关节炎和力学因素

关节炎和力学因素的关系可涉及病因学、病理学、诊断学和治疗学。本简述了关节软骨和滑液的生物力学及关节运动学和动力学与关节炎的关系，涉及了应力和一氧化氮的作用，解释了关节源性肌抑制，分析了关节炎康复治疗中力学原理的应用。该提出，力是关节炎发生、发展的原因之一，关节炎又可导致关节结构的力学性能改变。治疗关节炎时，必须运用生物力学原理。     

本期继教园地思考题(1)

下列各题哪一项答案是错误的１．关节炎和力学因素的关系大致涉及以下几方面：A．力学因素与关节炎病因之间的关系B．关节炎造成关节力学环境的改变C．关节炎的治疗D．关节炎患者的性别２．关节运动可分为以下几个关节面的运动：A．冠状面B．矢状面C．水平面D．纵侧面３．关节炎的评价可分以下几部分：A．严重程度的评价B．关节基本功能的评价C．日常生活能力的评价D．健康状态的评价E．生存质量的评价F．抑郁状态的评价４．关节基本功能的评价包括以下几方面：A．形态学检查B．疼痛C．肌力测定D．ROM的测量E．步态分析F．本体感…     

骨关节康复中的力学问题

从生物力学角度出发 ,采用力学研究方法 ,对组织的力学性质进行研究 ,可为康复治疗的机理探讨和治疗手段的改进提供理论依据。本文简要介绍在制动综合征、软组织损伤、颈椎牵引、关节挛缩等一些骨科康复领域中所涉及的力学问题 ,以期更好地指导临床治疗。     

有限元分析Ilizarov技术对肘膝关节屈伸挛缩畸形矫正器作用的机制

背景:目前国内外鲜见采用有限元法分析Ilizarov技术在骨科疾病肢体延长及对关节挛缩外固定器的作用机制。目的:利用三维有限元分析Ilizarov技术对肘膝关节屈伸挛缩畸形矫正器的作用机制。方法:利用Ilizarov生物学理论设计出的符合人体生物力学特性和可以广泛应用于临床的关节挛缩矫正器。通过三维有限元分析应用Ilizarov技术在肘膝关节屈伸挛缩畸形矫正器设计中的力学有效性和科学性。结果与结论:建立了几何外型逼真、生物力学特性全面的肘膝关节三维有限元模型。通过三维有限元模型及力学分析计算出各组织包括骨与软组织的弹性模量和泊松比等力学指标,可通过施加关节挛缩矫正器的载荷分析其关节内、外的应力-应变分布及变化情况。Ilizarov技术可对肘膝关节挛缩畸形矫正器的设计与优化改良提供理论依据,利用有限元力学分析揭示了肘膝关节屈伸挛缩畸形病变组织结构的生物力学变化中的机制。     

有限元分析Ilizarov技术对肘膝关节屈伸挛缩畸形矫正器作用的机制

背景：目前国内外鲜见采用有限元法分析Ilizarov技术在骨科疾病肢体延长及对关节挛缩外固定器的作用机制。目的：利用三维有限元分析Ilizarov技术对肘膝关节屈伸挛缩畸形矫正器的作用机制。方法：利用Ilizarov生物学理论设计出的符合人体生物力学特性和可以广泛应用于临床的关节挛缩矫正器。通过三维有限元分析应用Ilizarov技术在肘膝关节屈伸挛缩畸形矫正器设计中的力学有效性和科学性。结果与结论：建立了几何外型逼真、生物力学特性全面的肘膝关节三维有限元模型。通过三维有限元模型及力学分析计算出各组织包括骨与软组织的弹性模量和泊松比等力学指标,可通过施加关节挛缩矫正器的载荷分析其关节内、外的应力-应变分布及变化情况。Ilizarov技术可对肘膝关节挛缩畸形矫正器的设计与优化改良提供理论依据,利用有限元力学分析揭示了肘膝关节屈伸挛缩畸形病变组织结构的生物力学变化中的机制。     

