双膝骨性关节炎患者步态特征的研究

目的:比较双侧膝骨性关节炎(knee osteoarthritis,KOA)患者与健康成年人步态特征的差异。方法:应用现代步态测试系统对双侧KOA患者及健康成年人(各50例)进行步态检测,比较并分析受试者足底各区域受力时间参数、步角、单足支撑时间。结果:双侧KOA患者足底受力时间百分比M1值明显低于健康成年人,而M2、M3值则明显高于健康成年人(均P0.05);双侧KOA患者与健康成年人步角差异无统计学意义(P0.05);双侧KOA患者单足支撑时间明显大于健康成年人(P0.05)。结论:双侧KOA患者与健康成年人的步态特征存在差异。     

家兔膝关节骨关节炎动物模型的建立

【目的】建立一个与人膝关节软骨损伤伴半月板损伤相似的骨关节炎的动物模型。【方法】通过在家兔后腿膝关节的股骨内髁关节面部位用骨钻造成其关节软骨的损伤,同时切除半月板。以后按一定时间取出其股骨髁,用内眼、光镜及电镜观察破损部软骨修复情况。【结果】家兔后腿膝关节股骨内髁关节面的关节软骨损伤后,有纤维软骨修复,但无透明软骨出现。与人膝关节软骨损伤后的修复情况相似。【结论】实验性兔关节面软骨损伤的病理变化机制,可作为研究人膝关节损伤致骨关节炎的动物模型。     

兔膝关节骨性关节炎的模型制作及组织病理学

目的探讨骨性关节炎(OA)的发病机制及组织病理学基础。方法20只健康雄性白兔随机分为正常组和模型组各10只。模型组采用管型石膏伸直位制动方法复制出膝关节OA模型。6周后处死白兔并观察软骨的大体改变及Mankin评分;并取血清及关节灌洗液标本检测超氧化物歧化酶(SOD)及丙二醛(MDA)的含量。结果模型组白兔膝关节滑膜均存在不同程度增生、肥厚、水肿;光镜及电镜下关节软骨呈明显退行性变;Mankin评分模型组显著高于正常组(P<0.05);关节灌注液中SOD和血清中MDA含量模型组显著升高(P<0.01)。结论滑膜组织的炎症、关节软骨的退变以及自由基的改变是导致OA发生的病理学基础,如何阻断这些病理环节是防治OA的关键。     

膝骨关节炎的关节镜手术治疗

目的：探讨膝骨关节炎的关节镜手术疗效。方法；78例膝骨关节炎分为保守治疗组和关节镜手术组。分别进行膝关节综合评分，并比较疗效对比分析。结果：保守治疗组膝关节综合评分：优19例，良11例，可8例，差4例；关节镜手术组膝关节综合评分：优21例，良10例，可5例，差0例，疗效明显优越(P＜0．01)。结论：关节镜的使用为治疗膝骨关节炎提供了一种创伤小、疗效好的方法。     

膝骨关节炎患者步态中膝关节三维运动特征

目的:观察中老年膝关节骨关节炎(KOA)患者步态中膝关节的三维运动特征,为膝关节骨关节炎患者设计康复训练提供研究依据.方法:纳入符合标准的KOA患者29例为观察组;15例无KOA者纳入对照组.2组的年龄、身高、体重和身体质量指数(BMI)相匹配.2组受试者均使用KneeKG系统进行测量,对比自重状态下步行时两组受试者膝...     

