开放楔形胫骨高位截骨术治疗膝关节内侧间室骨关节炎近期疗效观察

目的 探讨膝关节内侧间室骨关节炎患者行开放楔形胫骨高位截骨术治疗的近期疗效及安全性.方法 膝关节内侧间室骨关节炎患者17例,均行开放楔形胫骨高位截骨术治疗.记录手术时间、术中出血量、住院时间及术后并发症发生情况.术后随访,记录骨折愈合时间,比较术前及术后3个月患侧膝关节内外侧间室高度比、胫股角、疼痛视觉模拟评分(vis...     

胫骨高位截骨术治疗膝关节骨性关节炎66例报道

选取我院2006年1月～2013年12月收治的66例膝关节骨性关节炎患者,均行胫骨高位截骨术,对其临床疗效进行分析。结果 66例患者术前评分33～75（53.6±10.9）分,术后42～97（73.2±16.8）分,两者比较,差异具有统计学意义（P〈0.05）。胫骨高位截骨术治疗治疗膝关节骨性关节炎临床效果明显。     

胫骨高位截骨术治疗膝关节内侧间室骨关节炎的效果及对血清炎性因子、PⅡANP水平的影响

目的探讨胫骨高位截骨术治疗膝关节内侧间室骨关节炎的效果及对血清炎性因子、PⅡANP水平的影响。方法选取2017年4月至2018年6月本院收治的55例膝关节内侧间室骨关节炎患者为研究对象,所有患者均行胫骨高位截骨术治疗。观察患者的治疗效果。结果术后3 d、1个月的HSS评分与术前比较,差异无统计学意义(P>0.05);术后3、6个月和1年的HSS评分明显高于术前,差异具有统计学意义(P<0.05);术后3 d、1、3、6个月及1年的VAS评分均低于术前,差异具有统计学意义(P<0.05)。术后不同时间的WOMAC评分均较术前升高,差异具有统计学意义(P<0.05);术后不同时间的胫骨近端内侧角及生理性外翻角均较术前显著增大,差异具有统计学意义(P<0.05)。术后不同时间的IL-6、IL-17、IL-1和PⅡANP水平均显著低于术前,差异具有统计学意义(P<0.05)。结论胫骨高位截骨术治疗膝关节内侧间室骨关节炎能有效改善患者膝关节功能,减轻疼痛症状,消除血清炎症因子,具有推广应用价值。     

内侧开放与外侧闭合胫骨高位截骨治疗内侧间室膝骨性关节炎的早期疗效对比

目的 对比内侧开放(OWHTO)与外侧闭合(CWHTO)胫骨高位截骨治疗膝关节内侧间室骨性关节的临床疗效.方法 回顾性分析2014年1月至2018年12月收治的膝关节内侧间室骨性关节炎患者48例,其中采用OWHTO术式25例,采用CWHTO术式23例.术后定期随访,测量髋膝踝角(HKA)及胫骨近端内侧角(MPTA),采...     

探讨胫骨高位截骨术治疗早期膝关节骨性关节炎的临床应用价值

目的 探析在早期膝关节骨性关节炎患者治疗过程中运用胫骨高位截骨术的临床价值.方法 选取2020年8月至2021年7月济南市莱芜人民医院收治的90例早期膝关节骨性关节炎患者,采用随机数字表法将其分为对照组(45例)与试验组(45例).对照组患者接受关节置换术治疗方式,试验组患者接受胫骨高位截骨术治疗方式.比较两组患者治疗...     

胫骨高位开放截骨术并关节镜微骨折术治疗膝内侧骨关节炎

目的:探讨胫骨高位开放截骨术并关节镜微骨折术治疗膝内侧骨关节炎的临床疗效。方法:回顾性分析2017年1月～2019年1月收治的膝内侧骨关节炎患者60例的临床资料,按治疗方法不同将60例患者分为截骨组和联合组,各30例。截骨组采用胫骨高位开放截骨术治疗,联合组采用胫骨高位开放截骨术并关节镜微骨折术治疗,比较两组手术前后疼痛评分、膝关节评分、膝关节功能评分及股胫角。结果:术后6个月,两组疼痛评分较术前降低,股胫角较术前减小,且联合组术后疼痛评分低于截骨组,股胫角小于截骨组(P0.05);术后6个月,两组膝关节评分及功能评分均较术前升高,且联合组高于截骨组,差异有统计学意义(P0.05)。结论:采用胫骨高位开放截骨术并关节镜微骨折术治疗膝内侧骨关节炎患者具有较好的临床疗效,可减轻患者疼痛程度,改善患者膝关节功能。     

