关节镜下关节清理术联合髌周支持带平衡术治疗膝关节OA（附27例报告）

目的观察关节镜下关节清理术联合髌周支持带平衡术治疗伴有髌股关节对合紊乱的膝关节骨性关节炎（OA）的疗效。方法将47例（69膝）膝关节OA患者随机分为A、B组,A组（20例27膝）在关节镜下行单纯膝关节清理术,B组（27例42膝）在关节镜下行关节清理术加髌周支持带平衡术。结果术后平均随访1 a,B组术后Lysholm膝关节评分及Kujala评分明显优于A组（P〈0.05）。结论关节镜下髌周支持带平衡术能有效治疗膝关节OA,尤其适合纠正髌股关节对合关系紊乱所致的应力失衡。     

膝关节骨性关节炎关节镜下不同程度清理术的疗效比较

目的分析关节镜下广泛清理术与有限清理术治疗膝关节骨性关节炎的疗效及手术范围。方法回顾性分析324例接受关节镜治疗的膝关节骨性关节炎患者术前、术后膝关节功能评分,对比广泛清理术与有限清理术的疗效。结果关节镜手术能减轻膝关节疼痛,改善膝关节功能;X线为Ⅰ、Ⅲ级的骨性关节炎行广泛清理术与有限清理术远期效果相同;X线为Ⅱ级者行广泛清理术后远期效果好。结论膝关节骨性关节炎患者行关节镜手术治疗疗效确切,对X线为Ⅰ、Ⅲ级的膝关节骨性关节炎患者行有限清理术,对X线为Ⅱ级的膝关节骨性关节炎可行广泛清理术。     

关节镜清理术后联合冷敷及中药薰药综合治疗膝关节骨性关节炎

目的 探讨关节镜清理术后联合冷敷及中药薰药等综合治疗膝关节骨性关节炎的疗效和安全性.方法 对2007-05～2010-07收治的87例早中期膝关节骨性关节炎患者首先在膝关节镜下进行关节清理手术治疗,术后结合关节腔内注入玻璃酸钠、医用冷敷器冷敷、中药薰药及CPM下肢关节活动器等康复治疗,并对其中73例患者进行了随访,随访时间0.5～2.5年,平均随访时间1.5年.结果 痊愈43例,显效17例,有效12例,无效1例,总体优良率达82.2%.结论 应用膝关节镜手术治疗,术后再结合冷敷及中药薰药等相关的综合康复治疗措施,是治疗早中期膝关节骨性关节炎的有效方法.     

关节镜微创清理术治疗老年膝关节骨性关节炎

目的探讨关节镜微创清理术治疗老年骨性关节炎的疗效与相关因素.方法对66例60～80岁的老龄膝关节骨性关节炎(OA),采用局麻下选择性、有限化关节镜清理术.手术包括刨削或射频汽化清理增生肥厚的炎性滑膜组织,修平退变剥脱的软骨创面,切除和修整破损的半月板,取出游离体和碎骨屑,髁间窝成型解除撞击和ACL磨损.结果随诊61例,平均22个月(12～43个月),大多数患者临床症状消失或疼痛明显减轻,关节功能改善.Lyshoml评分术前平均39分,术后76分,提高37分.结论局麻关节镜下选择性、有限化微创清理术治疗老年骨性关节炎,可有效解除临床症状,改善功能,延缓病程,提高生活质量.     

关节镜下清理术治疗膝骨性关节炎

采用关节镜下清理术治疗膝骨性关节炎83例（106膝）,优45例、良25例、可8例、差5例,优良率达83%.认为关节镜下清理术可以有针对性地进行镜下处理,延缓膝骨性关节炎的进展,同时避免因过多操作而加重对关节的干扰,影响疗效.     