老年双膝骨性关节炎患者膝关节屈伸肌力与静态平衡的变化特征

目的探讨老年双膝骨性关节炎（KOA）患者膝关节屈伸肌力与静态平衡功能的变化特征。方法采用等速肌力测试仪和静态平衡测定仪对59例老年KOA患者（KOA组）和50例非KOA患者（对照组）进行膝关节肌力和静态平衡功能定量测定。结果与对照组比较,在低速向心模式下,KOA组屈伸肌群的峰力矩、总功、平均功率、力矩加速能均降低（P〈0.05）,而腘绳肌与股四头肌峰力矩比值升高（P〈0.05）;在闭眼模式下与对照组相比,KOA组轨迹长度、轨迹面积、单位面积轨迹长均显著升高（P〈0.01）;在KOA组,与睁眼模式相比,闭眼模式下轨迹长度、轨迹面积、单位面积轨迹长均明显升高（P〈0.05）;KOA组腘绳肌与股四头肌峰力矩比和单位面积轨迹长升高有较显著的相关关系（P〈0.01）。结论KOA患者膝屈伸肌群肌力下降,静态平衡功能也随之下降,其中屈伸肌力不同步性降低影响尤为明显。     

A Mediation Appraisal of Catastrophizing,Pain-Related Outcomes,and Race in Adults With Knee Osteoarthritis

The current cross-sectional study investigates whether pain catastrophizing mediates the relationship between ethnicity/race and pain, disability and physical function in individuals with knee osteoarthritis. Furthermore, this study examined mediation at 2-year follow-up. Participants included 187 community-dwelling adults with unilateral or bilateral knee pain who screened positive for knee osteoarthritis. Participants completed several self-reported pain-related measures and pain catastrophizing subscale at baseline and 2-year follow-up. Non-Hispanic Black (NHB) adults reported greater pain, disability, and poorer functional performance compared to their non-Hispanic White (NHW) counterparts (Ps < .05). NHB adults also reported greater catastrophizing compared to NHW adults. Mediation analyses revealed that catastrophizing mediated the relationship between ethnicity/race and pain outcome measures. Specifically, NHB individuals reported significantly greater pain and disability, and exhibited lower levels of physical function, compared to NHW individuals, and these differences were mediated by higher levels of catastrophizing among NHB persons. Catastrophizing was a significant predictor of pain and disability 2-years later in both ethnic/race groups. These results suggest that pain catastrophizing is an important variable to consider in efforts to reduce ethnic/race group disparities in chronic pain. The findings are discussed in light of structural/systemic factors that may contribute to greater self-reports of pain catastrophizing among NHB individuals.PerspectiveThe current study examines whether pain catastrophizing mediates the relationship between ethnicity/race and OA-related pain, disability, and functional impairment at baseline and during a 2-year follow-up period in non-Hispanic Black and non-Hispanic White adults with knee pain. These results point to the need for interventions that target pain catastrophizing.     

Moving to Maintain Function in Knee Osteoarthritis: Evidence From the Osteoarthritis Initiative

Dunlop DD, Semanik P, Song J, Sharma L, Nevitt M, Mysiw J, Chang RW, for the Osteoarthritis Initiative Investigators. Moving to maintain function in knee osteoarthritis: evidence from the Osteoarthritis Initiative.

Objectives

To investigate the association between baseline physical activity and 1-year functional performance in adults with knee osteoarthritis (OA).

Design

Prospective cohort study of knee OA development and progression with 1-year follow-up.

Setting

Community.

Participants

Osteoarthritis Initiative public data on adults with knee OA (n=2274; age, 45-79y) who participated in functional performance assessments (timed 20-m walk and chair stand test) at baseline and 1-year follow-up.

Interventions

Not applicable.

Main Outcome Measure

A good 1-year performance outcome (separately defined for walk time and chair stand measures) was improvement from baseline quintile or maintenance in the best quintile.

Results

Almost 2 in 5 persons with radiographic knee OA improved or maintained high performance at 1 year. Physical activity measured by the Physical Activity Scale for the Elderly (PASE) was significantly associated with good walk rate and chair stand outcomes (odds ratio per 40 units PASE [95% confidence interval]=1.13 [1.13, 1.17] and 1.10 [1.05, 1.15], respectively), as were participation in sports/recreational activities (1.45 [1.23, 1.71] and 1.29 [1.09, 1.51], respectively) and lifestyle activities (1.11 [1.06, 1.16] and 1.09 [1.04, 1.14], respectively). An independent protective relationship for these physical activity measures approached significance after adjusting for sociodemographic and health factors. Older adults reported the least baseline physical activity and least frequent good 1-year outcomes.

