膝症状性骨关节炎335例临床分析

对３３５例膝骨关节炎临床分析结果显示：膝ＯＡ患病率随着增龄而增加，且病情也随之加重，部分可合并骨质疏松，并以女性多见，本组体块指数平均值为２６．１。，有１２％为肥胖，６１％为超重。提示ＢＭＩ过高是引起膝ＯＡ原因之一。以往临床不太重视的体征如骨摩擦音，骨关节肿胀等体征十分常见。     

全膝置换术后症状性深静脉血栓危险因素

[目的]探讨全膝关节置换（total knee arthroplasty, TKA）术后症状性深静脉血栓（deep vein thrombosis, DVT）发生的危险因素。[方法] 2018年—2023年于遵义市第一人民医院关节外科行TKA治疗的926例患者纳入研究。观察血栓的发生情况。采用单因素比较和多元逻辑回归分析探索DVT发生的危险因素。[结果]926例患者中,76例术后临床与超声检查确诊为症状性DVT,发生率为8.2%(76/926);1例肺动脉CTA检查确诊为肺动脉栓塞,发生率为0.1%(1/926)。血栓组患者男性占比[男/女,(23/53) vs (147/703), P=0.006]、吸烟者占比[是/否,(14/62) vs (75/775), P=0.008]、合并高血压[是/否,(50/26) vs (413/437), P=0.004]、心率失常[是/否,(7/69) vs (33/817), P=0.029]及下肢静脉瓣膜功能不全[是/否,(57/19) vs (488/362), P=0.004]的比率、术中失血量[(151.4±77.9) ml vs (1...     

关节镜治疗膝骨性关节炎的临床分析

[目的]探讨关节镜手术治疗膝骨性关节炎的临床效果及影响因素。[方法]2000年5月～2007年11月关节镜手术治疗的膝骨性关节炎共362例,获得完整随访124例,采用Lvsholm评分评价治疗效果。按交锁征、X线分级、关节镜分级、手术方式将病人分为亚组。资料数量化后输入计算机,采用SPSS16.0软件行配对t检验、方差分析和多元逐步线性回归分析。[结果]124例患者随访7～96个月,平均39.6个月。Lysholm评分术前(46.10±2.80)分,随访时(70.69±2.90)分,两者差异显著(t=9.362,P0.01)。有无交锁征组间差异显著(F=10.654,P0.01),不同X线分级组间差异显著(F=18.008,P0.001),不同关节镜分级组间差异显著(F=9.293,P0.001),不同手术方式组间差异显著(F=7.443,P0.01)。以随访时Lysholm评分为因变量的多元逐步线性回归分析表明,X线分级(B=-9.320,P0.01)、关节镜分级(B=-10.411,P0.01)、交锁(B=9.820,P0.01)、手术方式(B=11.432,P0.05)、入选方程(R=0.561,F=13.688,P0.001)。[结论]关节镜手术治疗能够明显缓解膝关节骨性关节炎症状,改善膝关节的功能。X线分级、关节镜分级、交锁及手术方式是影响疗效的因素。X线和关节镜分级越重手术效果越差,有交锁者疗效好于无交锁者。     

膝骨关节炎126例临床分析

对126例膝症状性骨关节炎(OA)临床分析显示:膝(OA)有遗传倾向,机械因素在膝(OA)的发病机制中起主导作用。MRI不失为检查膝(OA)的一种有效方法,可协助判断疾病病程。根据临床表现、X片、MRI片可把膝(OA)分为3期。膝(OA)治疗尚无特效药物,应根据病人情况施行个体化治疗。应重视早中期病人的治疗,以减慢疾病进程,提高生活质量。     

膝骨关节炎150例临床分析

目的探讨膝骨关节炎临床功能评分、X线片表现、软骨退变程度及三者之间的关系.方法对150例膝骨关节炎患者进行HSS功能评分、X线检查、136例行关节镜手术、14例行关节表面置换术,术中观察记录软骨退变程度.将其结果分期归类,对比分析.结果X线片和膝关节HSS功能评分跟软骨退变程度的符合率均较低,但对Ⅲ度退变的符合率均较高,分别达到80%和63%.结论在诊断膝骨关节炎中,X线片及HSS功能评分均有其局限性,不能准确反映膝骨关节炎的病变程度,但对晚期的骨关节炎诊断符合率较高,提示将两者结合起来,可能对诊断更有价值.     

