兔膝关节伸直挛缩模型的建立

目的 建立新西兰白兔膝关节伸直挛缩模型,为进一步研究关节挛缩的发病机制及其治疗方案提供实验基础。 方法 将雄性骨骼成熟的新西兰白兔30只采用随机数字表法分为6组（对应不同固定时间）,即对照组、固定1周组、固定2周组、固定4周组、固定6周组、固定8周组,每组5只新西兰白兔。利用管型石膏将5个固定组兔左膝关节于伸直位分别固定1周、2周、4周、6周和8周。每个对应的时间点应用过量的戊巴比妥钠对6组新西兰白兔实施安乐死,拆除石膏后测量关节液中转化生长因子-β1（TGF-β1）含量、总挛缩程度、肌源性挛缩程度、关节源性挛缩程度及后方关节囊厚度,然后以固定时间作为单因素,对各组所得指标进行单因素方差分析。 结果 6组新西兰白兔关节液中TGF-β1的含量组间两两比较,差异均有统计学意义（P<0.05）。对照组、固定1周组、固定2周组和固定4周组的总挛缩程度组间两两比较,差异均有统计学意义（P<0.05）。固定1周组的肌源性挛缩程度为（14.6 ± 2.7）°,与其余5组比较,差异均有统计学意义（P<0.05）;固定2周组的肌源性挛缩程度与对照组比较,差异有统计学意义（P<0.05）。除固定6周组和固定8周组外,其余各组关节源性挛缩程度组间比较,差异均有统计学意义（P<0.05）。除对照组和固定1周组外,其余各组后方关节囊厚度组间比较,差异均有统计学意义（P<0.05）。 结论 通过石膏固定建立的新西兰白兔膝关节伸直挛缩模型简单实用,可用于膝关节挛缩发生和恢复的进一步探索,能为研究伸直型膝关节挛缩的发生机制及相关治疗策略提供较好的动物模型。     

膝关节伸直位僵硬的松解治疗与康复

目的:探讨关节松解术结合短期屈曲位固定与早期康复训练治疗膝关节伸直位僵硬的效果。方法: 对21例膝关节伸直位僵硬的患者实施关节松解术,术后将膝关节屈曲位固定72h,同时积极进行早期康复治疗,观察功能恢复情况。结果: 21例患者术前膝关节屈曲度10°—55°,平均36°。术后随访5—21个月（平均11.8个月）,膝关节屈曲度100°—140°,平均123°,与手术前相比增加87°(P<0.01）。结论：关节松解术结合短期屈曲位固定以及早期康复训练治疗膝关节伸直位僵硬可以获得良好的功能恢复,明显改善生存质量。     

早期膝关节骨关节炎的关节源性肌肉软弱

目的：了解早期膝关节骨关节炎的关节源性肌肉软弱的特性。方法：１４例发病１个月内的单侧膝关节骨关节炎患者的等速肌力参数的自身对照研究。结果：患侧屈伸膝等速肌力参数处于低位,其中大部分明显弱于健侧。结论：早期膝关节骨关节炎即表现出屈伸膝肌群的肌肉软弱,由于萎缩因素少,这种肌肉软弱应该主要是关节源性肌肉抑制的后果。     

肱尺关节分离技术对上肢骨折后肘关节功能障碍的治疗

目的观察单纯肱尺关节分离技术对肘关节功能障碍的疗效。 方法选取因上肢骨折固定制动造成肘关节功能障碍的患者27例,分为对照组14例和观察组13例。对照组采用多种关节松动术与被动牵伸技术相结合的综合治疗方法;观察组则单纯采用肱尺关节分离技术并辅以无痛且无负重的主动运动训练进行治疗。2组患者均于治疗前和治疗1,2,4周后采用关节活动度（ROM）与Mayo肘关节功能评分（MEPS）对疗效进行评估。 结果治疗前,对照组患者和观察组患者肘关节屈曲的ROM值分别为（47.86±23.35）°和（48.46±22.86）°,2组间差别无统计学意义（P&rt;0.05）。治疗4周后,2组患者肘关节屈曲的ROM值与组内治疗前比较,差异有统计学意义（P<0.05）,观察组肘关节屈曲的ROM值为（110.00±20.00）°,显著优于对照组的（80.36±23.57）°,且差异有统计学意义（P<0.05）。 结论单纯的肱尺关节分离技术治疗肘关节功能障碍所取得的疗效明显优于多种关节松动术结合被动牵伸技术的综合治疗方法。     