关节镜下有限清理术结合玻璃酸钠注射治疗膝关节骨性关节炎的近期疗效

目的客观评价关节镜下有限清理术结合关节内注射玻璃酸钠治疗膝关节骨性关节炎的临床疗效与安全性。方法选取我院2006年1月至2008年1月收治膝关节骨性关节炎患者120例,随机分为三组(组Ⅰ:单纯玻璃酸钠注射,组Ⅱ:单纯清理术,组Ⅲ:清理术结合玻璃酸钠注射),每组40例;治疗前对上述三组患者进行膝关节Lysholm评分、膝关节X诊断分级;分别于术后2、4、6 w、3个月,采用同一膝关节Lysholm评分量表对患者进行评分,评分越高,膝关节功能恢复越好。通过Smith临床疗效评定标准计算临床疗效显效率。结果 120例患者失访17例,术前膝关节平均Lysholm评分,组间无差异(P>0.05),术后第3个月平均Lysholm评分,组Ⅰ:(72.4±6.01)分,组Ⅱ:(80.5±5.98)分,组Ⅲ:(89.3±6.32)分;临床疗效显效率,组Ⅰ:79.8%,组Ⅱ:84.5%,组Ⅲ:90.6%,各组中均未见明显毒副作用。结论膝关节镜有限清理结合术后玻璃酸钠关节内注射治疗膝关节骨性关节炎并发症少,短期内可明显缓解疼痛和改善关节功能,有利于术后康复,疗效满意,是治疗膝关节骨性关节炎的一种安全、有效的方法。     

膝骨性关节炎关节镜手术治疗效果影响因素分析

回顾性分析58例膝骨性关节炎（OA）关节镜手术治疗效果的影响因素。采用Shahariaree标准判定疗效,良25例（27膝）,可30例（34膝）,差3例（3膝）,总有效率为95．31％。认为髌股关节炎的存在、膝周软组织因素、过度治疗与治疗不足可影响关节镜手术治疗膝关节OA的效果。应注意术前、术中对髌股关节情况的判断和处理,加强股四头肌康复训练和腘窝部挛缩软组织的伸筋疗法,针对关节内原发病变和继发病变采取个体化治疗方案。     

玻璃酸钠联合曲氨奈德治疗膝骨性关节炎并滑膜炎

膝骨性关节炎(OA)并滑膜炎(SY)是中老年人常见疾病,两种常用的治疗方法是关节内注射激素类药物或玻璃酸钠(SH).激素类药物短期内有效,但是可能损伤关节软骨,我们临床观察发现玻璃酸钠治疗膝OA效果好,但对SY治疗效果不佳.联合应用两种药物治疗膝OA并SY是否能增强疗效并减少副作用,临床尚未见报道.我们采用SH联合曲氨奈德(TA)治疗膝OA并SY患者,效果较好,副作用少.     

膝关节清理术腔内注射曲安奈德和玻璃酸钠治疗膝骨性关节炎的临床疗效观察

骨性关节炎(osteoarthritis,OA)是一种退行性关节病变,其最基本的病理变化是由于力学和生物学因素引发关节软骨组织合成与降解之间的正常关系失衡〔1〕,由于其病因尚不确切,具体发病机制目前仍然未明,尽管治疗方法繁多,但效果均不理想。近年来随着关节镜技术的不断发展,人们普遍认同关节镜清理术和关节腔内注射玻璃酸钠治疗骨性关节炎〔2,3〕,现在又有学者指出关节内注射曲安奈德注射液可明显提高骨性关节炎的疗效。为验证三种方法结合治疗OA的疗效,我们共采用关节镜下关节清理术配合玻璃酸钠注射液和关节镜下关节清理术加腔内注射玻璃酸…     

老年膝关节骨性关节炎80例综合康复治疗

老年膝关节骨性关节炎(OA)物理治疗的目的是止痛、消肿,减少增生骨质周围软组织的慢性渗出,改善关节功能活动,减轻疼痛,减缓疾病进一步发展.本文分析综合康复疗法治疗膝关节OA患者的疗效. 1资料与方法 1.1 一般资料 2006年3月至2011年7月我科收治的老年膝关节OA 150例,均符合美国风湿病学会推荐的OA诊断标准.随机分为对照组和治疗组.治疗组80例:男31例,女49例,年龄60 ～ 86岁,平均67.9岁.病程2个月至18年,平均18.5个月;对照组70例:男26例,女44例,年龄60～84岁,平均66.3岁,病程平均17.9个月.两组临床表现均有:膝关节疼痛、膝软、跛行,膝关节肿胀,活动受限等.X线片均显示不同程度骨质增生、关节间隙狭窄及关节软骨下骨质硬化.     

Total knee arthroplasty in HIV-positive haemophilic patients

In the era of total joint replacements in orthopaedics, total knee arthroplasty (TKA) should be indicated in haemophilic patients suffering from severe knee pain and disability. However, the expected high risk of infection and other postoperative complications is a concern. Although the message of this article may seem conservative, it should not be inferred that TKA should still be avoided in a haemophilic patient, but rather that the orthopaedic surgeon should weigh the risks and benefits carefully. Clinical and immunological status should be considered before suggesting a total knee replacement to a haemophilic patient. If TKA is contraindicated, knee arthrodesis is the alternative. However, knee joint debridement can relieve pain for several years and delay the need for TKA.     