单髁关节置换术治疗膝关节内侧间室骨性关节炎疗效观察

目的:探讨膝关节内侧间室骨性关节炎患者采用单髁关节置换术治疗的临床效果。方法:回顾性分析2018年1月～2019年5月收治的55例膝关节内侧间室骨性关节炎患者的临床资料,其中24例行单髁关节置换术治疗的为观察组,31例行全膝关节置换术治疗的为对照组。比较两组手术相关指标、膝关节功能、膝关节活动度、人工关节遗忘指数及生活质量评分。结果:观察组手术时间、术中失血量及住院时间均优于对照组(P0.05);术后,两组膝关节功能美国特种外科医院评分和膝关节活动度均较术前有所提高,且观察组术后膝关节功能美国特种外科医院评分、膝关节活动度高于对照组(P0.05);观察组术后3个月人工关节遗忘指数及生活质量评分均高于对照组(P0.05)。结论:采用单髁关节置换术治疗膝关节内侧间室骨性关节炎患者临床疗效确切,手术创伤较小,患者恢复快,能改善膝关节功能,提高患者生活质量。     

不同时期膝关节镜检+单髁关节置换对前内侧间室膝关节骨性关节炎患者膝关节功能的影响

目的 研究不同时期膝关节镜检+单髁关节置换对前内侧间室膝关节骨性关节炎患者膝关节功能的影响。方法 回顾性分析2015年10月－2019年10月该院收治的100例前内侧间室膝关节骨性关节炎患者的临床资料,所有患者均行膝关节镜检+单髁关节置换。其中,56例行同期手术治疗的患者作为观察组（Outerbridge分级为Ⅲ级或Ⅳ级）,44例行分期手术治疗的患者作为对照组（Outerbridge分级为Ⅰ级或Ⅱ级）。比较两组患者的临床疗效、手术相关指标、治疗前及治疗后3、6和12个月的膝关节活动度、治疗前后膝关节功能评分［疼痛视觉模拟评分（VAS）、牛津大学膝关节评分（OKS）和美国西安大略和麦克马斯特大学骨性关节炎指数（WOMAC）评分］,以及术后并发症发生情况。结果 观察组总有效率为94.64%,与对照组的88.64%比较,差异无统计学意义（P > 0.05）。观察组手术时间和住院时间短于对照组,差异有统计学意义（P < 0.05）。两组患者治疗后3、6和12个月膝关节活动度较治疗前增大,差异有统计学意义（P < 0.05）,但不同时期组间比较,差异无统计学意义（P > 0.05）。两组患者治疗后VAS、OKS和WOMAC评分较治疗前降低（P < 0.05）;观察组治疗后WOMAC和OKS评分较对照组低（P < 0.05）;两组患者VAS比较,差异无统计学意义（P > 0.05）。患者均未发生严重并发症,两组患者并发症发生率比较,差异无统计学意义（P > 0.05）。结论 同期与分期行膝关节镜检+单髁关节置换治疗前内侧间室膝关节骨性关节炎,临床疗效相当,但同期膝关节镜检 + 单踝关节置换可促进膝关节功能恢复,值得临床推广。     

膝关节清理加胫骨高位截骨治疗内翻型膝骨性关节炎46例分析

目的 介绍膝关节清理加胫骨高位截骨术治疗内翻型膝骨性关节炎的方法及较好的治疗效果。方法 ①切除髌股关节以及股胫关节边缘增生的骨赘；清除关节游离体及变性并即将脱落软骨面；切除变性滑膜。②在胫骨外侧，胫骨平台关节面下作楔型截骨，并用自制“U”型钉内固定。结果 46例病人，经随访1-3．5年，优良率占91．3％，效果满意，无加重影响功能的并发症。结论 膝关节清理加胫骨高位截骨术为治疗膝骨性关节炎可行的外科治疗方法，截骨部位愈合良好，费用低廉，是基层医院治疗内翻型膝关节关节炎的有效方法．     