膝关节功能障碍被动治疗引起疼痛的防治

目的研究膝关节功能障碍被动治疗所引起疼痛的防治。方法将32例骨折后膝关节功能障碍患者分为单纯手法治疗组和综合治疗组,治疗前后分别测关节活动度和恢复程度,同时评定患者的疼痛值。结果单纯手法治疗组治疗前关节活动范围(ROM)主动(64±30)°,被动(73±27)°,综合治疗组治疗前ROM主动(57±30)°,被动(67±30)°,两组间无显著差异(P>0.05)。治疗后综合治疗组ROM改善程度明显优于单纯治疗组,数字评价量表(NRS)评分也明显低于单纯手法治疗组。结论综合治疗能有效防治手法治疗骨折后膝关节功能障碍所引起的疼痛,并明显促进膝关节功能恢复。     

人工膝关节置换术后连续被动活动对关节功能的影响

目的观察连续被动活动(CPM)对人工膝关节置换术后膝关节功能的恢复情况,进行临床对照研究评估连续被动活动在全膝置换术后康复中的作用。方法将本院行首次全膝置换的44例患者以单纯随机抽签方法分成两组,23例术后除行物理康复治疗外辅助应用CPM康复治疗,21例患者仅行物理康复治疗。对所有患者进行术后随访,记录术后第7,10,14天,6周,6个月及1年时的关节活动范围(ROM)。结果与未应用CPM组相比,应用CPM组患者平均膝关节活动度在术后7,10,14d,6周,3,6个月及1年时分别多19°,15°,10°,8°,8°,2°和5°(t=4.763,3.621,3.529,2.614,2.507,2.178,2.117,P<0.05)。结论CPM有助于全膝置换患者术后较早恢复膝关节活动度。     

持续被动运动对膝关节镜术后关节功能的影响

目的观察早期持续被动运动对膝关节镜术后关节功能的影响. 方法将53例行膝关节镜手术的患者随机分成两组,其中对照组25例,术后未作持续被动运动(CPM);CPM组28例,在手术24 h后即行CPM锻炼, 分别记录入院时、出院时、术后3个月时两组患者关节活动度和膝关节功能综合评分. 结果出院时膝关节活动度对照组屈(69.40±15.17)°,伸(-4.32±4.71)°;CPM组屈(90.64±16.57)°,伸(-0.71±3.78)°.膝关节功能评分对照组(11.24±1.42)分,CPM组(8.89±1.84)分.出院时关节活动范围达90°者, 对照组6例(24%),CPM组21例(75%). 结论早期作CPM能明显提高膝关节镜术后效果,能增加膝关节活动度、改善膝关节功能、缩短住院时间,但远期效果还需进一步深入研究.     

四肢骨折内固定术后早期功能锻炼的临床研究

目的:研究四肢骨折内固定术后系统的功能锻炼对关节活动度(ROM)的影响。方法:对224例患者术后10d、30d时的膝、肘关节ROM进行统计。结果:上肢肘关节ROM:伤后10d达89.6°±22.3°、30d达123.5°±19°,膝关节ROM:伤后10d达85.4°±25.8°、伤后30d达120°±18°。结论:早期系统的功能锻炼可使骨折患者的关节活动度尽快恢复正常。     

牵伸联合低强度脉冲超声对兔膝关节挛缩影响的研究

摘要 目的：观察牵伸联合低强度脉冲超声（low intensity pulsed ultrasound，LIPUS）对固定诱导的兔膝关节囊纤维化的影响，并明确牵伸联合LIPUS对兔膝关节源性挛缩的影响。 方法：选取新西兰白兔30只，随机分为以下5组，每组6只：对照组（C）、自然恢复组（NR）、LIPUS组（LT）、牵伸组（ST）、牵伸联合LIPUS组（CT）。C组不进行任何处理，其余4组将兔左膝关节伸直位固定6周后，再解除固定分为：NR组进行自然恢复，LT组进行LIPUS干预，ST组进行牵伸干预，CT组进行牵伸联合LIPUS干预。各组干预时间为4周，通过关节活动测量仪检测各组膝关节源性挛缩角度、马松（Masson）染色分析膝关节前囊胶原沉积百分比、蛋白质免疫印迹分析（Western blot）膝关节前囊内转化生长因子（TGF）-β1、α-平滑肌肌动蛋白（SMA）、Ⅰ型胶原（Collagen Ⅰ）、Ⅲ型胶原（Collagen Ⅲ）的蛋白表达水平。 结果：在干预4周后，与NR组比较，LT组、ST组、CT组均能有效减小膝关节源性挛缩角度（P＜0.05）；LT组、ST组、CT组均能减轻关节囊纤维化（P＜0.05），表现为胶原沉积百分比降低（P＜0.05）以及TGF-β1、α-SMA、Collagen Ⅰ、Collagen Ⅲ的蛋白表达水平降低（P＜0.05）。值得注意的是，CT组取得最好的干预效果（与其他干预组相比均P＜0.05）。 结论：牵伸联合低强度脉冲超声通过降低膝关节囊内胶原沉积和TGF-β1、α-SMA、Collagen Ⅰ、Collagen Ⅲ的蛋白水平表达来减轻关节囊的纤维化，继而改善膝关节源性挛缩角度。     