Retrospective study of relationship between vastus medialis volume on SPECT-CT and outcome of unilateral total knee arthroplasty

Although the importance of quadriceps femoris function was reported previously, little is known about volume-related factors and their effects on clinical outcomes after total knee arthroplasty (TKA). We sought to determine whether there was a bilateral difference in vastus medialis muscle volume measured on single-photon emission computed tomography–computed tomography (SPECT-CT) in patients who underwent unilateral TKA. We also aimed to determine whether vastus medialis volume was related to osteoarthritis (OA) severity or scintigraphic uptake degree around the knee joint on SPECT-CT. And finally, we attempted to investigate the factors, such as vastus medialis volume and scintigraphic uptake degree, associated with the functional outcomes of TKA.This retrospective study included 50 patients (41 female, 9 male) undergone unilateral TKA due to primary OA. The maximal cross-sectional area of the vastus medialis was measured on axial SPECT-CT images. Scintigraphic uptake degrees and Kellgren-Lawrence (K-L) grade at the tibiofemoral joints were assessed. We compared maximal cross-sectional area of the vastus medialis on SPECT-CT for difference of bilateral lower limbs. We also analyzed the relationship between volume of vastus medialis and scintigraphic uptake measured on SPECT-CT and the severity of OA on conventional radiographs. The clinical outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at baseline and at 1 and 2 years after surgery. The relationship between preoperative muscle volume and scintigraphic uptake on SPECT-CT and WOMAC index was analyzed.The amount of muscle volume measured on SPECT-CT was smaller in operated limb in patients who underwent unilateral TKA. Preoperative vastus medialis muscle volume was not related to preoperative OA severity measured on conventional radiographs and scintigraphic uptake on SPECT-CT. However, a decreased vastus medialis muscle volume was related to worse clinical outcomes after TKA (P = .045), whereas the degree of scintigraphic uptake on SPECT-CT was not associated with postoperative clinical outcomes.Muscle volume of vastus medialis was decreased in the operated knee than in the nonoperated knee, and that was correlated with worse postoperative results. Even if the preoperative volume of vastus medialis were not related to OA severity on conventional radiographs and scintigraphic uptake on SPECT-CT, preservation and improvement of the muscle mass of the knee undergoing TKA is important.     

The effect of joint aspiration and corticosteroid injections in osteoarthritis of the knee

Aim: To evaluate the benefits of knee joint aspiration and injection in knee osteoarthritis (OA). Methods: A retrospective, pilot study involved 110 patients with knee OA from a dedicated OA clinic in a Melbourne tertiary hospital from 2007 to 2009. Only those who had completed two Multiple Attribute Prioritization Tool (MAPT) questionnaires within 6 months of the initial review were included. The MAPT was designed to help prioritise patients on orthopedic waiting lists. Three groups were analyzed: patients who had no corticosteroid injection or aspiration, patients who received corticosteroid injections, and patients who received both joint aspiration with corticosteroid injections. Results: Patients who had both joint aspiration and injection reported an improvement in pain compared with those who had no injection (56.3%vs. 32.2%, P = 0.03). Those who had joint injections also did better than those without injection (62.7%vs. 32.2%, P = 0.001). Reduced analgesia use was noted in 12.5% of patients with aspiration and injection compared with 1.7% with no injection or aspiration (P = 0.03). Improved walking distance was noted in 22.4% of patients who had injections compared with 8.5% of patients with no injections (P = 0.03). No significant differences in MAPT scores among the different treatment groups were noted. Conclusion: This pilot study appears to show a beneficial trend in giving corticosteroid injections and to aspirate the knee in OA patients. Further studies are needed to address the mechanical benefits, quadriceps strengthening and pain reduction with knee aspiration, as well as the effects that different volumes of fluid may have on knee mechanics and symptoms.     

The role of joint afferents in sensory processing in osteoarthritic knees

OBJECTIVE: To test the role of joint receptors for proprioception in patients with bilateral knee osteoarthritis (OA) and patients who had undergone unilateral total knee arthroplasty (TKA). METHODS: Nine patients were tested bilaterally with a conventional movement detection paradigm that evaluated conscious detection perception and a newly developed hunting paradigm that measured maximal sensory performance (hunting perception). RESULTS: For detection perception, patients exhibited a slightly lower threshold on the arthritic side than on their TKA side. For hunting perception, the patients showed threshold values that were an order of magnitude smaller than for the conventional paradigm in both knees. Performance was much better on prosthetic knees than on OA knees. CONCLUSION: The joint receptors of OA knees might have an adverse effect on the maximal proprioceptive performance, being important for the normal reflexive knee joint functions. These deficits may be overcome by joint receptor removal during knee replacement.     