力学因素对骨关节炎软骨的影响

骨关节炎（osteoarthritis，OA）是一组有不同病因但有相似的生物学、形态学和临床表现的疾病。该病不仅发生关节软骨损害，还累及整个关节，包括软骨下骨、韧带、关节囊、滑膜和关节周围肌肉等，最终发生关节软骨的退变、纤维化、断裂、溃疡及整个关节面的损害。目前已知易感因素包括性别、年龄、种族、营养因素、创伤等，这些易感因素导致局部生物力学改变（如关节损伤、关节变形、肌力下降等），从而引起关节软骨退变，诱发严重的关节炎。许多研究均已证明，力学因素对OA的影响较大。现将力学因素对OA的影响综述如下。     

运动疗法在膝骨性关节炎临床应用的研究进展

膝骨性关节炎(knee osteoarthritis,KOA)是临床上常见的退行性疾病,因其高发病率和致残率而受到广泛关注。膝关节不稳定和力线异常是导致KOA的主要生物力学因素,膝关节周围肌力下降、关节失稳和疼痛三者之间形成恶性循环,引起胫股关节、髌股关节面应力分布异常,从而导致了KOA的发生和发展。运动疗法有助于阻断肌力下降、关节失稳和疼痛这三者之间的恶性循环,减缓关节损害的发展,维护关节的力学稳定,从而提高关节功能,改善疼痛程度、活动受限等临床症状,提高患者的膝关节活动能力和生活质量。     

玻璃酸钠关节腔注射结合股四头肌训练用于治疗膝关节骨性关节炎的疗效观察

骨性关节炎(osteoarthritis,OA)在全球范围内是最常见的一种关节慢性退行性病变;其中又以膝关节发生率最高。对于骨性关节炎的发病机制仍然不是清楚,现在一般认为与机体衰老退变和生物力学的改变有关,其中关节软骨的退变是骨性关节炎的最直接原因[1—2]。目前骨关节炎的治疗方法多种多样,其疗效亦各不相同。我们通过玻璃酸钠关节腔注射结合股四头肌训练治疗膝关节骨性关节炎取得满意疗效,现报告如下。     

免荷膝关节矫形器干预对膝关节骨性关节炎疼痛及行走能力的影响

正骨性关节炎是关节软骨退变引起的一类关节疾患。最早出现症状是膝关节内侧腔(股骨内髁和胫骨内侧平台部),这种病理变化是由于膝关节的应力分布不均衡所造成的,久而久之,也会出现韧带、关节囊纤维层和滑膜层张力不均衡,关节面上的软骨逐渐变性、坏死、缺损。随着退变日益加重,继而出现关节间隙狭窄,半月板磨损,导致关节失稳,局部炎症引发疼痛,并继发产生关节的生物力学问题。本研究采用矫形器干预膝关节骨性关节炎患者,治疗其     

硫酸氨基多聚糖在治疗膝骨性关节炎中的作用

骨性关节炎是一种以关节软骨变性和丢失及关节边缘和软骨下骨骨质增生为特征的慢性关节疾病。随着年龄的增长和各种原因造成关节软骨损伤,关节软骨自身缺乏修复和再生能力,造成骨性关节炎的发生。骨性关节炎可导致关节功能障碍,对不同期的骨性关节炎治疗方法是不同的。对早期的骨性关节炎可用物理方法治疗和药物治疗,目前临床上较为有效的治疗药物是硫酸氨基多聚糖(维骨力)。     

Hyperbaric Oxygen Treatment Is Comparable to Acetylsalicylic Acid Treatment in an Animal Model of Arthritis

Approximately 1 in 5 adults in the United States are affected by the pain, disability, and decreased quality of life associated with arthritis. The primary focus of treatment is on reducing joint inflammation and pain through a variety of pharmacotherapies, each of which is associated with various side effects. Hyperbaric oxygen therapy is an alternative treatment that has been recommended to treat a variety of inflammatory diseases, ranging from chronic brain injury to exercise induced muscle soreness. The purpose of this set of experiments was to explore the effect of hyperbaric oxygen therapy on joint inflammation and mechanical hyperalgesia in an animal model of arthritis, and compare these effects to treatment with aspirin. Hyperbaric oxygen therapy significantly reduced both joint inflammation and hyperalgesia. As compared with aspirin treatment, hyperbaric treatment was equally as effective in decreasing joint inflammation and hyperalgesia. PERSPECTIVE: This article reports that hyperbaric oxygen treatment decreases pain and inflammation in an animal model of arthritis. The effect of hyperbaric oxygen treatment is very similar in magnitude to the effect of acetylsalicylic acid treatment. Potentially, hyperbaric oxygen could be used to treat pain and inflammation in patients with arthritis.     

