关节腔灌洗联合康复训练对膝骨性关节炎疗效的影响

目的 探讨关节腔灌洗联合康复训练对膝骨性关节炎疗效的影响.方法 将82例膝骨性关节炎患者随机分为现察组和对照组各41例,对照组采用关节腔灌洗后予以常规护理,观察组在此基础上予以早期功能锻炼.采用目测类比定级法(VAS)和膝关节日常活动(ADL)能力评分,比较患者治疗前后患膝疼痛程度并对膝关节日常活动(ADL)能力进行评定.结果 治疗30 d后,两组患者症状均减轻,但观察组VAS及ADL能力评分显著优于对照组(均P＜0.01).结论 关节腔灌洗联合康复训练可明显提高膝骨性关节炎患者的日常活动能力,并减轻疼痛.     

关节腔冲洗配合透明质酸钠注射治疗膝骨性关节炎72例

我们采用关节腔冲洗配合透明质酸钠注射及手法点穴治疗膝骨性关节炎取得了较好的疗效,现报告如下.     

关节镜治疗膝骨性关节炎随访观察

1998年5月2004年6月应用膝关节镜做关节清理术，治疗膝关节骨关节炎100例（112膝），随访6个月-6年，疗效满意，现总结如下。     

膝骨性关节炎分级治疗的疗效分析

目的评价非手术治疗、关节镜和全膝关节置换术治疗不同严重程度的膝骨性关节炎的效果.方法对采用这三种方法治疗的213例(304膝)患者,依据膝骨性关节炎严重性指数(ISOA)及Kellgren-Lawrance(K-L)X线分级标准不同进行分组,对治疗前后的ISOA进行回顾性分析.结果经3～62个月(平均20.6个月)的随访,K-L分级Ⅰ、Ⅱ和Ⅲ级且ISOA＜14者,非手术治疗组和关节镜组治疗前后ISOA均有显著性差异;K-L分级Ⅲ级且ISOA≥14、Ⅳ级者,全膝关节置换术组治疗前后ISOA有显著性差异.结论K-L分级Ⅰ、Ⅱ和Ⅲ级且ISOA＜14者,应选择非手术治疗或关节镜治疗;K-L分级Ⅲ级且ISOA≥14、Ⅳ级者,全膝关节置换术是唯一有效的方法.     

透明质酸钠关节腔内注射治疗膝骨性关节炎的长期随访观察

我院自1998年4月至今，选择门诊膝骨性关节炎(OA)患者100例137个膝关节，均符合1995年美国风湿病协会(ACR)制订的膝关节OA的临床症状和体征的诊断标准，行关节腔内注射透明质酸钠(sodium hyaluronate，SH)治疗，经长期随访，疗效满意，报告如下。     

全膝关节置换术治疗晚期膝骨性关节炎

目的 探讨全膝关节置换术(TKA)治疗晚期膝骨性关节炎的临床疗效.方法 采用TKA治疗30例晚期膝骨性关节炎老年患者(33膝).比较手术前后膝关节最大被动屈曲度、HSS评分、疼痛VAS评分,采用HSS评分标准评价膝关节功能恢复情况.结果 患者均获得随访,时间6～24个月.未出现术后切口感染、深静脉血栓、假体松动等并发症...     

膝关节灌洗结合透明质酸钠治疗膝关节骨性关节炎疗效观察

目的 探讨关节灌洗对透明质酸钠治疗膝骨性关节炎疗效的影响.方法 对64例膝关节骨性关节炎分别应用透明质酸钠或关节灌洗合并透明质酸钠治疗.结果 配合关节灌洗的关节腔注射透明质酸钠在治疗开始后1周症状明显改善,5周疗效达到最佳效果,9个月后疗效明显下降.单纯关节腔注射透明质酸钠在治疗开始后1周症状改善较不明显,在5周疗效达到最佳效果,6个月后疗效明显下降.结论 关节灌洗可以明显提高透明质酸钠关节腔注射对膝关节骨性关节炎的疗效,配合关节腔灌洗的关节腔注射透明质酸钠较单纯关节腔注射透明质酸钠起效更快、疗效更好,疗效持续时间更长.     

超声引导下膝周神经脉冲射频联合关节腔注射富血小板血浆治疗膝关节骨性关节炎

目的 探讨超声引导下膝周神经脉冲射频联合关节腔注射自体富血小板血浆治疗膝关节骨性关节炎的有效性.方法 纳入自2016-07-2017-06诊治的50例膝关节骨性关节炎,关节腔注射自体富血小板血浆后,于穿刺点处置入1根脉冲射频套管针,在超声引导下将电压调至0.3 V以下与50 Hz频率进行感觉刺激,然后再以2 Hz频率进...     