内侧间室膝骨性关节的下肢关节生物力学变化

目的：了解内侧间室膝骨性关节炎患者与正常人群在行走过程中的下肢生物力学参数的差异,以便准确客观的对患者下肢功能进行评定。方法：通过三维步态分析系统和测力板分别对正常人群（正常组）25例和内侧间室膝骨性关节炎患者（患病组）25例进行时间空间以及髋、膝、踝关节的运动学和动力学参数采集,并进行比较。结果：与正常组比较,患病组在行走过程中的最大膝关节曲,踝关节跖/背屈,髋关节曲/伸角度以及关节活动范围均明显降低,髋关节内收力矩明显减小,膝关节内收力矩明显增加（均P〈0.05）。结论：内侧间室膝骨性关节炎患者下肢关节生物力学发生变化,步行过程中的膝关节所受的压力明显高于正常人群,为其康复评定及治疗提供客观评价依据。     

膝骨关节炎患者膝屈伸肌群等速肌力及其与功能的相关性

目的观察膝关节骨关节炎(KOA)患者膝屈伸肌群等速肌力变化及其与膝关节功能的关系。方法23 例双侧KOA患者及14 名正常人进行膝屈伸肌等速肌力检查、五次坐-起试验(FTSST)、静态平衡测试、步态分析。KOA组还完成疼痛视觉模拟评分(VAS)及WOMAC骨关节炎指数评定。结果KOA组伸肌及屈肌峰力矩、峰力矩均值、平均功率、单次最佳做功及总功主患侧均小于对侧(P<0.05);峰力矩屈肌/伸肌(H/Q)百分比主患侧大于对侧(P<0.05)。组间比较,伸肌所有观察指标、屈肌平均功率KOA组均小于正常对照组(P<0.05);峰力矩H/Q 百分比KOA组大于正常对照组(P<0.05)。KOA组伸肌等速肌力峰力矩与FTSST、步行速度、步行距离、跌倒指数、VAS 评分、WOMAC-疼痛评分之间存在相关性(P<0.05),屈肌等速肌力峰力矩与FTSST、步态参数、跌倒指数、VAS评分、WOMAC评分之间无明显相关性(P>0.05)。结论KOA患者伸肌及屈肌等速肌力主患侧较对侧减弱,伸肌等速肌力较正常人减弱,膝伸屈肌肌力变化不同步。KOA患者伸肌等速肌力峰力矩与膝关节疼痛、功能之间存在相关性。     

双醋瑞因治疗老年膝骨关节炎的临床疗效及机制探讨

[目的]观察双醋瑞因对老年膝骨关节炎（KOA）的临床疗效,并探讨其机制.[方法]KOA患者62例,予双醋瑞因胶囊50mg、2次/天口服治疗,疗程12周.在治疗前和随访3个月、6个月、12个月时分别进行关节功能测定,同时检测膝关节液MMP-3的含量.[结果]治疗3个月后,患者WOMAC评分较治疗前下降;治疗6个月时,WOMAC评分进一步下降;治疗12个月时,WOMAC评分保持稳定（F=15.264,P=0.000）.OA严重程度指数变化也显示出相同的趋势（F=11.145,P=0.000）.MRI的Recht分级显示随着治疗时间的延长,膝关节软骨的正常到轻度异常的比例增高 （χ^2=28.269,P=0.003）.关节液MMP-3的含量治疗3个月时下降;至6个月时,MMP-3含量继续下降;到12个月,MMP-3含量保持稳定（F=12.375,P=0.000）.MMP-3含量和WOMAC评分及OA严重程度指数均呈正相关,相关系数分别为0.775（t=6.876,P=0.003）和0.710（t=5.461,P=0.014）.[结论：]双醋瑞因治疗老年KOA有较好的临床疗效,其机制可能与MMP-3的表达下降有关.     