Conclusions

These findings support public health recommendations to be physically active in order to preserve function for persons with knee OA. Physical activity messages should specifically target older adults whose low activity levels may jeopardize their ability to maintain functional performance.     

Baker's Cyst with Knee Osteoarthritis: Clinical and Therapeutic Implications

ObjectiveSeveral symptoms are common to knee osteoarthritis and Baker''s cyst. To what extent each condition contributes to the patient''s discomfort is still a matter of debate. The aim of the present study was twofold: first, to compare the burden of symptoms in patients with isolated knee osteoarthritis and patients with knee osteoarthritis associated with Baker''s cyst; second, to assess the outcomes after conservative treatments.Subject and MethodsPatients suffering from monolateral idiopathic knee osteoarthritis were enrolled. Demographic, anthropometric and clinical data (KOOS scale) were collected. Ultrasound evaluation was performed according to standard protocols. On the basis of the clinical presentation different therapeutic options were used (fluid withdrawal, hyaluronic acid and/or steroids injections).ResultsOne-hundred and thirty patients were included in the study (97 with isolated knee osteoarthritis, 33 with knee osteoarthritis and Baker''s cyst). In basal conditions, lower scores in KOOS sub-scales were observed in patients with knee osteoarthritis associated with Baker''s cyst and in patients with effusion compared with patients without effusion. At 3 months after therapy significant higher scores were observed in both groups. At 6 months the scores were unchanged in the patients without Baker''s cyst, but worsened in those with Baker''s cyst.ConclusionsThe study shows that Baker''s cysts associated with knee osteoarthritis contribute to the burden of symptoms. The conservative treatment of both conditions allows significant improvements, but in the medium term (6 months) the efficacy of the therapy declines in patients with knee osteoarthritis associated with Baker''s cyst.     

老年膝骨关节炎综合疗法的短期效果观察

目的观察综合疗法对老年膝骨关节炎的短期治疗效果。方法30例老年膝骨关节炎患者在接受健康教育指导的基础上,进行10次双氯芬酸二乙胺乳胶剂经脉冲超声波导入、6次推拿手法治疗和每日1～2次的股四头肌肌力增强训练,并在治疗前、后完成视觉模拟疼痛评分(VAS)、10 m步行速度测试、5次起坐时间测试和下肢等速肌力测试。结果30例膝骨关节炎患者治疗前后的疼痛程度、步行能力、起坐能力、下肢肌力均有改善(P<0.05或P<0.001)。结论双氯芬酸二乙胺乳胶剂经脉冲超声波导入、推拿手法治疗联合股四头肌肌力增强训练对于膝骨关节炎具有较好的短期治疗效果。     

氯诺昔康联合中药舒筋洗治疗膝骨关节炎疗效分析

目的:观察氯诺昔康联合中药舒筋洗外用治疗膝骨关节炎的临床疗效。方法:80例膝骨关节炎患者,随机分为氯诺昔康组和联合治疗组,每组40例。氯诺昔康组口服氯诺昔康每次8mg,bid,连续4周;联合治疗组在氯诺昔康组基础上加用舒筋洗浸洗患处,每天2次,连续治疗4周。分别在治疗前后进行疗效评估。结果:2组对膝骨关节炎的休息痛、活动痛、关节压痛、关节肿胀、关节活动度和15m步行时间等各项指标的有效率均超过70%;与氯诺昔康组比较,联合治疗组在对关节肿胀指标的改善上有显著性差异(P <0.05)。2组均未见明显不良反应。结论:氯诺昔康联合中药外洗治疗膝关节骨关节炎效果显著,对于关节肿胀的患者尤为适用。     