腓骨近端截骨联合膝关节镜下关节腔清理术治疗膝关节内侧间室骨性关节炎的疗效分析

目的探讨腓骨近端截骨联合膝关节镜下关节腔清理术治疗膝关节内侧间室骨性关节炎的临床疗效。方法回顾性分析自2014-01—2017-12月诊治的67例膝关节内侧间室骨性关节炎患者。按照治疗方式不同分为观察组(26例,腓骨近端截骨联合膝关节镜下关节腔清理术)和对照组(41例,玻璃酸钠注射结合药物治疗)。比较2组不同时间段(治疗前、治疗后1周、3个月、6个月、12个月)的疼痛VAS评分和HSS评分。结果所有患者均获得随访,随访时间12～16(14.5±1.6)个月。观察组对治疗效果的满意率(80.8%)高于对照组(53.7%),差异有统计学意义(P 0.05)。治疗前2组间疼痛VAS评分和HSS评分相比,差异均无统计学意义(P0.05)。术后3个月、6个月、12个月的疼痛VAS评分及HSS评分方面,观察组均高于对照组(P 0.05)。结论腓骨近端截骨联合膝关节镜下关节腔清理术治疗膝关节内侧间室骨性关节炎创伤小,恢复快,早期疗效满意。     

关节镜治疗老年膝骨性关节炎的护理

目的：探讨关节镜治疗老年膝骨性关节炎的护理。方法：根据骨性关节炎及老年患者的特点，术前详细评估患者全身情况、做好心理护理、术前准备及饮食的指导；术后除观察术肢情况外，加强全身情况观察、早期股四头肌肌力和关节活动的功能锻炼。结果：89例患者对手术效果满意，膝关节肿痛症状消失，关节功能明显改善，术后未出现关节内血肿、感染及深静脉栓塞等并发症。结论：通过手术前后的精心护理，保证了手术治疗效果，促进了患者早日康复。     

个体化股骨远端外旋截骨全膝关节置换术对膝关节骨性关节炎病人关节功能及康复效果的影响

目的 探究个体化股骨远端外旋截骨全膝关节置换术（TKA）对膝关节骨性关节炎（KOA）病人膝关节功能及康复效果的影响。方法 选取2021年3月至2022年3月我院医治的98例KOA病人,依据随机数字表法分为两组,各49例。对照组采用常规TKA治疗,研究组采用个体化股骨远端外旋截骨TKA治疗。比较两组围术期情况,手术前后纽约特种外科医院膝关节评分（HSS）、美国膝关节学会评分（KSS）、关节活动度,以及关节液基质金属蛋白酶-9（MMP-9）、可溶性细胞间黏附分子-1（sICAM-1）、关节液肿瘤坏死因子-α（TNF-α）等康复效果相关指标,冠状位股骨远端机械轴外侧角（mLDFA）、下肢机械轴夹角（HKA）等力线参数,支撑时间百分比、步幅、步速等步态参数,疼痛视觉模拟量表（VAS）评分,关节炎生活质量测量量表2（AIMS2）评分,术后并发症。结果 两组随访时间均在6个月以上,无失访病例。研究组住院时间明显短于对照组［（6.24±1.18） d vs. （7.36±1.05） d］,差异有统计学意义（P＜0.05）。术后研究组并发症发生率（6.12%）与对照组（10.20%）相比,差异无统计学意义（P＞0.05）。两组术后各项指标均较术前改善,且研究组术后第3、6个月HSS评分、KSS稳定性评分、活动度均高于对照组,冠状位mLDFA、HKA均低于对照组,支撑时间百分比、步速、步幅均高于对照组,VAS评分、AIMS2评分低于对照组,组间比较,差异均有统计学意义（P＜0.05）。术后第3个月,研究组和对照组关节液TNF-α、sICAM-1、MMP-9水平均低于术前（P＜0.05）,但组间比较,差异无统计学意义（P＞0.05）。结论 与常规TKA治疗相比,个体化股骨远端外旋截骨TKA治疗能降低关节液TNF-α、sICAM-1、MMP-9水平,改善关节力线参数,提高膝关节功能,调整步态参数,降低术后疼痛程度,提高病人术后生活质量。     

Experimental Osteoarthritis in the Rabbit Knee Joint

The development of arthrotic-like changes following resection of the cruciate ligaments in the knee joint of rabbits has been studied at intervals from 2 weeks to 10 months in 35 animals. Signs of cartilage degeneration were followed by changes in the subchondral bone, where formation of osteophytes and condensation took place. An increased vascular supply was demonstrated by microangiographic and scintigraphic investigations. The uptake of ¹⁸F and '⁹⁹mTc-polyphosphate reached a maximal value about 2 months after the operation and then diminished despite further development of arthrotic changes.     

Experimental Osteoarthritis in the Rabbit Knee Joint

The development of arthrotic-like changes following resection of the cruciate ligaments in the knee joint of rabbits has been studied at intervals from 2 weeks to 10 months in 35 animals. Signs of cartilage degeneration were followed by changes in the subchondral bone, where formation of osteophytes and condensation took place. An increased vascular supply was demonstrated by microangiographic and scintigraphic investigations. The uptake of ¹⁸F and '⁹⁹mTc-polyphosphate reached a maximal value about 2 months after the operation and then diminished despite further development of arthrotic changes.     