Prevalence of generalised osteoarthritis in patients with advanced hip and knee osteoarthritis: the Ulm Osteoarthritis Study

OBJECTIVES: Different prevalences of generalised osteoarthritis (GOA) in patients with knee and hip OA have been reported. The aim of this investigation was to evaluate radiographic and clinical patterns of disease in a hospital based population of patient subgroups with advanced hip and knee OA and to compare the prevalence of GOA in patients with hip or knee OA, taking potential confounding factors into account. METHODS: 420 patients with hip OA and 389 patients with knee OA scheduled for unilateral total joint replacement in four hospitals underwent radiographic analysis of ipsilateral and contralateral hip or knee joint and both hands in addition to a standardised interview and clinical examination. According to the severity of radiographic changes in the contralateral joints (using Kellgren-Lawrence > or = grade 2 as case definition) participants were classified as having either unilateral or bilateral OA. If radiographic changes of two joint groups of the hands (first carpometacarpal joint and proximal/distal interphalangeal joints defined as two separate joint groups) were present, patients were categorised as having GOA. RESULTS: Patients with hip OA were younger (mean age 60.4 years) and less likely to be female (52.4%) than patients with knee OA (66.3 years and 72.5% respectively). Intensity of pain and functional impairment at hospital admission was similar in both groups, while patients with knee OA had a longer symptom duration (median 10 years) compared with patients with hip OA (5 years). In 41.7% of patients with hip OA and 33.4% of patients with knee OA an underlying pathological condition could be observed in the replaced joint, which allowed a classification as secondary OA. Some 82.1% of patients with hip and 87.4% of patients with knee OA had radiographic changes in their contralateral joints (bilateral disease). The prevalence of GOA increased with age and was higher in female patients. GOA was observed more often in patients with knee OA than in patients with hip OA (34.9% versus 19.3%; OR = 2.24; 95% CI: 1.56, 3.21). Adjustment for the different age and sex distribution in both patient groups, however, takes away most of the difference (OR = 1.32; 95% CI: 0.89, 1.96). CONCLUSION: The crude results confirm previous reports as well as the clinical impression of GOA being more prevalent in patients with advanced knee OA than in patients with advanced hip OA. However, these different patterns might be attributed to a large part to a different distribution of age and sex in these hospital based populations.     

关节镜清理术联合玻璃酸钠注射治疗膝关节骨性关节炎的临床观察

目的探讨关节镜清理术联合玻璃酸钠药物注射治疗膝关节骨性关节炎的临床效果。方法将2017年6月至2019年3月本院收治的98例膝关节骨性关节炎患者按随机数字表法分为试验组与对照组,各49例。试验组接受关节镜清理术联合玻璃酸钠药物注射治疗,对照组接受单独关节镜清理术治疗。观察两组治疗前后关节疼痛程度、关节液炎症细胞因子表达、膝关节功能及并发症发生率。结果相较于治疗前、治疗后24小时、4个月两组关节疼痛VAS评分均降低,且试验组评分低于对照组,差异有统计学意义(P<0.05)。相较于治疗前,治疗后4个月两组关节液内IL-1β、TNF-α表达均降低,且试验组IL-1β、TNF-α表达分别为(309.64±20.48)pg/ml、(425.37±32.24)pg/ml,低于对照组的(328.76±21.63)pg/ml、(463.31±35.09)pg/ml,差异有统计学意义(P<0.05)。相较于治疗前,治疗后4个月两组膝关节功能均改善,且试验组(79.53±1.57)分高于对照组的(70.36±1.68)分,差异有统计学意义(P<0.05)。两组并发症总发生率对比(14.29%vs 10.20%),差异无统计学意义(P>0.05)。结论关节镜清理术联合玻璃酸钠药物注射治疗膝关节骨性关节炎疗效确切,能减轻或消除关节疼痛等症状,降低炎症反应,改善患者膝关节功能,且并发症少,值得推广。     

Evaluation of analgesic effect,joint function recovery and safety of meloxicam in knee osteoarthritis patients who receive total knee arthroplasty: A randomized,controlled, double-blind study

