How to quantify knee function after total knee arthroplasty?

Total knee arthroplasty (TKA) is being undertaken in a younger population than before and as a result the functional demands on the knee are likely to be increasing. As a consequence, it is important to define quantitative functional knee tests that can monitor any increase.A valuable functional knee test has to be able to distinguish small differences (selectivity) and has to be independent of pain (content validity). In this study, patient-based questionnaires (WOMAC and Knee Society score) and performance-based tests (sit-to-stand movement, maximal isometric contraction and timed-up-and-go) were used to assess which of these tests are selective and valid to measure knee function. Tests were considered to be selective if they could discriminate between knee patients and healthy control subjects, and to have functional content validity if they were relatively independent of pain. Twenty-eight patients were measured 16 months after surgery and compared to a healthy control group of 31 subjects.The sit-to-stand movement and timed-up-and-go test were both selective and functionally content valid. The timed-up-and-go test can be used for a quick initial assessment of global function and the sit-to-stand movement as a more biomechanical instrument identifying how the knee function of the patient is affected.     

延边地区膝骨性关节炎患者滑膜组织基因谱的表达

背景：原发性骨性关节炎的发展是多种相关基因表达失常的缘故。采用mRNA基因表达谱芯片技术,检测膝关节骨性关节炎滑膜差异表达基因,有助于阐明骨性关节炎病理过程的相关机制。 目的：比较延边地区膝关节骨性关节炎和正常关节滑膜的基因表达谱变化,筛选出与膝关节骨性关节炎相关的差异表达基因,并探讨其在骨性关节炎发病机制中的意义。 方法：选择延边地区原发性膝关节骨性关节炎患者9例及正常对照者3例,应用mRNA基因表达谱芯片技术检测所获得的滑膜组织中表达差异的基因,筛选出表达差异基因并对其进行GO分析。 结果与结论：膝关节骨性关节炎及正常对照者滑膜的差异表达基因分析结果显示,延边地区膝关节骨关节炎滑膜中的差异表达基因共有1 261个,其中上调的基因有451个,下调的基因有810个。差异表达基因GO统计分析显示,信号转导、翻译调节、趋化作用、炎症应答、细胞增殖等多种基因的表达有差异。基因芯片技术能有效地筛选出骨性关节炎差异表达的基因,并进一步证实了骨性关节炎的病理过程是多种功能基因参与的复杂的病理过程。     

Extracting Information from Cortical Connectivity Patterns Estimated from High Resolution EEG Recordings: A Theoretical Graph Approach

Over the last 20 years, a body of techniques known as high resolution EEG has allowed precise estimation of cortical activity from non-invasive EEG measurements. The availability of cortical waveforms from non-invasive EEG recordings allows to have not only the level of activation within a single region of interest (ROI) during a particular task, but also to estimate the causal relationships among activities of several cortical regions. However, interpreting resulting connectivity patterns is still an open issue, due to the difficulty to provide an objective measure of their properties across different subjects or groups. A novel approach addressed to solve this difficulty consists in manipulating these functional brain networks as graph objects for which a large body of indexes and tools are available in literature and already tested for complex networks at different levels of scale (Social, WorldWideWeb and Proteomics). In the present work, we would like to show the suitability of such approach, showing results obtained comparing separately two groups of subjects during the same motor task and two different motor tasks performed by the same group. In the first experiment two groups of subjects (healthy and spinal cord injured patients) were compared when they moved and attempted to move simultaneously their right foot and lips, respectively. The contrast between the foot–lips movement and the simple foot movement was addressed in the second experiment for the population of the healthy subjects. For both the experiments, the main question is whether the “architecture” of the functional connectivity networks obtained could show properties that are different in the two groups or in the two tasks. All the functional connectivity networks gathered in the two experiments showed ordered properties and significant differences from “random” networks having the same characteristic sizes. The proposed approach, based on the use of indexes derived from graph theory, can apply to cerebral connectivity patterns estimated not only from the EEG signals but also from different brain imaging methods.     