盘状半月板损伤的关节镜手术方法与术后康复

目的探讨关节镜下盘状半月板损伤的手术方法、效果及术后康复。方法关节镜下诊断盘状半月板并损伤54例,39例行半月板成形术,保留半月板边缘6~8 mm,9例行盘状半月板次全切除术,6例行盘状半月板完全切除术,术后即行膝关节功能锻炼,入院与术后1月、1年行膝关节活动范围测量,其中47例获1~4年10个月的随访。结果按照Lkeuchi评价方法,优38例(70.4%),良11例(20.0%),可5例(9.3%),差0例,优良率为90.4%。入院时膝关节活动范围屈曲平均118°±16°,伸直10°±4,°术后1月膝关节活动范围屈曲平均133°±4,°伸直0°±3°,术后1年膝关节活动范围屈曲平均135°±3°,伸直0°±3°,经统计学分析,术后1月、1年与入院时比较均差异有统计学意义。结论关节镜下盘状半月板成形术创伤小,疗效满意。     

挛缩膝关节中肌源性成分的实验研究

Immobilizationisafrequentlyusedtreatmentformuscu－loskeletalinjuries．However，prolongedimmobilizationmayleadtojointcontractureandfunctionallimitations．Inordertopreventandtreatthistypeofcontracture，onehastodistinguishthedifferentstructuresinvolvedintherestrictionofmotion．Contractureshavebeengroupedintofourclasses：arthrogenic，softtissue，myogenicandmixed．Inanormaljointdevelopingacontracture，whentheskinandnervesupplyareintact，onehastodifferentiatethearthrogenic（bone，capsule，ligaments…     

膝关节固定后髌骨腱的生物力学改变

背景：骨关节固定常作为防止受伤组织被再次损伤的方法。目的：膝关节固定对兔髌骨腱力学特性及超微形态的影响。方法：将20只成年兔等分为固定组和对照组。固定组兔左后肢通过石膏和2个可调铝夹板,保持膝伸直,踝关节屈曲90°,固定6周后,取髌骨腱-骨复合物,观察两组髌骨腱的生物力学性能和超微结构变化。结果与结论：膝关节固定6周拉伸强度和切线模量分别下降至对照组的64.44%和53.08%（P〈0.01）,但两组伸长率和最大负荷差异没有显著性意义。两组材料常数及应力应变关系曲线完全不同。固定组髌骨腱的横截面积明显大于对照组（P〈0.01）,小胶原纤维占有优势。说明固定不仅会导致髌骨腱生物力学的变化,而且对髌骨腱自身也产生影响。     

三维骨建模系统在人工全膝关节置换旋转对位中的作

背景:前期人工全膝关节置换试验证实,采用以三维骨建模为基础的计算机辅助系统可以进行精确地假体三维定位及下肢力线重建,减少髌股关节并发症,取得韧带平衡,获得良好的临床效果.目的:拟进行人工全膝关节置换时假体旋转对位的量化分析,验证三维骨建模的计算机辅助手术系统对量化操作的精确性和有效性.设计、时间及地点:回顾性病例分析,于2002-11/2003-06在法国亨利蒙多医院矫形与创伤外科完成.对象:纳入保守治疗无效的三间隔骨性关节炎患者21例(21膝),其中14例膝内翻,7例膝外翻;患者均为初次置换,所用假体为后稳定型人工表面全膝关节(Hermes(R),Ceraver,法国).方法:采用三维骨建模Ceravision系统对21例患者(21膝)进行人工全膝关节置换.计算机系统提供假体预设方案,安置好截骨定位导向装置后进行截骨,注意保持良好的伸屈膝关节间隙和韧带平衡及关节稳定,额面上控制应力下膝内外翻在±3°以内,下肢力线(180±3)°以内,适当地假体旋转对位后行假体固定.主要观察指标:根据相关的临床体检、影像学和导航系统资料,对术中假体旋转对位测量值、置换后3个月膝关节活动度、膝关节松弛度和髌骨稳定性进行观察分析.结果:在保证下肢力线与膝关节额面松弛度于正常范围内,术中股骨假体旋转对位内旋1°～外旋5°,胫骨假体旋转对位内旋0°～外旋5°.其中14例膝内翻患者,股骨假体旋转对位内旋1°～外旋5°,胫骨假体旋转对位内旋2°～外旋5°;7例膝外翻患者,股骨假体旋转对位内旋1°～外旋4°,胫骨假体旋转对位内旋0°～外旋 4°.置换后3个月时,膝关节最大屈膝度为105°～130°,平均115°,无膝痛、髌骨失稳和脱位等并发症,膝关节额面松弛度无异常.结论:应用以三维骨建模为基础的人工全膝关节置换计算机辅助手术系统,可针对患者个体精确三维截骨和假体旋转对位,获得良好的膝关节屈伸位下关节等距间隙,保证良好的膝关节韧带张力与平衡稳定, 避免髌-股并发症,可在手术中常规使用.     