Klippel-Trenaunay综合征膝严重退变全膝置换1例报告

<正>Klippel-Trenaunay综合征(Klippel-Trenaunay syndrome, KTS)又名静脉畸形骨肥大综合征,是一种罕见的先天性血管发育异常所致的疾病。该病以血管畸形、静脉曲张和软组织及骨肥大三联征为主要表现^[1]。KTS发病率在活胎中为2/10万～5/10万^[2],KTS大多为散发,少有家族遗传倾向,其病因和发病机理尚未明确,     

膝表面置换术在类风湿性膝关节炎和骨性膝关节炎的应用和比较

目的探讨膝关节表面置换术治疗类膝关节风湿性关节炎(RA)和膝关节骨性关节炎(OA)的临床疗效、安全性差异。方法自2010-01—2012-04采用膝关节表面置换术治疗68例(84膝)膝关节疾患,按照疾病类型分为OA组和RA组,对比分析2组手术时间、术中出血量、VAS评分、切口愈合时间、HSS单项评分及总分等。结果术后68例(84膝)获得平均47个月随访,随访期间无人工膝关节假体脱位。OA组手术时间、术中失血量、术后引流量及VAS评分显著低于RA组,差异有统计学意义(P0.05)。OA组术后1个月疼痛和HSS总分显著高于RA组,差异有统计学意义(P0.05),OA组术后1年和3年疼痛、功能、活动范围单项评分和HSS总分均显著高于RA组,差异有统计学意义(P0.05)。结论OA及RA人工全膝置换术后功能均有一定改善,与OA相比,RA患者术后近中期疗效相对较差,但远期疗效差异有待进一步研究。     

关节镜治疗退行性膝骨性关节炎205例

目的：探讨关节镜治疗早中期退行性骨性膝关节炎的短期效果。方法：采用镜下关节腔灌洗、软骨修整、骨赘切除、滑膜部分切除、游离体摘除、半月板修整或部分切除等方法治疗早、中膝关节骨性关节炎205例,208个膝。结果：术后随访6个月~5年,无手术并发症,优良率81%。其中随访2年以内者,优良率90%,随访2年以上者,优良率72%。结论：关节镜下清理术治疗早、中期骨性关节炎安全、有效、创伤小,手术时间短,康复快,但需要严格掌握其临床适应证。     

膝骨关节炎膝内翻畸形的全膝关节置换术

目的：探讨人工全膝关节置换术治疗膝骨关节炎膝内翻畸菜的临床疗效。方法：对40例人工全膝关节置换术进行3个月～6年的随访,手术的假体均使用后稳定型人工膝关节,并应用HSS膝关节评分系统进行分析。结果：手术优良率为95％,忠者术后在疼痛、功能及关节活动度等方面都有明显改善,各种产发症的发生率低。结论：全膝关节置换术是治疗膝骨关节炎膝内翻畸形的有效方法,术中应注意膝周软组织平衡的重要性,术后应加强功能康复训练。     

关节镜清理加髓腔减压治疗膝骨性关节炎

我科在中西医结合治疗膝骨性关节炎的基础上[1],从2001年2月采用关节镜下清理膝关节,辅以在髌骨和胫骨上端钻孔减压的方法治疗膝骨性关节炎46例,疗效满意,报道如下.……     

Fractal Analysis of Trabecular Bone in Knee Osteoarthritis (OA) is a More Sensitive Marker of Disease Status than Bone Mineral Density (BMD)

The purpose of this study was to determine whether fractal analysis (FSA) of macroradiographs or bone mineral density (BMD) is more sensitive in detecting disease-related cancellous bone alterations in knee osteoarthritis (OA). Differences in BMD between 11 OA (6 females) and 11 non-OA reference (7 females) tibiae were compared with differences in trabecular organization measured by computerized method of fractal signature analysis (FSA) of digitized macroradiographs (×3.5 to ×5). OA knees had anatomic and radiographic evidence of medial compartment disease. FSA measured cancellous bone organization at 4 regions of interest (ROI): medial and lateral subchondral (Sc) and subarticular (Sa) sites, dual X-ray absorptiometry (DXA) measured BMD at the same ROIs. Compared to non-OA, OA tibiae had significant increased (P < 0.05) in FSA of vertical trabeculae in the medial Sa region (trabecular size range: 0.42–0.54; 0.90–1.98 mm) and significant decrease (P < 0.05) in FSA for some horizontal trabeculae in the Sc region (trabecular size range: medial side 0.12–0.18 mm; lateral side 0.12–0.24 mm). Compared to non-OA, BMD of OA tibiae was not significantly different at any ROI. BMD was not sensitive to changes in trabecular organization detected by FSA. The increase in FSA of vertical trabeculae in the medial Sa region was consistent with trabecular fenestration and thinning, which may have been detected as decreased BMD in a larger sample. For studies involving small sample sizes, quantifying changes in trabecular organization is more sensitive than BMD for detecting bone alterations in knee OA.     