膝骨性关节炎关节周围肌肉功能改善的治疗评价

背景：膝骨性关节炎患者存在膝关节周围肌肉萎软无力,综合治疗辅助膝关节周围肌力训练,可以明显缓解症状,恢复膝关节周围肌肉力量。 目的：用等速肌力测试膝骨性关节炎患者综合治疗前后膝关节周围肌肉的功能变化与膝关节功能的相关性,探讨膝骨性关节炎的病理机制,为临床康复及治疗提供依据。 方法：筛选Ⅱ期及Ⅲ期30例单侧膝骨性关节炎患者,用美国特种外科医院膝关节评分系统判定膝关节的功能情况,标准目测类比量表评分评定患者疼痛情况;测定治疗前膝骨性关节炎患者膝关节周围肌肉功能状况;对Ⅱ期及Ⅲ期膝骨性关节炎患者进行最少1个月的主动股四头肌等长性肌肉收缩运动及口服塞来昔布并关节腔内注射透明质酸钠的综合治疗,测定治疗后的膝关节肌肉功能状况,随访评价美国特种外科医院膝关节评分及标准目测类比量表评分。 结果与结论：与健侧相比,Ⅱ期及Ⅲ期膝骨关节炎患者屈伸肌峰力矩与作功量在60 (°)/s测试及180 (°)/s测试时,患侧肌力明显下降(P < 0.05)。经综合治疗后,膝骨性关节炎患者美国特种外科医院膝关节评分明显增加(P < 0.05),而标准目测类比量表疼痛评分明显下降(P < 0.05),患侧肌力明显增强(P < 0.05);且治疗后膝骨关节炎患者患侧肌力与健侧的差异无显著性意义(P > 0.05),但综合治疗前后膝骨性关节炎患者患侧膝腘绳肌股四头肌峰力矩比值在60 (°)/s测试中差异无显著性意义(P > 0.05),而在180 (°)/s测试测试中差异有显著性意义(P < 0.05)。提示膝骨性关节炎患者存在膝关节周围肌力下降,通过肌肉功能锻练配合有效的止痛、营养关节药物的综合治疗,可以明显缓解症状,提高肌肉力量,恢复患者膝关节功能。     

膝骨性关节炎患者胫骨软骨下骨超微结构改变的CT评价

文题释义： 膝骨性关节炎：是一种以渐进性的关节损伤为主要特征,并最终导致患者关节疼痛甚至残疾,极大地降低患者生活质量。 CT：利用精确准直的X射线束、γ射线、超声波等,与灵敏度极高的探测器一同围绕人体的某一部位作一个接一个的断面扫描,具有扫描时间快、图像清晰等特点。 背景：软骨下骨的改变在膝骨性关节炎的作用得到了越来越多的重视,但是既往研究主要以动物为观察对象,由于动物与人存在差异,因而直接在人体关节内获得相关数据是非常必要的。 目的：通过CT技术评价非膝骨性关节炎患者与膝骨性关节炎患者软骨下骨板及软骨下骨超微结构的区别,来探讨软骨下骨在膝骨性关节炎疾病的发生和发展中的作用。 方法：于2016年7月至2018年7月在郑州市骨科医院影像科就诊患者中,收集30例膝骨性关节炎患者(膝骨性关节炎组)及30例非膝骨性关节炎患者(非膝骨性关节炎组)的CT扫描数据,使用MIMICS软件比较2组胫骨平台内外侧软骨下骨板以及软骨下骨小梁超微结构。试验于2016-06-10经郑州市骨科医院伦理委员会审批通过,审批号为2016医院伦审第004号。 结果与结论：①与非膝骨性关节炎组相比,膝骨性关节炎组软骨下骨板在外侧部位和内侧部位骨密度都明显增加,孔隙率则出现显著的下降,而软骨下骨板厚度内侧部分较非膝骨性关节炎组显著增厚;②膝骨性关节炎软骨下骨小梁同样存在明显变化,表现为膝骨性关节炎组内外侧软骨下骨骨小梁厚度较非膝骨性关节炎组均明显增加,同时内侧松质骨分离度也较非膝骨性关节炎组低;膝骨性关节炎组结构模型指数和连接密度值低于非膝骨性关节炎组;③结果表明,膝骨性关节炎患者胫骨软骨下骨板及软骨下骨松质骨的改变主要在于超微结构稳态的破坏,这一改变可能是膝骨性关节炎发病原因之一。 ORCID: 0000-0002-9805-3084(白玉) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