Four Cardinal Principles of Joint Mobilization and Joint Play Assessment

Abstract

The teaching and learning of fundamental principles that guide valid and effective assessment and intervention techniques in joint mobilization is a basic foundation to those health professions that make use of manual therapy. Such principles help establish the specificity of manual therapy techniques, the foremost quality of 'best practice.' However, authors of few textbooks or reference books devote space to establishing such fundamental principles for learners and practitioners of manual therapy techniques. The purpose of this paper is to present four cardinal principles that have impressed us, over our years as educators and clinicians, as the foundation for the teaching and practice of sound manual therapy techniques for either joint play assessment or joint mobilization. These principles are utilized in practice from entry-level to master clinicians, they can guide educators as to how to introduce and monitor effective manual therapy skills among students and colleagues, and they can also serve as a source of refreshment for experienced clinicians who desire continuing education for maintenance of their hands-on skills in manual therapy interventions and assessment.     

蜂针疗法治疗类风湿性关节炎的疗效观察

目的观察蜂针疗法对类风湿关节炎患者的临床疗效。方法将75例符合类风湿性关节炎诊断标准的患者随机分为蜂针组、药物组和蜂针+药物组。比较3组的疗效。结果治疗结束后以及治疗结束后3个月随访,3组患者关节疼痛度、关节肿胀度、关节压痛度、晨僵时间(h)、关节疼痛数变化、HAQ、ESR、RF、CRP均有显著差异(P0.05)。结论蜂针疗法能有效缓解类风湿关节炎患者的临床症状。     

Septic arthritis. Clinical approach to the 'hot joint'

Joint space infections continue to be among the most common forms of arthritis. Diagnosis can be difficult, particularly in the presence of underlying joint disease. Septic arthritis should be suspected in all patients who present with an acutely swollen joint. Immediate joint aspiration with Gram's stain and culture of the synovial fluid is essential. Intensive, long-term antibiotic therapy is necessary to prevent a high rate of morbidity and, possibly, death.     

痛风性膝关节炎治疗方法及效果比较

目的探讨不同治疗方法对痛风性膝关节炎的治疗效果。方法自2001年2月一2006年2月共收治29例痛风性膝关节炎患者，对8例痛风性关节炎患者采取药物保守治疗，7例行关节冲洗术治疗，14例行关节镜手术治疗。术后常规坚持正规的降尿酸治疗。结果经保守治疗及行关节冲洗术治疗组不能发现关节内结构的病变情况及采取相应治疗措施阻止关节内结构的损伤，随访发现关节症状好转不明显。14例关节镜手术患者术后症状均明显缓解，关节功能有良好的恢复，伤口均甲级愈合，术后无并发症出现。随访关节功能良好。结论比较以上3种治疗方法，关节镜治疗痛风性膝关节炎具有起效快、效果明显、关节功能恢复满意等特有优势，结合药物治疗，能取得良好的治疗效果。     

Current concepts review: Septic arthritis of the knee pathophysiology, diagnostics, and therapy

