泥浴疗法治疗膝骨关节炎疼痛的荟萃分析

背景：泥浴疗法治疗膝骨关节炎一直受到研究者的重视,但其有效性在以往的各项研究中尚存在争议。 目的：分析研究泥浴疗法治疗膝骨关节炎疼痛的有效性。 方法：计算机检索 Pubmed/Medline 数据库以及手工检索相关文献的参考文献。所有检索截止至2013年3月9日。收集国内外公开发表的有关泥浴疗法治疗膝骨关节炎的随机对照试验和前瞻性对照试验。 结果与结论：纳入Meta分析的研究共7个,累计研究对象410例。治疗组和对照组的目测类比疼痛评分（标准化标准差[SMD]-0.74）和 WOMAC 疼痛评分（标准化标准差[SMD]-0.30）组间差异有显著性意义。可见泥浴疗法可改善膝骨关节炎疼痛的症状。但此结论有待更多高质量的随机对照试验进一步证实。     

膝骨关节炎患者伸肌肌力与疼痛和功能状况的关系

目的调查膝骨关节炎患者患肢肌力与其疼痛和功能状况之间的关系。方法对25例经放射影像学确诊且有临床症状的膝关节骨关节炎患者进行西安大略和麦克马斯特大学（WOMAC）骨关节炎指数评分和等速肌力测试。结果膝骨关节炎患者患肢伸肌肌力与WOMAC疼痛得分、WOMAC日常活动能力得分、WOMAC总分之间存在相关性（P<0.05）。结论膝骨关节炎患者的疼痛和功能状况与患肢的伸肌肌力之间存在密切关系。     

不同剂量体外冲击波治疗早中期膝骨关节炎近期疗效比较

目的：探讨不同剂量体外冲击波治疗早中期膝骨关节炎的近期疗效，为临床提供参考。方法：选取原发性早中期膝骨关节炎患者80例（80膝），按随机数字表法分为低能流密度组（A组）和高能流密度组（B组）各40例（40膝），均使用体外冲击波治疗4周。剂量选择：A组为0.12 mJ/mm2，B组为0.24 mJ/mm2。分别在治疗前（T1）、治疗结束时（T2）、治疗后4周（T3）采用疼痛目测类比（VAS）、美国西安大略及麦克马斯特大学骨性关节炎指数问卷（WOMAC）对所有患者进行评定，比较临床疗效。结果：组间相同时点比较：T1时点，两组患者VAS及WOMAC评分无显著性差异；T2、T3时点，A组VAS和WOMAC评分与B组比较有显著降低（P<0.01）。组内不同时点比较，2组患者T2与T1、T3与T1比较，VAS和WOMAC明显降低（P<0.01），T2与T3比较则无显著性差异。结论：体外冲击波能有效缓解早中期膝骨关节炎患者的临床症状、改善膝关节功能，采用能流密度0.12 mJ/mm2的体外冲击波治疗，近期临床效果更佳。     

综合康复治疗老年膝骨性关节炎伴骨质疏松症的疗效观察

目的对比观察综合康复治疗和单纯药物治疗老年膝骨性关节炎伴骨质疏松症的疗效。 方法选择58例临床确诊为老年膝骨性关节炎伴骨质疏松症患者,依照入选顺序按完全随机化分组方法分为康复组和药物组,药物组给予口服消炎止痛药、钙制剂和维生素D,康复组在药物治疗的同时进行规范化的康复训练。治疗前、后采用目测类比评分法（VAS）评定患者疼痛情况,采用西安大略与麦克马斯特大学骨关节炎指数（WOMAC）评定患者关节功能,检测患者双股骨颈骨密度值（BMD）。 结果治疗4周后,2组的VAS、WOMAC评分均比治疗前明显降低（P<0.01）;且康复组的VAS、WOMAC评分明显低于药物组,差异有统计学意义（P<0.05或0.01)。治疗24周后,2组的BMD与治疗前比较均显著增加（P<0.01）,且康复组BMD明显高于药物组（P<0.01)。 结论综合康复治疗与药物治疗对老年膝骨关节炎伴骨质疏松症均有显著疗效,综合康复治疗在缓解疼痛、减轻僵硬和改善日常活动能力方面的疗效更显著。     

西安大略和麦克马斯特大学骨关节炎指数的重测信度

目的了解西安大略和麦克马斯特大学（WOMAC）骨关节炎指数对我国膝骨关节炎患者的重测信度。方法2名经过正式培训的测评人员对24例经放射影像学确诊且有临床症状的膝骨关节炎患者在24 h内进行2次WOMAC骨关节炎指数量表的指导性测试。结果各评分部分和总分的组内相关系数分别是0.937、0.914、0.856、0.921。结论WOMAC骨关节炎指数具有极好的信度。     