Dynamic optimization of walker-assisted FES-activated paraplegic walking: Simulation and experimental studies

In this paper, we propose a musculoskeletal model of walker-assisted FES-activated paraplegic walking for the generation of muscle stimulation patterns and characterization of the causal relationships between muscle excitations, multi-joint movement, and handle reaction force (HRF). The model consists of the lower extremities, trunk, hands, and a walker. The simulation of walking is performed using particle swarm optimization to minimize the tracking errors from the desired trajectories for the lower extremity joints, to reduce the stimulations of the muscle groups acting around the hip, knee, and ankle joints, and to minimize the HRF. The results of the simulation studies using data recorded from healthy subjects performing walker-assisted walking indicate that the model-generated muscle stimulation patterns are in agreement with the EMG patterns that have been reported in the literature. The experimental results on two paraplegic subjects demonstrate that the proposed methodology can improve walking performance, reduce HRF, and increase walking speed when compared to the conventional FES-activated paraplegic walking.     

Knee flexors/extensors in gait of elderly and young able-bodied men (II)

In this study the fundamental tasks of muscle activity at the knee during gait in elderly and young able-bodied subjects were identified using principal component analysis (PCA). Role discrepancies between the older and younger subjects for the actions executed by the knee flexors and extensors during the gait cycle were also investigated. The t-test for independent groups was applied to determine significant differences between spatio-temporal and peak muscle moment parameters (P<0.05). PCA as a multivariate classification and curve structure detection method was applied to the sagittal knee muscle moment curves of twenty elderly (72 +/-5.5 years) and twenty young (25 +/- 8.1 years) subjects. The first three principal components (PCs) which accounted for 80% (older) and 93% (younger) of the information were retained for further analysis. Providing stable locomotion was recognised as a major task of the knee in the older subjects, while for the younger subjects the knee contributed to both balance and propulsion. Supporting the body during single limb support should be considered the only common task at the knee level in elderly and young subjects' gait. The lack of muscle power for propulsion might be the reason for not identifying the knee extensor muscle roles in the first three major tasks during elderly gait. Functional asymmetry can be considered the result of a different ordering of the functional roles of the muscles acting at the knee level in elderly and young subjects.     

Main functional roles of knee flexors/extensors in able-bodied gait using principal component analysis (I)

This study was undertaken to demonstrate how principal component analysis (PCA) can be used to detect the main functional structure of actions taken by knee flexors/extensors during able-bodied gait. PCA was applied as a classification and curve structure detection method for knee sagittal muscle moment developed during walking of 20 young, healthy male subjects. Over 90% of the information provided by the first three principal components (PCs) was chosen for further biomechanical interpretation. PCA was able to identify the three main functional contributions of knee sagittal muscle moment during able-bodied gait, namely control balance, foot clearance/limb preparation and shock absorption.     

The effects of 11 weeks whole body vibration training on jump height,contractile properties and activation of human knee extensors