Modelling knee range of motion post arthroplasty: clinical applications

Purpose: To model change in knee range of motion (ROM) post total knee arthroplasty (TKA) and to show how this information can be incorporated into clinical decision making.Method: We applied a variable-occasion repeated-measures study design. Patients' knee flexion and extension ROM were assessed pre- and post arthroplasty over the ensuing 60 weeks. We examined change in ROM post TKA using linear and nonlinear mixed-effects modelling, and examined whether age, body mass index, prearthroplasty ROM, and gender were determinants of recovery in post-arthroplasty ROM.Results: Of 93 eligible patients, 74 provided pre- and post-arthroplasty data. A random intercept nonlinear model fit the flexion data best, and a random intercept linear model fit the extension data best. Pre-arthroplasty ROM was found to be a determinant of recovery in ROM post arthroplasty. This finding was common to both flexion and extension models.Conclusions: Our study showed that the greatest improvement for knee ROM took place during the first 12 weeks post arthroplasty. Of the variables examined, only pre-arthroplasty ROM was a determinant of outcome (p<0.05). The study results provide clinicians with data to determine expected rates of improvement for patients as well as the projected maximum ROM, facilitating improved clinical decision making.     

膝关节固定后髌骨腱的生物力学改变(英文)

背景:骨关节固定常作为防止受伤组织被再次损伤的方法。目的:膝关节固定对兔髌骨腱力学特性及超微形态的影响。方法:将20只成年兔等分为固定组和对照组。固定组兔左后肢通过石膏和2个可调铝夹板,保持膝伸直,踝关节屈曲90°,固定6周后,取髌骨腱-骨复合物,观察两组髌骨腱的生物力学性能和超微结构变化。结果与结论:膝关节固定6周拉伸强度和切线模量分别下降至对照组的64.44%和53.08%(P<0.01),但两组伸长率和最大负荷差异没有显著性意义。两组材料常数及应力应变关系曲线完全不同。固定组髌骨腱的横截面积明显大于对照组(P<0.01),小胶原纤维占有优势。说明固定不仅会导致髌骨腱生物力学的变化,而且对髌骨腱自身也产生影响。     

The effect of duration of stretching of the hamstring muscle group for increasing range of motion in people aged 65 years or older

BACKGROUND AND PURPOSE: Stretching protocols for elderly people (> or = 65 years of age) have not been studied to determine the effectiveness of increasing range of motion (ROM). The purpose of this study was to determine which of 3 durations of stretches would produce and maintain the greatest gains in knee extension ROM with the femur held at 90 degrees of hip flexion in a group of elderly individuals. SUBJECTS: Sixty-two subjects (mean age = 84.7 years, SD = 5.6, range = 65-97) with tight hamstring muscles (defined as the inability to extend the knee to less than 20 degrees of knee flexion) participated. Subjects were recruited from a retirement housing complex and were independent in activities of daily living. METHODS: Subjects were randomly assigned to 1 of 4 groups and completed a physical activity questionnaire. The subjects in group 1 (n = 13, mean age = 85.1 years, SD = 6.4, range = 70-97), a control group, performed no stretching. The randomly selected right or left limb of subjects in group 2 (n = 17, mean age = 85.5 years, SD = 4.5, range = 80-93), group 3 (n = 15, mean age = 85.2 years, SD = 6.5, range = 65-92), and group 4 (n = 17, mean age = 83.2 years, SD = 4.6, range = 68-90) was stretched 5 times per week for 6 weeks for 15, 30, and 60 seconds, respectively. Range of motion was measured once a week for 10 weeks to determine the treatment and residual effects. Data were analyzed using a growth curve model. RESULTS: A 60-second stretch produced a greater rate of gains in ROM (60-second stretch = 2.4 degrees per week, 30-second stretch = 1.3 degrees per week, 15-second stretch = 0.6 degrees per week), which persisted longer than the gains in any other group (group 4 still had 5.4 degrees more ROM 4 weeks after treatment than at pretest as compared with 0.7 degrees and 0.8 degrees for groups 2 and 3, respectively). DISCUSSION AND CONCLUSION: Longer hold times during stretching of the hamstring muscles resulted in a greater rate of gains in ROM and a more sustained increase in ROM in elderly subjects. These results may differ from those of studies performed with younger populations because of age-related physiologic changes.     