基于镜像神经元理论的动作观察疗法对膝骨性关节炎的疗效探究

目的：探究动作观察疗法(AOT)结合常规运动治疗对膝骨性关节炎(KOA)患者的影响。方法：60例KOA患者随机分为观察组和对照组各30例,2组都接受常规运动治疗,观察组在常规运动治疗的基础上进行AOT治疗,对照组观看与运动无关视频。分别在治疗前和治疗12周后对2组患者采用视觉模拟评分(VAS)和西安大略与麦克马斯特大学骨关节炎指数(WOMAC)进行评估。结果：治疗12周后,2组VAS评分、WOMAC各项评分及总分均显著低于治疗前（均P＜0.05）,且观察组VAS评分及WOMAC中疼痛、关节功能、总分均明显低于对照组（均P＜0.05）,但2组WOMAC中僵硬评分比较差异无统计学意义。结论：AOT结合常规运动治疗可显著改善膝骨性关节炎患者的疼痛,僵硬和关节功能,在改善疼痛和膝关节功能方面优于单纯运动治疗。     

体外冲击波治疗早中期膝骨关节炎的效果

目的探讨体外冲击波疗法(ESWT)治疗早中期膝骨关节炎的有效性。方法70 例膝骨关节炎患者随机分为ESWT组(n=34)和对照组(n=36)。ESWT组予放射状ESWT干预,对照组将能流密度调整为0。在干预前和12 周后,采用活动时疼痛视觉模拟评分(VAS)、Lequesne 指数评分和WOMAC骨关节炎指数评分进行评定。结果干预后,ESWT组VAS评分、Lequesne 指数评分和WOMAC骨关节炎指数评分均明显优于对照组(P<0.01)。结论ESWT对早中期膝骨关节炎治疗有效。     

全膝关节表面置换围术期北京协和医院膝关节功能评分量表的拟合优度分析

背景：北京协和医院膝关节功能评分量表在解放军第306医院推广应用2年,积累了一些临床数据。目的：通过分析证实北京协和医院膝关节功能评分量表的稳定性及适合临床医疗实践的可能性。
　　方法：纳入膝关节骨关节炎患者55例,患者分为治疗前组、治疗后随访3个月组和随访6个月组3个时间段进行观察。将应用该量表所获得的测量结果与西部安大略麦克马斯特大学骨关节炎指数(WOMAC)、疼痛目测类比评分、美国特种外科医院评分(HSS 评分)相比较,应用结构方程模型对该膝关节功能评估量表进行拟合优度分析。
　　结果与结论：量表对骨关节炎患者症状和体征的评分结果与患者关节炎疼痛目测类比评分中疼痛程度呈正相关关系;随访6个月时患者总体经该量表评分较治疗前有明显改善。随访3,6个月患者评分均明显高于治疗前,其结果与HSS评分相当。该量表评分在治疗后3,6个月时患者总体评估均Ⅰ级以上改善,疼痛目测类比评分下降超过30%。在WOMAC疼痛评估项及生理功能评估项中,随访6个月时显著优于治疗前(P<0.05);随访3个月时与疼痛目测类比评分比较,差异有显著性意义的与相关疼痛程度减轻相关;且伴有功能和关节僵硬的评分显著改善。北京协和医院膝关节功能评分量表最终获得4个维度22个评估项目,拟和优度分析证明,该量表的拟和优度良好,具有科学性和使用价值。     

脉冲射频或神灯照射治疗慢性膝关节炎的临床研究

目的：探讨脉冲射频或神灯照射（TDP）治疗慢性膝关节炎的临床疗效。方法：回顾性选取我院2019年8月至2021年7月收治的慢性膝关节炎患者240例,根据治疗方法不同分为观察组110例和对照组130例。观察组采用脉冲射频治疗,对照组采用TDP照射治疗。对比两组临床疗效,治疗前后疼痛情况、膝关节功能状态及血清炎症介质水平。结果：观察组治疗总有效率高于对照组（P＜0.05）。治疗前两组疼痛视觉模拟评分法（VAS）评分、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分比较,差异无统计学意义（P＞0.05）;治疗1周、3周、12周后,观察组VAS、WOMAC评分均低于对照组（P＜0.05）。治疗前两组白介素-1（IL-1）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平比较,差异无统计学意义（P＞0.05）;治疗2周后,观察组IL-1、IL-6、TNF-α水平均低于对照组（P＜0.05）。结论：采用脉冲射频治疗慢性膝关节炎效果较好,能够减轻患者疼痛水平,改善其膝关节功能,减轻炎症反应。     