The purpose of the present study was to investigate whether 11 weeks of whole body vibration (WBV) training applied in a way that is commonly seen in practice, i.e. without additional loads, would improve muscle activation and/or contractile properties of the knee extensor muscles and counter movement jump height in healthy subjects. Ten subjects belonging to the experimental group trained three times a week and stood bare-foot with a 110 ° knee angle on a vibration platform (30 Hz, 8 mm amplitude). They underwent five to eight sets of 1-min vibration with 1 min rest in between. Ten control subjects followed the same training programme but stood (110 ° knee angle) beside the platform. Before, during and following the training period the subjects were tested. Values [mean (SEM)] obtained in the last test were expressed as percentages of the baseline value and presented for control and experimental groups. Quadriceps femoris isometric muscle force [105.4 (6.2)%, 99.9 (2.0)%; P=0.69], voluntary activation [107.1 (6.0)%, 101.1 (2.3)%; P=0.55] and maximal rate of voluntary force rise [95.4 (6.0)%, 103.3 (7.7)%; P=0.57] did not improve. The maximal rate of force rise during electrical stimulation was increased [102.3 (4.5)%, 123.6 (7.5)%; P=0.02]. Counter movement jump height was not affected by WBV [103.7 (1.8)%, 103.0 (2.8)%; P=0.71]. In conclusion, 11 weeks of standard two-legged WBV training without additional training loads did not improve functional knee extensor muscle strength in healthy young subjects.     

The influence of knee rigidity on balance corrections: a comparison with responses of cerebellar ataxia patients

Knee rigidity due to aging or disease is associated with falls. A causal relationship between instability and knee rigidity has not been established. Here, we examined whether insufficient knee movement due to knee rigidity could underlie poor balance control in patients. We addressed this by examining the effect of artificially “locking” the knees on balance control in 18 healthy subjects, tested with and without individually fitted knee casts on both legs. Subjects were exposed to sudden rotations of a support surface in six different directions. The primary outcome measure was body centre of mass (COM) movement, and secondary outcome measures included biomechanical responses of the legs, pelvis and trunk. Knee casts caused increased backward COM movement for backward perturbations and decreased vertical COM movement for forward perturbations, and caused little change in lateral COM movement. At the ankles, dorsiflexion was reduced for backward perturbations. With knee casts, there was less uphill hip flexion and more downhill hip flexion. A major difference with knee casts was a reversed pelvis pitch movement and an increased forward trunk motion. These alterations in pitch movement strategies and COM displacements were similar to those we have observed previously in patients with knee rigidity, specifically those with spinocerebellar ataxia (SCA). Pelvis roll and uphill arm abduction were also increased with the casts. This roll movement strategy and minor changes in lateral COM movement were not similar to observations in patients. We conclude that artificial knee rigidity increases instability, as reflected by greater posterior COM displacement following support surface tilts. Healthy controls with knee casts used a pitch movement strategy similar to that of SCA patients to offset their lack of knee movement in regaining balance following multidirectional perturbations. This similarity suggests that reduced knee movements due to knee rigidity may contribute to sagittal plane postural instability in SCA patients and possibly in other patient groups. However in the roll plane, healthy controls rapidly compensate by adjusting arm movements and hip flexion to offset the effects of knee rigidity.     

Characteristics of trunk lean motion during walking in patients with symptomatic knee osteoarthritis

OBJECTIVE: Trunk lean motion on the frontal plane shifts the pressure across the medial-lateral cartilage of the stance limb's knee. The purpose of this study was to investigate trunk lean motion during walking in patients with knee osteoarthritis. MATERIALS AND METHODS: The study involved five healthy normal controls and 12 patients with symptoms of knee osteoarthritis (six with unilateral and six with bilateral). The trunk lean angle and the direction during one stride cycle of walking were calculated using a three-dimensional gait analysis. RESULTS: There was no significant difference between the three groups (normal, unilateral knee OA, and bilateral knee OA group). However, patients with bilateral limb knee osteoarthritis displayed a tendency to lean their trunk toward the swing side. CONCLUSION: This study determined that bilateral OA patients exhibit the characteristic gait which may progress knee OA.     

Manual for guided home exercises for osteoarthritis of the knee

INTRODUCTION:

Physiotherapy is one of the most important components of therapy for osteoarthritis of the knee. The objective of this prospective case series was to assess the efficiency of a guidance manual for patients with osteoarthritis of the knee in relation to pain, range of movement , muscle strength and function, active goniometry, manual strength test and function.

METHODS:

Thirty-eight adults with osteoarthritis of the knee (≥ 45 years old) who were referred to the physiotherapy service at the university hospital (Santa Casa de Misericórdia de São Paulo) were studied. Patients received guidance for the practice of specific physical exercises and a manual with instructions on how to perform the exercises at home. They were evaluated for pain, range of movement, muscle strength and function. These evaluations were performed before they received the manual and three months later. Patients were seen monthly regarding improvements in their exercising abilities.