Effect of Anterior Tibiofemoral Glides on Knee Extension during Gait in Patients with Decreased Range of Motion after Anterior Cruciate Ligament Reconstruction

Purpose: The purpose of this preliminary investigation was to evaluate the effect of anterior tibiofemoral glides on maximal knee extension and selected spatiotemporal characteristics during gait in patients with knee extension deficits after anterior cruciate ligament (ACL) reconstruction.Methods: Twelve patients with knee-extension deficits after recent ACL reconstructions underwent quantitative gait analyses immediately before and after 10 minutes of repeated anterior tibiofemoral glides on the operative limb, and again after a 10-minute seated rest period.Results: Maximum knee extension during stance phase of the operative limb significantly increased immediately after the treatment (mean increase: 2.0°±4.1°, 95% CI: 0.6°-3.3°). Maximum knee extension decreased after the 10-minute rest period (mean decrease: 0.9°±1.8°, 95% CI: -0.1°-1.8°), although the decrease was not statistically significant. Small increases in operative limb step length, stride length, and gait speed were observed after the rest period compared to baseline values only.Conclusions: A single session of anterior tibiofemoral glides increases maximal knee extension during the stance phase of gait in patients with knee-extension deficits. Increases in knee extension are small and short-lived, however, suggesting that continued activity is required to maintain the observed improvements.     

早期应用淋巴引流结合持续被动活动对膝关节周围骨折术后康复的影响

目的:探讨早期应用淋巴引流手法结合持续被动活动(CPM)对膝关节周围骨折术后膝关节功能康复的临床疗效。方法:41例膝关节周围骨折术后患者随机分为观察组21例和对照组20例,对照组予常规康复治疗(包括关节松动、肌力训练、冰敷等),观察组在常规康复治疗的基础上应用淋巴引流手法及CPM治疗。治疗前及治疗4周后测量患肢膝关节周径评定水肿情况,采用关节活动度及lysholm膝关节功能评分(LKSS)评定膝关节功能。结果:治疗4周后,2组膝关节周径较治疗前均降低(均P0.01),其中观察组降低更明显(P0.01);2组ROM、LKSS评分较治疗前均提高(均P0.01),其中观察组提高更明显(P0.01)。结论:膝关节周围骨折术后早期应用淋巴引流手法结合CPM能减轻膝关节肿胀、改善膝关节活动度及膝关节功能。     

Extent and direction of joint motion limitation after prolonged immobility: an experimental study in the rat

OBJECTIVES: To test the hypotheses that contractures progress at different rates in relation to the time after immobilization, that immobilization in flexion leads to loss of extension range of motion, and that joints of sham-operated animals are better controls than the contralateral joint of experimental animals. STUDY DESIGN: Experimental, controlled study in which 40 adult rats had one knee joint immobilized at 135 degrees of flexion for up to 32 weeks and 20 animals underwent a sham procedure. At intervals of 2, 4, 8, 16, and 32 weeks, 8 experimental and 4 sham-operated animals were killed and their knee motion measured in flexion and extension. RESULTS: In the experimental group, the range of motion decreased in the first 16 weeks of immobility at an average rate of 3.8 degrees per week (p<.0001) to reach 61.1 degrees of restriction. A plateau was then observed from which the contracture did not progress further. The loss in range of motion occurred in extension, not in flexion. CONCLUSION: This study defined an acute stage of contractures starting at the onset of immobility and lasting 16 weeks, during which the range of motion was progressively restricted, and a chronic stage during which no additional limitation was detected. The loss in motion was attributed to posterior knee structures not under tension during immobilization in flexion. Contrary to the hypothesis, the contralateral joint was validated as a control choice for range-of-motion experiments.