从“筋骨、痹痿、虚实、动静、刚柔”谈膝骨关节炎功能障碍的特点

膝骨关节炎(KOA)属于进展性骨关节病,其功能障碍主要表现为膝关节疼痛、僵硬、屈伸行走不利或受限,以及关节失稳、运动控制下降和本体感觉低下等。我国KOA患者众多,且还在逐年增加,引起的功能障碍严重影响着患者健康与生活质量,因此对其开展康复的研究与实践至关重要。中医康复着眼于功能,注重辨证康复,是我国康复医学的固有特色及优势。前期的研究基于KOA功能障碍的中医证候表现,本研究经大量文献梳理及多年临床实践,从“筋骨、痹痿、虚实、动静、刚柔”5个角度为切入点,提出KOA功能障碍具有“筋骨同病、痹痿并见、虚实错杂、动静失衡、刚柔失常”5个基本特点。鉴于KOA功能障碍具有早、中、晚三期的阶段性特点,在该病发生发展的不同阶段,其功能障碍在“筋骨、痹痿、虚实、动静、刚柔”之间的表现又各有所侧重。本研究从“筋骨同病、痹痿并见、虚实错杂、动静失衡、刚柔失常”5个方面分别阐释了KOA功能障碍的特点:“筋骨同病”侧重于病位,是KOA所致功能障碍的基本病机特征,贯穿于其发病的始终;“痹痿并见、虚实错杂”偏重病性,是KOA功能障碍的基本特点;“动静失衡”偏重病因,是引起KOA病情反复及加重的重要因素;“刚柔失常”则是兼具病状与病因,是膝关节失去“骨正筋柔”的表现方式,也是KOA功能障碍的重要特征。本研究旨在进一步完善KOA的中医康复理论,为其康复治疗提供参考。

Dysfunction Characteristics of Knee Osteoarthritis with the Conception ofMuscles and Bones,Arthralgia and Flaccidity,Asthenia and Sthenia,Dynamic and Static,Hardness and Softness

Knee osteoarthritis(KOA)is a progressive disease,which is mainly manifested by knee joint pain,stiffness,restricted flexion and extension,joint instability,decreased motor control,and low proprioception.KOA significantly impacts an individual's overall health and quality of life.The increasing incidence rate of KOA in China indicates the importance of related rehabilitation research and practice.Traditional Chinese medicine(TCM)rehabilitation places an emphasis on the function and differential diagnosis,which has inherent characteristics and advantages for KOA treatment.Based on previous literature and clinical TCM knowledge of KOA dysfunction,our research team summarized KOA syndromes into five categories:"comorbidity of tendons with bones","coexistence of arthralgia and flaccidity","mixture of asthenia with sthenia","imbalance between dynamic and static statuses",and"disorder between hardness and softness".At different KOA stages,the comorbidity of tendons with bones is the basic pathogenic characteristic of KOA dysfunction,which focuses on disease location and extends throughout the KOA process;coexistence of arthralgia and flaccidity,and mixture of asthenia with sthenia emphasize the basic characteristic of KOA dysfunction;imbalance between dynamic and static statuses is the main factor of KOA relapse and aggravation,which focuses on KOA etiology;disorder between hardness and softness emphasizes both syndrome and etiology,indicating the disorder between bones and tendons.TCM rehabilitation theory for KOA and serves as a reference and clinical guidance for its rehabilitation treatment.The analysis attempts to further improve the TCM rehabilitation theory for KOA and provides a reference for its rehabilitation treatment.