RESULTS:

The program was effective for improving muscle strength, controlling pain, maintaining range of movement of the knee joint, and reducing functional incapacity.

DISCUSSION:

A review of the literature showed that there are numerous clinical benefits to the regular practice of physical therapy exercises by patients with osteoarthritis of the knee(s) in a program with appropriate guidance. This study shows that this guidance can be attained at home with the use of a proper manual.

CONCLUSIONS:

Even when performed at home without constant supervision, the use of the printed manual for orientation makes the exercises for osteoarthritis of the knee beneficial.     

The importance to including objective functional outcomes in the clinical follow up of total knee arthroplasty patients

In clinical practice, it is increasingly important to assess patients' daily functionality routinely and objectively. Acceleration-based gait analysis (AGA) has shown to be reliable and technically suitable for routine clinical use outside the laboratory. This study investigated the suitability of AGA for measuring function in orthopaedic patients with symptomatic gonarthrosis listed for total knee arthroplasty (TKA) by investigating (a) the ability of AGA to distinguish patients from healthy subjects, (b) the sensitivity to gait changes of AGA in assessing recovery following total knee arthroplasty in a subpopulation, and (c) correlations between AGA parameters and clinical scales. Gait was assessed using AGA in 24 patients with symptomatic gonarthrosis listed for TKA, and in 24 healthy subjects. AGA parameters (e.g. speed, asymmetry) and clinical scales (e.g. KSS) were used to monitor progress in 12 patients 3 months after TKA. The Mann–Whitney-U test, Receiver Operating Characteristic (ROC) curves, repeated measurement ANOVA and Pearson correlations were performed. AGA differentiated pathological from healthy gait. The area under the ROC curve, sensitivity and specificity values were high for speed, step frequency and step length. Different recovery profiles were found, with clinical scales showing faster recovery rates. None or only weak correlations were found between AGA and clinical scores. AGA was found to be of clinical relevance in identifying and monitoring patients with symptomatic gonarthrosis in orthopaedic practice, providing objective and additional information about function beyond clinical scales. This, together with the fact that AGA can be applied routinely, suggests the suitability of AGA for use in rehabilitation programs.     

Muscle strength and exercise intensity adaptation to resistance training in older women with knee osteoarthritis and total knee arthroplasty

OBJECTIVES:

To analyze muscle strength and exercise intensity adaptation to resistance training in older women with knee osteoarthritis and total knee arthroplasty.

METHODS:

Twenty-three community-dwelling women were divided into the following groups: older, with knee osteoarthritis and total knee arthroplasty in the contralateral limb (OKG; N = 7); older, without symptomatic osteoarthritis (OG; N = 8); and young and healthy (YG; N = 8). Muscle strength (1-repetition maximum strength test) and exercise intensity progression (workload increases of 5%–10% were made whenever adaptation occurred) were compared before and after 13 weeks of a twice-weekly progressive resistance-training program.

RESULTS:

At baseline, OKG subjects displayed lower muscle strength than those in both the OG and YG. Among OKG subjects, baseline muscle strength was lower in the osteoarthritic leg than in the total arthroplasty leg. Muscle strength improved significantly during follow-up in all groups; however, greater increases were observed in the osteoarthritic leg than in the total knee arthroplasty leg in OKG subjects. Greater increases were also seen in the osteoarthritic leg of OKG than in OG and YG. The greater muscle strength increase in the osteoarthritic leg reduced the interleg difference in muscle strength in OKG subjects, and resulted in similar posttraining muscle strength between OKG and OG in two of the three exercises analyzed. Greater exercise intensity progression was also observed in OKG subjects than in both OG and YG subjects.

CONCLUSIONS:

OKG subjects displayed greater relative muscle strength increases (osteoarthritic leg) than subjects in the YG, and greater relative exercise intensity progression than subjects in both OG and YG. These results suggest that resistance training is an effective method to counteract the lower-extremity strength deficits reported in older women with knee osteoarthritis and total knee arthroplasty.     