Analyzing the History of Falls in Patients with Severe Knee Osteoarthritis

Background

One out of three adults over the age of 65 years and one out of two over the age of 80 falls annually. Fall risk increases for older adults with severe knee osteoarthritis, a matter that should be further researched. The main purpose of this study was to investigate the history of falls including frequency, mechanism and location of falls, activity during falling and injuries sustained from falls examining at the same time their physical status. The secondary purpose was to determine the effect of age, gender, chronic diseases, social environment, pain elsewhere in the body and components of health related quality of life such as pain, stiffness, physical function, and dynamic stability on falls frequency in older adults aged 65 years and older with severe knee osteoarthritis.

Methods

An observational longitudinal study was conducted on 68 patients (11 males and 57 females) scheduled for total knee replacement due to severe knee osteoarthritis (grade 3 or 4) and knee pain lasting at least one year or more. Patients were personally interviewed for fall history and asked to complete self-administered questionnaires, such as the 36-item Short Form Health Survey (SF-36) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and physical performance test was performed.

Results

The frequency of falls was 63.2% for the past year. The majority of falls took place during walking (89.23%). The main cause of falling was stumbling (41.54%). There was a high rate of injurious falling (29.3%). The time patients needed to complete the physical performance test implied the presence of disability and frailty. The high rates of fall risk, the high disability levels, and the low quality of life were confirmed by questionnaires and the mobility test.

Conclusions

Patients with severe knee osteoarthritis were at greater risk of falling, as compared to healthy older adults. Pain, stiffness, limited physical ability, reduced muscle strength, all consequences of severe knee osteoarthritis, restricted patient''s quality of life and increased the fall risk. Therefore, patients with severe knee osteoarthritis should not postpone having total knee replacement, since it was clear that they would face more complicated matters when combining with fractures other serious injuries and disability.     

Patients With Knee Osteoarthritis Have Lower Total Hip Bone Mineral Density in the Symptomatic Leg Than in the Contralateral Hip

Osteoarthritis (OA) of the knee is common in the aging population. In patients with OA, bone mineral density (BMD) is usually increased, but the fracture rate does not appear to be systematically lower than in age-matched healthy controls. The aim of our study was to describe hip BMD in patients presenting with unilateral symptomatic knee OA. Patients with painful knee OA were prospectively included in a single-center, randomized, double-blind, placebo-controlled clinical trial to evaluate the structure-modifying efficacy of an oral chondroitin sulfate treatment on the knee joint. The majority of these patients underwent additional measurements of BMD of their lumbar spine and both hips using dual-energy X-ray absorptiometry (DXA). The hip BMD values of the leg with symptomatic knee OA were compared with the contralateral hip. One-hundred and sixty-one patients (81 men and 80 women; aged 62.6 +/- 9.2 yr, range 40-82 yr) underwent DXA. The median total hip BMD was higher than in age-matched controls, but patients had a relatively lower hip BMD in the knee OA-affected leg (p = 0.001). Our knee OA patients rarely presented with concomitant osteoporosis, but usually had a relatively lower hip BMD on the affected leg. Therefore, we suggest that the hip of the leg with symptomatic knee OA should be measured if DXA is acquired only at one hip. Future studies have to assess whether the relative decrease of BMD at the hip of the leg with knee OA might influence fracture incidence.     

膝骨关节炎病人生活质量与疼痛信念的相关性分析

目的 了解膝骨关节炎（KOA）病人生活质量与疼痛信念的现状及其相关性,并对其生活质量的影响因素进行分析,为提高膝骨关节炎病人的生活质量提供依据。方法 选取2022年1月至8月贵州省人民医院骨科门诊确诊的146例膝骨关节炎病人为调查对象,运用一般情况调查表、疼痛信念与感知量表（PBPI）及健康调查简表（SF-36）进行调查。结果 膝骨关节炎病人疼痛信念得分为-16~25（M=3.00）分,认为感到疼痛很神秘、自责感及疼痛信念总分与生活质量各维度呈负相关（P＜0.05,P＜0.01）;多元线性回归分析显示其生活质量与疼痛程度、年龄和家庭人均月收入有关（P＜0.05）。结论 膝骨关节炎大部分病人存在负性疼痛信念且生活质量较低,医务人员应重视病人疼痛信念,及时采取针对性措施,并结合其生活质量的影响因素进行针对性干预,从而提高病人的生活质量。     

Chinese Clinical Practice Guidelines in Treating Knee Osteoarthritis by Periarticular Knee Osteotomy