The Effect of Therapeutic Ultrasound on Pain and Physical Function in Patients with Knee Osteoarthritis

Osteoartritis (OA) is one of the most frequent causes of pain, loss of function and disability in adults. The prevalence of OA is expected to increase substantially in the future. Knee OA is the most common subset of OA. Therapeutic ultrasound (US) is one of several physical therapy modalities suggested for the management of pain and loss of function due to OA. The purpose of our study was to investigate the efficacy of US therapy in reducing pain and functional loss and improving the quality of life in patients with knee OA in comparison to sham US therapy. The study involved 62 patients. The patients were randomly divided into two groups. The patients in group 1 (n = 30) were administered 1 W/cm², 1 MHz continuous US, and the patients in group 2 (n = 32) were administered sham US. The US treatment was applied for 8 min to each knee, 16 min in total, 5 d a wk, for a total of 10 sessions during 2 wk. The patients were evaluated immediately after treatment and 1 mo after therapy according to the visual analog scale (VAS), night pain, range of motion, morning stiffness, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne and Short Form-36 (SF-36) scales and 6 min walking distance. Improvement in pain and joint functions was observed in both groups according to the evaluation immediately after treatment and at 1 mo after the therapy. According to the evaluation results immediately after treatment, there was significant improvement in all pain scales (VAS, WOMAC, Lequesne, SF-36), morning stiffness and 6 min walking distance in patients receiving real US treatment (p < 0.05), but only in some pain scales (VAS, WOMAC) and functions in the group receiving sham US (p < 0.05). Significantly better improvement was observed in some pain scales (SF-36), functions (WOMAC, SF-36) and 6 min walking distance in the real US group. At 1 mo after therapy, no significant difference was observed between groups except for improvement in night pain in the real US group. In conclusion, US therapy has been found to be effective in reducing pain and improving physical function in the short term, but this positive effect was not persistent in the long term. However, we believe that the results of our study may contribute to ongoing research for the treatment of patients with knee OA, and further systematic investigation on larger patient populations may delineate the role of US in knee OA treatment.     

针刺配合中国灸穴位贴敷治疗膝骨关节炎疗效观察

目的：比较针刺配合中国灸穴位贴敷与单纯针刺治疗膝骨关节的临床疗效。方法：将60例符合膝骨关节炎诊断的病员随机分为针刺加中国灸治疗组和单纯针刺对照组,两组均取穴血海、梁丘、犊鼻、膝眼、鹤顶、阳陵泉治疗,治疗组每天加用中国灸穴位贴敷治疗。10次一疗程,2个疗程后观察疗效。结果：治疗组30例中显效20例,好转8例,无效2例,总有效率为93．3％。对照组30例中显效9例,好转16例,无效5例,总有效率为83．3％。两组有效率有显著性差异（P〈0．05）。结论：针剌配合中国灸穴位贴敷治疗膝骨关节疗效优于单纯针刺。     

帕瑞昔布超前镇痛对膝关节骨性关节炎全膝关节置换术患者的镇痛效果及对炎性因子的影响

目的探讨帕瑞昔布超前镇痛对膝关节骨性关节炎行全膝关节置换术患者的镇痛效果及对炎性因子的影响。方法选取2016年10月—2018年10月收治的行全膝关节置换术的膝关节骨性关节炎78例,根据是否采用超前镇痛方法,分为观察组(n=38)和对照组(n=40)。观察组于麻醉诱导前30 min静脉注射帕瑞昔布,对照组术前不采取任何超前镇痛措施。采用视觉模拟评分(visual analog scale,VAS)评估术后6、12、24 h的疼痛程度,记录术后24 h自控镇痛泵(patient controlled analgesia,PCA)按压次数与曲马多使用量,检测术前和术后6、12、24 h血清炎性因子相关指标[白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子(tumor necrosis factor,TNF)-α]水平,观察术后24 h不良反应发生情况。结果与对照组比较,观察组术后6、12、24 h的VAS及IL-6、TNF-α水平降低,术后24 h的PCA按压次数及曲马多使用量均减少,差异有统计学意义(P<0.05)。观察组、对照组不良反应总发生率分别为7.89%(3/38)、27.50%(11/40),比较差异有统计学意义(χ2=3.964,P=0.016)。结论帕瑞昔布超前镇痛对行全膝关节置换术的膝关节骨性关节炎患者的镇痛效果良好,可减少术后镇痛药物使用量及不良反应发生情况,减轻机体炎性反应。     

