.     

膝关节镜下清理术改善骨性关节炎患者疼痛和关节功能的中期疗效

目的:探讨关节镜下清理术治疗骨性关节炎的中期疗效以及适应证。方法:回顾性分析采用关节镜下清理术治疗骨性关节炎共124例,158侧膝关节的临床结果。所有病例术前膝关节存在中度以上疼痛犤视觉模拟评分(VAS)法≥4分犦,经正规保守治疗至少3个月以上,症状控制不满意。术后随访时间2.5～4.8年,平均随访3.5年。随访内容包括疼痛程度(VAS评分),膝关节活动度,Lysholm评分,以及对手术的满意程度。结果:随访时疼痛,关节活动度和Lysholm评分较术前明显改善,患者的满意率达67.3%。结论:关节镜下关节清理术是治疗膝关节骨性关节炎的简便有效的方法之一,只要严格掌握适应证,可以取得满意的疗效。     

关节镜下冲洗改善膝关节骨关节炎患者的关节疼痛

Many methods are adopted in treatment of osteoarthritis and NSAID drugs and hormones are often used in clinic,but these methods can only alleviate symptoms in a short time and can't prevent progressing of disease.Many researches have been done these years directing to the key that degeneration of cartilage and destroy of surface lead to osteoarthritis. Systematic clearance and douche under arthroscope have a good effect in alleviating pain and improving symptoms to osteoarthritis.     

Changes in posttraumatic ankle joint mobility, pain, and edema following intermittent pneumatic compression therapy

The changes in posttraumatic ankle joint mobility, pain, and edema following intermittent pneumatic compression (IPC) therapy were examined in patients with lower leg fractures after six to 12 weeks of immobilization in a cast. The study group consisted of 22 patients with distal fractures of the lower leg. Each patient was given IPC treatment on five consecutive days for 75 minutes daily. The control group consisted of 12 patients with lower leg fractures who were not given any treatment. Ankle joint mobility in the study group increased by 11.9 degrees (SE = 1.5), but by only 1.0 degree (SE = 0.8) in the control group. The difference is highly significant (p less than 0.001). The study group also experienced markedly greater pain relief than did the control patients. The reduction of edema was 170 ml (SE = 23) in the study group and only 15 ml (SE = 12) in the control group (p less than 0.001). This study suggests that IPC treatment promotes the rehabilitation of the posttraumatic conditions.     

Disturbance and recovery of trunk stiffness and reflexive muscle responses following prolonged trunk flexion: influences of flexion angle and duration

Background

Experimental studies suggest that flexed working postures reduce passive support of the spine, which could represent a significant risk factor for the development of occupational low back disorders. Neuromuscular compensations to reduced passive stiffness include increases in baseline activity or reflexive activation of trunk muscles. Yet, alterations and recovery of the synergy between active and passive tissues following prolonged flexion in humans are currently unknown.

Methods

Twelve healthy participants were exposed to all combinations of two trunk flexion durations (2 and 16 min) and three flexion angles (33, 66, and 100% of individual flexion–relaxation angle). Load relaxation was recorded throughout exposures, whereas trunk stiffness and reflexive behaviors of the lumbar extensor muscles were investigated during dynamic responses to sudden perturbations.

Findings

The magnitude of load relaxation increased with increasing flexion angle. Trunk stiffness decreased and reflex gains increased following flexion exposures; for both outcomes, acute changes were larger following exposure to increasing flexion angle. Reflex gains remained elevated one hour after exposure to maximum flexion.

Interpretation

Exposure to prolonged trunk flexion changed trunk stiffness and reflex behavior in patterns consistent with epidemiological evidence linking such exposure with the risk of occupational low back disorders. Observed increases in reflex gains, at least among healthy individuals, may be a compensation for decreases in passive trunk stiffness following acute exposure to flexed postures. It remains to be determined whether the neuromuscular system can similarly respond to accumulated disturbances in passive structures following exposure to repeated flexion tasks.     

关节镜清理术并功能锻炼后老年膝关节骨性关节病患者关节功能恢复

INTRODUCTION In recent years, arthroscope has become a new approachfor treatment ofosteoarthritis of knee joint. We obtained favorable effect of arthroscopicarticular debridement in patients with bony arthropathy of knee joint.     