膝骨性关节炎患者关节镜术后局部冷敷的效果观察

目的探讨膝骨性关节炎患者关节镜术后减轻关节肿胀的有效方法。方法60例行关节镜手术的膝骨性关节炎患者随机分为冷敷组和对照组各30例。两组术前均予经髌骨上缘测量膝关节周径,并取3点以龙胆紫标记;冷敷组术后术膝予冰袋冷敷24h,对照组行常规术后处理;分别于术后第24小时、第48小时、第72小时经标记点再次测量膝关节周径,比较两组关节肿胀程度的变化情况。结果两组患者术后第48小时关节肿胀最重,随后肿胀程度逐渐减轻;冷敷组术后关节肿胀程度较对照组轻。结论膝骨性关节炎患者关节镜术后第48小时关节肿胀最重,术后患肢给予冰袋冷敷可有效减少关节内渗出,减轻关节肿胀,促进患者康复。     

Association Between Disease-Specific Quality of Life and Magnetic Resonance Imaging Outcomes in a Clinical Trial of Prolotherapy for Knee Osteoarthritis

Objective

To assess the relation between knee osteoarthritis (KOA)-specific quality of life (QOL) and intra-articular cartilage volume (CV) in participants treated with prolotherapy. KOA is characterized by CV loss and multifactorial pain. Prolotherapy is an injection therapy reported to improve KOA-related QOL to a greater extent than blinded saline injections and at-home exercise, but its mechanism of action is unclear.

Design

Two-arm (prolotherapy, control), partially blinded, controlled trial.

Setting

Outpatient.

Participants

Adults with ≥3 months of symptomatic KOA (N=37).

Interventions

Prolotherapy: 5 monthly injection sessions; Control: blinded saline injections or at-home exercise.

Main Outcome Measures

Primary: KOA-specific QOL scores (baseline, 5, 9, 12, 26, and 52wk; Western Ontario and McMaster University Osteoarthritis Index). Secondary: KOA-specific pain, stiffness, function (Western Ontario McMaster University Osteoarthritis Index subscales), and magnetic resonance imaging–assessed CV (baseline, 52wk).

Results

Knee-specific QOL improvement among prolotherapy participants exceeded that among controls (17.6±3.2 points vs 8.6±5.0 points; P=.05) at 52 weeks. Both groups lost CV over time (P<.05); no between-group differences were noted (P=.98). While prolotherapy participants lost CV at varying rates, those who lost the least CV (“stable CV”) had the greatest improvement in pain scores. Among prolotherapy participants, but not control participants, the change in CV and the change in pain (but not stiffness or function) scores were correlated; each 1% CV loss was associated with 2.7% less improvement in pain score (P<.05).

Conclusions

Prolotherapy resulted in safe, substantial improvement in KOA-specific QOL compared with control over 52 weeks. Among prolotherapy participants, but not controls, magnetic resonance imaging–assessed CV change (CV stability) predicted pain severity score change, suggesting that prolotherapy may have a pain-specific disease-modifying effect. Further research is warranted.     

巨噬细胞移动抑制因子与膝骨关节炎的相关性研究

目的探讨MIF在膝骨关节炎中的作用及其与IL-1β的相关性。方法研究对象包括膝骨关节炎患者45例,正常人28例,应用ELISA测定MIF和IL-1β在关节滑液中的表达程度。结果试验组与对照组的滑液中MIF及IL-1β表达水平作单因素方差分析。MIF的KOA试验组与对照组比较有统计学意义(P<0.01),KOA患者的滑液中MIF的水平显著高于对照组。IL-1β的试验组与对照组比较有统计学意义(P<0.01),KOA患者的滑液中IL-1β的水平显著高于对照组。试验组中MIF与IL-1β水平作Spearman相关分析,相关系数为r=0.945(P<0.01),两者呈正相关。结论MIF可能是KOA发病过程中促进关节滑液炎症、介导软骨退变的重要因子。