Treatments for bacterial arthritis of the knee joint are arthroscopic irrigation and debridement with systemic antibiotic medication. This article summarizes the relevant data of pathophysiology, stage of infection, symptoms, and diagnostics as well as stage-dependent treatment of bacterial arthritis of the knee joint. The major treatment principles are joint decompression, elimination of the causative organisms by intensive irrigation of the joint with elimination of proteolytic and lysosomal enzymes. Debridement of necrotic soft tissues with the aim of preserving the synovial membrane as an immune-competent structure, and a natural barrier, is recommended. Good results in treating knee infections have been achieved with arthroscopic joint revision and stage-dependent surgical therapy. The infection staging I-IV suggested by G?chter was used most commonly, which mainly reflects the pathophysiologic infection stages. For stages I-III, arthroscopic joint decompression with joint irrigation and debridement is effective and can be repeated in cases of persisting infection. The incidence of repeated arthroscopic joint irrigation depends on the initial stage of the infection and varies between 0 and 41% of the cases. For stage IV infections, the open revision is needed or in seldom cases of therapy failure under initial or repeated arthroscopic joint revision. The success rate of healing infections by arthroscopic irrigation was high with 90-100%.     

208例痛风病人的伴发病及发病因素的回顾性研究

目的探讨痛风性关节炎与高血压、高脂血症、脂肪肝、糖尿病等伴发病的关系,及与饮食、疲劳、季节、遗传等因素的关系。方法本文收集了208例痛风病人,从性别、年龄、体重、病程、诱发因素、好发部位、好发季节、急性发作的间歇期、伴发病及家族遗传史、血尿酸水平等方面进行临床观察。结果痛风性关节炎病人中伴发高血压占68．75％,高血脂占53．37％,有家族史占21．15％;由高嘌呤饮食诱发占65．87％,疲劳诱发占32．21％;以第一跖趾关节好发的占42．79％。痛风病人的体重指数与血尿酸水平呈正相关（P〈0．05）。结论痛风性关节炎的发作与饮食、气候、疲劳因素等有相关性;往往与高血压、高血脂、糖尿病等代谢性疾病并发;有明显的家族遗传性;好发于下肢小关节,以第一跖趾关节最多见。     

护理干预对类风湿关节炎患者焦虑抑郁心理的影响

目的 :探讨护理干预对类风湿关节炎 (RA)患者焦虑抑郁心理的影响。方法 :应用Zung氏焦虑自评量表 (SAS)和抑郁自评量表 (SDS)评定患者情绪 ,并予以护理干预 ,包括建立类风湿关节炎患者个人康复档案 ,指导关节功能锻炼 ,集体进行健康教育 ,个别患者予以心理疏导、娱乐疗法等 ,比较护理干预前后的分值。结果 :类风湿关节炎患者存在明显的焦虑抑郁心理 ,与国内常模相比差异有显著性 (P <0 0 1 ) ;护理干预后症状明显改善 (P <0 0 1 )。结论 :对类风湿关节炎患者实施多层次、全方位、科学的护理干预。明显改善其焦虑抑郁心理。     

Mortality and functional prognosis in rheumatoid arthritis

Rheumatoid arthritis (RA) is characterized with inflammation of joints and damage of joints tissue. Therefore it induced the disability and handicap in RA patients. This paper described the mortality and functional prognosis in rheumatoid arthritis patients. The numerous number of studies concerning on mortality in RA patients revealed that RA is not benign disease, provided excess rate of mortality compared to normal population. The degree of joints damages was conventionally assessed with radiographic images. So X-P images reflects the course of disease activity and disabilities in RA. The previous assessments with X-P images revealed that the bone erosions and joint space narrowing occurred within two years after onset of RA among approximately 70 % patients. Now it is considered that the joint destruction induced early stage of RA, therefore the promising therapy are needed for the patients who are at risk of poor prognosis. It should be investigated whether the biologic drugs, including TNFalpha inhibitor can alter the mortality and functional prognosis in RA patients.     

甲巯咪唑致关节炎综合征一例并文献复习

目的报道1例服用甲巯咪唑(商品名赛治)出现抗甲状腺综合征的患者,并进行文献复习。方法对1例30岁女性服用赛治出现抗甲状腺综合征患者的临床资料进行回顾性分析,并复习相关文献。结果本例患者因甲状腺功能亢进症口服赛治(10 mg,tid)治疗,25 d后出现游走性多关节疼痛、活动受限。停用赛治,口服洛索洛芬钠(商品名乐松)治疗,关节疼痛好转。换用丙硫氧嘧啶治疗,无不良反应。结论口服赛治可发生抗甲状腺关节炎综合征,需立即停药。