膝关节股骨远端软骨硬化前后力学性能分析

目的建立膝关节有限元模型,研究正常及软骨硬化情况下膝关节的应力、应变变化,为临床治疗膝关节骨性关节炎提供参考。方法通过Mimics、ANSYS等软件结合正常膝关节CT扫描图像数据,建立膝关节三维有限元模型,并施加350 N压力载荷,设定软骨硬化前后相关的材料参数,分析膝关节主要组织的应力、应变改变情况。结果膝关节股骨远端软骨硬化后,关节软骨的减震和传递负荷等作用基本消失;股骨应力、应变变化量最大,受力分布极不均匀,股骨前端应力、应变较内、外侧髁明显,整体受力也有明显增加;半月板的应力、应变值最大。结论长期的软骨破坏会影响关节软骨营养代谢,导致骨性关节炎疾病进一步恶化。研究结果可以较好阐释骨性关节炎发病过程和机理,同时为建立参数化研究系统提供相关数据。     

The knee adduction angle of the osteo-arthritic knee: A comparison of 3D supine,static and dynamic alignment

BackgroundEnd-stage knee osteoarthritis (OA) commonly results in knee arthroplasty. Three dimensional (3D) supine imaging is often used for pre-operative planning to optimise post-operative knee adduction angles (KAA). However, supine imaging may not represent loaded knee alignment. The aim of this study was to investigate differences in knee alignment under supine, static and dynamic conditions in healthy subjects and subjects with knee OA.MethodsNine healthy subjects and 15 subjects with end-stage knee OA were recruited. All subjects underwent supine imaging and motion capture during gait. KAAs were calculated from supine images (SUPINE), upright standing (STATIC) and at the first peak ground reaction force during gait (DYNAMIC), and were compared.ResultsKAAs were significantly higher (more varus) during gait compared with static (loaded and unloaded) in healthy subjects (p < 0.01) but not in subjects with knee OA. There was a good correlation between SUPINE and DYNAMIC for both healthy and OA subjects (R² > 0.58), with differences in the two relationships; healthy knees had a higher KAA during gait for any given KAA in the supine position, whereas OA knees that were valgus in imaging became more valgus during gait, and the opposite occurred for varus knees.ConclusionsFactors that may contribute to the noted differences between healthy and OA subjects include morphological changes in the joint as a result of OA, and gait compensation strategies in people with end-stage OA. Dynamic 3D motion capture provides important information about functional alignment that is not provided by supine imaging or static motion capture.Clinical RelevanceGait analysis may provide useful information to the surgeon during surgical planning of knee arthroplasties.     

Lower extremity proprioceptive sensation in patients with early stage knee osteoarthritis: A comparative study

BackgroundKnee OA causes pain and proprioceptive impairment. The body acts as a closed kinetic chain, and deformation on the knee cannot only affect the knee joint but also can affect the other joints.ObjectiveTo assess the proprioception of lower extremity in early stage knee osteoarthritis compared with without knee osteoarthritis individuals.MethodsThe study sample consisted of 26 adults with early stage knee osteoarthritis and 26 subjects without knee osteoarthritis individuals. Western Ontario and McMaster Universities Osteoarthritis Index was used for clinical disease severity. Visual Analogue Scale was used for pain severity. Proprioception (position and motion sense) was measured by isokinetic dynamometer.ResultsWestern Ontario and McMaster Universities Osteoarthritis Index total score was 10.9 ± 5. Visual Analogue Scale scores during activity were found to be significantly higher than the scores at rest and night for both sides. Hip flexion and internal rotation joint position sense were significantly different between two groups (all p's < 0.05). Hip abduction, knee flexion, ankle and subtalar position sense, as well as hip and knee motion sense were similar between groups (all p's > 0.05). Ankle dorsiflexion and eversion motion sense were significantly different between two groups (all p's < 0.05).ConclusionsThis study demonstrated that the hip flexion and internal rotation position sense and ankle/subtalar joints motion sense may be affected on early stage of knee osteoarthritis. Investigation of the mechanism of proprioception for joints and also focusing on the longitudinal relationship between proprioception, knee OA disease and symptoms is recommended for future studies.     