Meloxicam is commonly administrated to control postoperative pain in orthopedic surgery, while its efficacy in total knee arthroplasty (TKA) is not clear. Therefore, this study aimed to explore the postoperative analgesic effect and tolerance of meloxicam in knee osteoarthritis (OA) patients undergoing TKA.Totally, 128 knee OA patients scheduled for TKA were enrolled in this randomized, controlled, double-blind study, then randomized into meloxicam group (N = 65) and control group (N = 63) as 1:1 ratio. Patients took meloxicam or placebo from 4 hours (h) to 72 h after TKA. Patients were followed up at 6 h, 12 h, day (D)1, D2, D3, D7, month (M)1, and M3.Pain visual analog scale score at rest was decreased in meloxicam group at 12 h, D1 and D3 compared to control group; pain visual analog scale score at flexion was reduced in meloxicam group at 6 h, 12 h, D1, D2, and D3 compared to control group. Additional and total consumption of patient-controlled analgesia were both attenuated in meloxicam group compared to control group. Furthermore, patient satisfaction score was higher on D1, D2, D3 in meloxicam group compared to control group. However, no difference of hospital for special surgery knee score score at M1 or M3 was found between the 2 groups. Moreover, the occurrence of adverse events was similar between the 2 groups.Meloxicam displays good effect on controlling postoperative pain and improving patient satisfaction, while does not affect long-term knee function recovery or safety profile in knee OA patients undergoing TKA.     

全膝关节置换术康复治疗的研究进展

全膝关节置换术(TKA)是治疗膝关节炎的有效方法.但TKA术后患者常存在关节疼痛、肿胀、活动受限、肌力下降等问题.康复治疗在改善TKA术后并发症以及促进肢体功能恢复有良好作用.该文为TKA术后康复治疗的研究进展作一综述.     

Follow-up results of arthroscopic synovectomy for the rheumatoid knee

Arthroscopic synovectomy (ASS) of a rheumatoid knee is performed in cases of intractable synovitis. This spares the articular cartilage, and is an effective and simple treatment for chronic knee synovitis. This retrospective study was performed to evaluate the outcome of surgical arthroscopy, and study the clinical results in detail. A total of 160 knees, in 138 patients, were assessed after a mean follow-up of 35 months. There was a statistically significant improvement in pain, synovitis, and walking ability for at least 24 months after surgery. Based on the results of our study, age, duration of rheumatoid arthritis (RA), and erythrocyte sedimentation rate (ESR) and level of C-reactive protein (CRP) at surgery were not predictors of a poor long-term outcome of ASS. However, the clinical results correlated with the Lansbury index, loss of extension of the knee joint, a modified Larsen score, and the Larsen grade of the knee joint. Of the cases studied, total knee arthroplasty (TKA) was performed in 29 knee joints. We concluded that although ASS can reduce local inflammation and delay the need for definitive replacement surgery, patients over 60 years of age who show severe radiographic changes should undergo primary TKA. Received: September 5, 2000 / Accepted: January 29, 2001     

Three-dimensional gait characteristics of patients after unilateral total knee arthroplasty

The purpose of this study is to evaluate the gait characteristics of bilateral limbs after unilateral total knee arthroplasty (TKA) using three-dimensional (3D) dynamic capture technology.Forty-two patients who underwent TKA were selected from the Orthopedic Medical Center of The Second Hospital of Jilin University from November 2018 to May 2019. We used a 3D dynamic capture system to measure the gait characteristics of patients at 3 months after TKA. The data, including relative position and direction of different body parts, the force between feet and ground, spatial and temporal relationship of the lower limb muscles, were measured. Besides, the surface electromyogram signal and the force plate analog signal were also collected. The walking ability, knee 3D kinematic, and kinetic characteristics were analyzed by the Cortex software.Spatial and temporal parameters, including stride frequency, double support phase, single support phase, step length, step time, step width, stride length, gait cycle, velocity, were no significant difference in bilateral lower extremities (P > .05). The reaction force of hip, knee, and ankle joint in the operation side were less than that of the healthy side, but the difference was not statistically significant (P > .05). However, when compared with the healthy side, the hip joint in operation side had a larger maximum extension angle (P < .001), the knee joint in operation side had a larger maximum valgus angle and valgus activity (P < .05), and had a smaller tibial maximum internal rotation angle (P < .05). Besides, the surface electromyogram signals of tibialis anterior muscles were reduced (P < .05).3D gait analysis, as an objective and quantitative evaluation method, is a safe, effective, and reliable method for evaluating postoperative knee function. The data of gait analysis prove that TKA is a vital treatment to improve the function of patients with knee arthritis. Besides, gait analysis also showed that there were various kinematic and biomechanical abnormalities in the knee after TKA, which may be the reason why the surgical knee could not immediately return to normal level.