Unicompartmental knee osteoarthritis (UKOA) is the early stage of knee joint degeneration, which is characterized by unicompartmental degeneration and mostly occurs in medial compartment. Pain and limited motion are main symptoms, which affect patients'' life quality. Periarticular knee osteotomy (PKO) for lower extremity alignment correction is an effective treatment for UKOA with abnormal alignment, which could relieve pain and improve joint function by adjusting lower extremity alignment. At present, no clinical guidelines are available for the treatment of UKOA by PKO for lower extremity alignment correction. Experts from the Clinical New Technology Application Committee of the Chinese Hospital Association, Joint Surgery Study Group of the Chinese Orthopaedic Association of the Chinese Medical Association, and Osteoarthritis Study Group of the Chinese Association of Orthopaedic Surgeons of the Chinese Medical Doctor Association formulated these guidelines. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) grading system and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) were adopted to select 25 most concerning questions. Finally, 25 recommendations were formulated through evidence retrieval, evidence quality evaluation, and the determination of directions and strength of recommendations. Recommendation items 1–5 are indications and contraindications for PKO for lower extremity alignment correction, items 6–21 are surgical methods and principles, item 22 describes 3D printing corrective osteotomy technique, and items 23–25 address the perioperative period, follow‐up management, and other content. These guidelines are designed to improve the normalization and standardization of KOA treatment by PKO for lower extremity alignment correction.     

膝骨关节炎单髁置换术后下肢冠状位力线对早期临床效果的影响

目的 探讨单髁置换术（unicompartmental knee arthroplasty,UKA）后不同的下肢冠状位力线对早期临床效果的影响。方法 2018年8月至2019年6月,对93例（102膝）UKA术后病人进行回顾性分析,根据术后下肢力线将102膝分为三组,轻度内翻组（0°~3°）36膝、中等内翻组（3°~6°）37膝和重度内翻组（6°以上）29膝。比较三组术前及末次随访时的西安大略和麦克马斯特大学（the Western Ontario and McMaster Universities,WOMAC）骨关节炎指数及膝关节功能活动度,评估病人术后满意度。结果 随访24~34个月,平均27.1个月。末次随访时各组WOMAC评分以及轻度内翻组、中等内翻组的活动度均显著优于术前,差异有统计学意义（P＜0.05）。轻度内翻组、中等内翻组末次随访的活动度值均显著优于重度内翻组,差异有统计学意义（P＜0.05）,但轻度内翻组和中度内翻组比较,差异无统计学意义（P＞0.05）。中度内翻组中有更多的病人（70%）认为非常满意（P=0.028）。结论 UKA术中将力线调整至内翻0°~6°均可获得不错的膝关节功能评分及活动度,但UKA术后力线在3°~6°范围内的病人较0°~3°组可有更好的早期满意度。     

微创单髁置换术治疗膝关节单间室骨性关节炎

目的探讨微创单髁置换术治疗膝关节单间室骨性关节炎的临床疗效。方法2011年10月～2013年3月,对51例（54膝）膝关节内侧间室骨性关节炎采用髓外定位法进行胫骨及股骨截骨,骨水泥固定OxfordⅢ单髁置换假体并植入移动半月板。观察切口长度,手术时间,手术前后血红蛋白下降量,术后直腿抬高时间,膝关节活动范围,术后髋膝踝角及并发症;采用Oxford评分法对术前、术后膝关节功能进行评估。结果2例出现内衬脱位并发症进行翻修。无感染、下肢深静脉血栓、假体位置不良,假体松动等并发症。切口长度（6．6±0．8）cm（5．5～8cm）。手术时间（59．9±6．6）min（50～80min）,术后3d血红蛋白下降（13．5±5．0）g／L（7～28g／L）。术后自主直腿抬高时间（3．4±1．6）d（1～8d）。术后2～3d行双下肢全长片检查,髋膝踝178．2°±2．6°（177°～183°）。术后无伸直受限,最大屈曲度121．3°±6．6°（110°-130°）。51例术后随访6～23个月,平均14．5月,无感染、下肢深静脉血栓、假体位置不良,假体松动等并发症。Oxford膝关节功能评分术前（24．6±1．9）分,术后末次随访（41．6±3．5）分,术前后比较有统计学差异（t=34．313,P=0．000）。结论微创单髁置换术治疗内侧间室骨性关节炎短期效果良好,中远期疗效需要进一步随访。     

Mechanisms of Osteoarthritis (OA) Pain

Purpose of Review

Osteoarthritis (OA) is a major cause of pain and disability worldwide. There is, however, a relatively poor correlation between the severity of OA based on plain radiograph changes and symptoms. In this review, we consider the mechanisms of pain in OA.

Recent Findings

It is now widely recognised that OA is a disease of the whole joint. Data from large observational studies which have used magnetic resonance imaging (MRI) suggest that pain in OA is associated with a number of structural factors including the presence of bone marrow lesions (BMLs) and also synovitis. There is evidence also of alterations in nerve processing and that both peripheral and central nerve sensitisation may contribute to pain in OA.

Summary

Identification of the causes of pain in an individual patient may be of benefit in helping to better target with appropriate therapy to help reduce their symptoms and improve function.