A comparison of eccentric isokinetic torque production and velocity of knee flexion angle during step down in patellofemoral pain syndrome patients and unaffected subjects

OBJECTIVE: To determine knee angular velocity changes during stair descent and slow velocity eccentric isokinetic quadriceps contraction, in normal controls and patellofemoral pain syndrome patients. DESIGN: Isokinetic and kinematic analysis of the performance of patellofemoral pain syndrome patients and matched normal controls. BACKGROUND: In the presence of increased patellofemoral joint stresses, patellofemoral pain syndrome patients have been shown to adopt compensatory strategies to minimise joint loading and therefore pain. One of the compensatory strategies reported, is that of the break phenomena, which results in a change quadriceps torque production. METHODS: Twenty female patients with patellofemoral pain syndrome and 20 asymptomatic matched controls participated in the study. All subjects had their isokinetic eccentric and concentric quadriceps torque assessed at 30 degrees/second and 2-dimensional video data taken when descending from a step. Variations in knee angular velocity and torque curves were then identified. RESULTS: None of the subjects demonstrated a break on isokinetic concentric quadriceps contraction. Of the patellofemoral pain syndrome patients, 50% (10 out of 20) had a break in eccentric torque curve on testing, compared with 15% (3 out of 20) of the controls. Abnormal curve perturbation was demonstrated to occur in none of the controls isokinetically, but 20% (4 out 20) of the patellofemoral pain syndrome patients had perturbations in their torque curves. On stair decent a break was seen in 60% (12 out of 20) of the patellofemoral pain syndrome patients and 15% (3 out of 20) of the control subjects on analysis of the knee angular velocity. Twenty percent (4 out of 20) of the patellofemoral pain syndrome patients and 10% (2 out of 20) of the controls had abnormal curve perturbation on analysis of their stair descent. CONCLUSIONS: The implications are that there appears to be a relationship between patellofemoral pain syndrome and control of eccentric quadriceps contraction. This relationship is possibly related to joint and soft tissue loading not just the degree of pain, with the break being a saving reflex to prevent further stress. RELEVANCE: Exercise to rehabilitate the quadriceps in patellofemoral pain syndrome should be chosen with regard to joint loading and range of movement as well as velocity of contraction, in order to facilitate quadriceps activation as opposed to inhibiting it.     

屈膝肌群在不同起始角度下的募集特征分析

目的:探讨在不同起始角度下,股后肌群与腓肠肌群参与屈膝动作的募集程度与动员顺序,为运动训练、运动康复的运动处方设计提供建议.方法:20例健康成年男子在坐姿屈膝训练器上,以5个起始角度做负荷为1RM(1次重复最大负荷)的80％屈膝动作3次,采集其屈膝肌群的表面肌电图.结果:①在同一起始角度下,屈膝动作中各肌群的募集比例一...     

Knee joint biomechanics in open-kinetic-chain flexion exercises

BACKGROUND: Different rehabilitation exercises such as open-kinetic-chain flexion and extension exercises are currently employed in non-operative and post-operative managements of joint disorders. The challenge is to strengthen the muscles and to restore the near-normal function of the joint while protecting its components (e.g., the reconstructed ligament) from excessive stresses. METHODS: Using a validated 3D nonlinear finite element model, the detailed biomechanics of the entire joint in open-kinetic-chain flexion exercises are investigated at 0 degrees, 30 degrees, 60 degrees and 90 degrees joint angles. Two loading cases are simulated; one with only the weight of the leg and the foot while the second considers also a moderate resistant force of 30 N acting at the ankle perpendicular to the tibia. FINDINGS: The addition of 30 N resistant force substantially increased the required hamstrings forces, forces in posterior cruciate and lateral collateral ligaments and joint contact forces/areas/stresses. INTERPRETATION: At post-anterior cruciate ligament reconstruction or injury period, the exercise could safely be employed to strengthen the hamstrings muscles without a risk to the anterior cruciate ligament. In contrast, at post-posterior cruciate/lateral collateral ligaments reconstructions or injuries, the open-kinetic-chain flexion exercise should be avoided under moderate to large flexion angles and resistant forces.