缓激肽B2受体基因多态性对膝关节骨关节炎易感性的影响

背景：据报道在膝骨关节炎患者中应用缓激肽B2受体拮抗剂能产生持久的镇痛效果,缓激肽B2受体(BDKRB2)在骨关节炎的发展中具有重要作用。 目的：进一步明确缓激肽B2受体基因多态性与骨关节炎易感性的相关性。 方法：共有278例膝关节骨关节炎患者和291名健康志愿者参与试验。测定受试对象的缓激肽B2受体基因多态性,根据基因型和放射学分型进行统计学处理。 结果与结论：骨关节炎组和对照组中+9/-9 bp多态性的基因型分布和等位基因频率差异明显。-9/-9 bp 多态性和+9/+9 bp相比,与骨关节炎的罹患风险和严重程度存在明显相关性。-9 bp 等位基因的表达,与骨关节炎的Kellgren-Lawrence分型相关。结果提示缓激肽B2受体基因+9/-9 bp多态性可能成为骨关节炎易感性和严重性筛查的分子标记。  中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

膝骨关节炎患者肌电标准化方法的信度研究

目的 评估标准等长收缩(standard isometric contraction, SIC)与最大随意等长收缩(maximum voluntary isometric contraction, MVIC)应用于膝骨关节炎(knee osteoarthritis, KOA)患者肌电标准化的重测信度。方法 采用无线肌电测试系统收集KOA患者患侧腿在慢跑、SIC测试和MVIC测试时臀大肌、半腱肌、股直肌、股外侧肌、胫骨前肌、外侧腓肠肌和比目鱼肌的肌电数据。使用组内相关系数和95%置信区间评估重测信度。结果 KOA患者执行SIC测试时7块肌肉的重测信度均较好,执行MVIC测试时5块肌肉重测信度一般,2块肌肉重测信度较好,7块肌肉在SIC测试中的重测信度均高于MVIC测试;KOA患者慢跑时7块肌肉经SIC标准化后的重测信度均高于经MVIC标准化的重测信度,且股直肌经SIC标准化后的重测信度显著高于经MVIC标准化的重测信度。结论 对于KOA患者,SIC是一种比MVIC更为可靠的表面肌电标准化方案,具有较好的临床推广潜力。     

软组织平衡技术在维吾尔族膝外翻人工关节置换中的应用

背景：因地域环境和饮食习惯致使新疆本地维吾尔族肥胖和骨关节炎患者较多,目前进行人工膝关节置换的患者日益增多,软组织平衡技术在不同体质和民族患者的人工膝关节置换过程中应如何掌握和进一步应用成为许多学者关注的焦点。 目的：分析软组织平衡技术在新疆维吾尔族膝外翻患者人工全膝关节表面置换中的应用效果。 方法：2009年2月至2010年12月针对60例(72膝)重度膝骨关节炎伴一定程度膝外翻患者采用膝前外侧入路及个体化的软组织平衡方法行全膝关节表面置换。随访方式为门诊随访,拍X射线片测量股胫角(即股骨和胫骨解剖轴线夹角的补角);定期随访评估美国膝关节协会(KSS)临床评分及功能评分,以评估膝关节功能。 结果与结论：随访6-35个月,总计有57例患者获得随访。患者股胫角由置换前27.9°降至5.6°,KSS临床评分由置换前16.7 分提高到87.5分,KSS功能评分由置换前7.9分提高到85.2分。置换前及末次随访评分差异均有显著性意义(P < 0.01)。57例患者置换后外翻畸形均得到完全矫正,且关节稳定性良好。提示在重度膝骨关节炎伴一定程度外翻畸形的患者中,选择个体化的软组织平衡方案,可以有效矫正软组织失衡并获得较为满意的修复效果。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程