A Randomized Controlled Trial on the Effects of Low-Dose Extracorporeal Shockwave Therapy in Patients With Knee Osteoarthritis

ObjectiveTo test the efficacy of low-dose extracorporeal shockwave therapy (ESWT) on osteoarthritis knee pain, lower limb function, and cartilage alteration for patients with knee osteoarthritis.DesignRandomized controlled trial with placebo control.SettingOutpatient physical therapy clinics within a hospital network.ParticipantsEligible volunteers (N=63) with knee osteoarthritis (Kellgren-Lawrence grade II or III) were randomly assigned to 2 groups.InterventionsPatients in the experimental group received low-dose ESWT for 4 weeks while those in the placebo group got sham shockwave therapy. Both groups maintained a usual level of home exercise.Main Outcome MeasuresKnee pain and physical function were measured using a visual analog scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Lequesne index at baseline, 5 weeks, and 12 weeks. Cartilage alteration was measured analyzing the transverse relaxation time (T2) mapping.ResultsThe VAS score, WOMAC, and Lequesne index of the ESWT group were significantly better than those of the placebo group at 5 and 12 weeks (P<.05). Both groups showed improvement in pain and disability scores over the 12-week follow-up period (P<.05). In terms of imaging results, there was no significant difference in T2 values between groups during the trial, although T2 values of the ESWT group at 12 weeks significantly increased compared to those at baseline (P=.004). The number and prevalence of adverse effects were similar between the 2 groups, and no serious side effects were found.ConclusionsA 4-week treatment of low-dose ESWT was superior to placebo for pain easement and functional improvement in patients with mild to moderate knee osteoarthritis but had some negative effects on articular cartilage.     

本体感觉训练联合肌内效贴对全膝关节置换术后患者膝关节功能与本体感觉的影响

目的:探讨本体感觉训练联合肌内效贴对全膝关节置换术后患者膝关节功能与本体感觉的影响.方法:将68例全膝关节置换术后患者随机分为本体感觉组和联合治疗组各34例.2组患者均进行基础治疗,并在治疗前及治疗4周后,分别采用膝关节评分(KSS)、"起立-行走"计时测试(TUGT)、主动关节角度重现偏差值进行评定,并评价术后6个月...     

Effect of Soft Braces on Pain and Physical Function in Patients With Knee Osteoarthritis: Systematic Review With Meta-Analyses

ObjectivesTo systematically review and synthesize the effects of soft braces on pain and on self-reported and performance-based physical function in patients with knee osteoarthritis.Data SourcesThe following electronic databases were searched from inception to April 20, 2016: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CINAHL, SPORTDiscus, Web of Science, and PEDro.Study SelectionRandomized controlled trials (RCTs) and nonrandomized controlled trials (non-RCTs), such as controlled clinical trials, crossover studies, and case-control studies, were included. Two reviewers independently screened articles and determined inclusion through predefined criteria.Data ExtractionData related to participant demographics, study design and methods, interventions, and outcomes, including numerical means and SDs, were extracted by 1 reviewer. Methodological quality assessment was independently performed by 2 reviewers.Data SynthesisEleven studies were identified, including 6 RCTs and 5 non-RCTs. The methodological quality of included RCTs was low. There was a moderate improvement in pain (standardized mean difference [SMD]=.52; 95% confidence interval [CI], .14–.89; P=.007; 284 participants) in favor of wearing a brace compared with not wearing a brace for the immediate, within-group comparison. There was a moderate improvement in pain (SMD=.61; 95% CI, .33–.89; P<.001; 206 participants) and a small to moderate improvement in self-reported physical function (SMD=.39; 95% CI, .11–.67; P=.006; 206 participants) in favor of patients receiving a soft brace versus standard care for the prolonged effect, between-group comparison.ConclusionsCurrently available evidence indicates that soft braces have moderate effects on pain and small to moderate effects on self-reported physical function in knee osteoarthritis. These findings highlight the importance of soft braces as a technique to improve pain and physical function in both the short- and long-term. Additional high-quality studies are warranted to improve confidence in the findings.