等速肌力训练联合肌内效贴对骨关节炎患者膝关节稳定性的影响

目的:探讨等速肌力训练联合肌内效贴对骨关节炎患者膝关节稳定性的影响.方法:将80例骨关节炎患者按照数字双盲法分为治疗组和对照组,每组40例.对照组给予常规臭氧治疗,治疗组在对照组的基础上加用等速肌力训练联合肌内效贴治疗.观察2组临床疗效,以及治疗前后疼痛视觉模拟评分法(VAS)评分、膝关节稳定性Lysholm评分,关节...     

功能锻炼对膝关节骨关节炎病人功能恢复的影响

目的：探讨功能锻炼对膝关节骨关节炎病人功能恢复的影响。方法：将60例病人随机分为功能锻炼组（锻炼组）与对照组,锻炼组在膝关节腔内注入透明质酸钠注射液,并进行功能锻炼;对照组仅膝关节腔内注入透明质酸钠注射液。于治疗后第5周,根据膝关节的疼痛、肿胀、压痛、活动度及行走情况综合评分,观察、比较两组疗效。结果：锻炼组其膝关节功能改善程度优于对照组（P＜0．01）。结论：功能锻炼对膝关节骨关节炎病人功能恢复有积极意义。     

常规康复结合强化本体感觉训练对运动所致膝关节前交叉韧带并半月板损伤患者术后康复效果的观察

目的:探讨分析运动所致膝关节前交叉韧带并半月板损伤患者术后康复训练对临床疗效和预后的影响。方法:选取收治的178例运动所致膝关节前交叉韧带并半月板损伤患者进行研究分析,患者均采用高频超声、MRI诊断,关节镜手术治疗。根据术后康复训练方法的不同分为两组,每组89例。研究组采用常规及本体感觉强化康复训练,对照组采用常规康复训练。观察比较两组患者半月板损伤及处理的结果,采用Lysholm评分、IKDC评分评价膝关节功能恢复情况及安全性。结果:全部患者治疗后随访6～12月,研究组愈合时间为(2.16±1.05)月,对照组为(3.87±1.24)月,研究组短于对照组(P0.05);研究组治疗前、治疗后6月、治疗后12月的IKDC评分分别为(40.38±8.12)分、(65.19±7.54)分、(84.15±6.78)分,Lysholm评分分别为(45.12±5.98)分、(72.38±6.26)分、(89.41±7.50)分;而对照组在此三个时间点的IKDC评分分别为(41.04±8.33)分、(54.06±7.82)分、(70.21±6.90)分,Lysholm评分分别为(45.67±6.44)分、(65.49±7.03)分、(76.35±6.82)分,研究组治疗后IKDC评分和Lysholm评分均小于对照组(P0.05)。两组治疗后均无韧带断裂、关节粘连、滑膜炎等并发症。结论:运动所致膝关节前交叉韧带并半月板损伤患者术后采用常规康复训练结合强化本体感觉训练效果较佳,能有效减轻膝关节功能障碍,预后良好,适合临床推广。     

The Effect of Instability Training on Knee Joint Proprioception and Core Strength

Although there are many studies demonstrating increased trunk activation under unstable conditions, it is not known whether this increased activation would translate into meaningful trunk strength with a prolonged training program. Additionally, while balance-training programs have been shown to improve stability, their effect on specific joint proprioception is not clear. Thus the objective of this study was to examine training adaptations associated with a 10-week instability-training program. Participants were tested pre- and post-training for trunk extension and flexion strength and knee proprioception. Forty-three participants participated in either a 10-week (3 days per week) instability-training program using Swiss balls and body weight as resistance or a control group (n = 17). The trained group increased (p < 0. 05) trunk extension peak torque/body weight (23.6%) and total work output (20.1%) from pre- to post-training while the control group decreased by 6.8% and 6.7% respectively. The exercise group increased their trunk flexion peak torque/body weight ratios by 18.1% while the control group decreased by 0.4%. Knee proprioception (combined right and left joint repositioning) improved 44.7% from pre- to post-training (p = 0.0006) and persisted (21.5%) for 9 months post-training. In addition there was a side interaction with the position sense of the right knee at 9 months showing 32.1% (p = 0.03) less deviation from the reference angle than the right knee during pre-testing. An instability-training program using Swiss balls with body weight as resistance can provide prolonged improvements in joint proprioception and core strength in previously untrained individuals performing this novel training stress which would contribute to general health.

Key points

• Although traditional free weight resistance exercises have been recommended as most beneficial for improving strength and power in athletes (Behm et al., 2010b), an IT program using Swiss balls and body weight as a resistance may provide an alternative starting point for the sedentary untrained population.
• As it is well documented that force or strength is decreased when unbalanced (Behm et al., 2010b) and balance-training programs improve balance (Behm and Kean 2006), this type of instability RT program can provide significant adaptations to improve trunk strength especially with the untrained.
• This type of training should also be incorporated into a new program as the improvements in joint proprioception may help protect from joint injuries over a protracted period.
• The finding that improved joint proprioception persists for months after training should be emphasized to those individuals whose training is regularly or inconsistently interrupted.

Key words: Instability resistance training, stability, back, abdominals