膝关节可调外翻矫形器在膝骨关节炎中的应用

目的：观察膝内侧间室骨性关节炎患者在规范化运动疗法的基础上佩戴自制改进膝关节可调外翻矫形器的效果。方法：60例膝内侧骨性关节炎患者,随机分为观察组和对照组各30例,对照组给予运动疗法治疗,观察组在此基础上佩戴定制矫形器训练,治疗前后进行McMaster大学骨关节炎指数评分（WOMAC）。结果：治疗后1d ,观察组WOMAC评分较治疗前显著减少（P＜0．05）,治疗后1周、1个月时 WOMAC 评分继续明显下降（P＜0．05）,治疗后2、3个月无明显变化;而对照组在治疗1个月后,WOMAC评分才较治疗前显著减少（P＜0．05）,第2、3个月WOMAC评分无显著变化。治疗后,观察组WOMAC评分均较对照组同时间点明显减少（P＜0．05）。结论：自制改进膝关节可调外翻矫形器对行运动疗法的膝内侧间室骨性关节炎患者有明显疗效。     

个体化设计一期关节置换治疗膝骨关节炎合并同侧股骨关节外畸形

背景：全膝关节置换治疗膝关节骨性关节炎合并关节外畸形目前仍面临挑战,为获得良好的力线及恢复恰当的软组织平衡,需制定个体化的置换方案。目的：观察个体化设计一期关节置换治疗膝骨关节炎合并同侧股骨关节外畸形安全及可行性。方法：纳入膝骨关节炎合并同侧股骨关节外畸形患者8例,根据置换前计划,5例患者进行关节内代偿截骨治疗,3例患者行关节外矫正截骨,记录肢体多平面畸形和软组织条件。主要评估指标包括 HSS评分,WOMAC评分和力线偏差。结果与结论：平均随访29个月,患者HSS评分从置换前32.5分提高至置换后87.5分,WOMAC从置换前的37.1分提高到置换后88.8分（P〈0.05）。力线偏差（无论是内翻或外翻）由置换前的17.1°变到置换后1.4°（P 〈0.05）。所有患者关节外矫正截骨的病理3个月内截骨端愈合,无置换后感染,假体松动或静脉血栓栓塞事件发生,仅1例患者残留5°膝过伸。结果证实,依据个体化的置换前计划,一期全膝关节置换治疗膝关节骨性关节炎合并同侧股骨关节外畸形安全有效。     

Effect of home exercise of quadriceps on knee osteoarthritis compared with nonsteroidal antiinflammatory drugs: a randomized controlled trial

OBJECTIVES: To examine the effect of home-based exercise on knee osteoarthritis among Japanese in comparison with that of nonsteroidal antiinflammatory drugs (NSAIDs). DESIGN: An open-labeled, randomized, controlled, multiclinic trial compared home-based quadriceps exercise with NSAIDs. Treatments were basically evaluated after 8 wks and compared with the baseline scores. Outcomes were evaluated with a set of psychometric measurements including the Western Ontario and McMaster Universities Arthritis Index (WOMAC), 36-Item Short-Form Health Survey (SF-36), Japanese Knee Osteoarthritis Measure (JKOM), and pain with the visual analog scale. RESULTS: A total of 142 patients entered this trial to provide the baseline data. After 21 cases withdrew, the final number analyzed was 121 cases: 63 for the exercise group and 58 for the NSAIDs group. Between these two groups, there was no significant difference in gender, age, body height and weight, body mass index, or each score at baseline. The subjects in both groups showed improvements in all scores at the end of intervention. The difference in improvement rate of each score between the two groups was not statistically significant, though the mean rank score measured with JKOM in the exercise was slightly better than that of the NSAIDs. CONCLUSIONS: Home-based exercise using quadriceps strengthening improves knee osteoarthritis no less than NSAIDs.     

Phase I design and evaluation of an isometric muscle reeducation device for knee osteoarthritis rehabilitation

Our long-term goal is to improve adherence to a home-based isometric program for rehabilitation of knee osteoarthritis (OA) using a force-biofeedback device (Isopad). Our goal for Phase I was to design and evaluate an Isopad-based program in a supervised clinical setting. Our subjects were five patients with knee OA of Kellgren stage II or greater. A capacitive force sensor was tested for accuracy, repeatability, and durability. An Arthritis Foundation home-based isometric program inspired the Isopad design. The Isopad provided visual and auditory feedback instantaneously and continuously about force generated between the ankles. The five subjects completed a supervised 8-week progressive isometric program using the Isopad. Absolute isolated quadriceps and hamstring torques were quantified with a dynamometer, and patients completed a self-assessment of symptoms (Western Ontario and McMaster Universities Osteoarthritis Index). The capacitive sensor accuracy error averaged 10% and repeatability 4%. Cognitively intact subjects used the Isopad successfully for isometric progressive resistance training. Quadriceps and hamstrings absolute torques increased an average of 30%. Patients reported decreased functional complaints (Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index). All changes were trends. The Isopad helped subjects with knee OA adhere to a supervised isometric program and meet progressive strength targets. The next-generation Isopad will be employed in a home-based program.     

The Effect of Aromatherapy Massage on Knee Pain and Functional Status in Participants with Osteoarthritis

This study was conducted to evaluate the effect of aromatherapy massage on knee pain and functional status in subjects with osteoarthritis. The study was designed as a non-randomized interventional study. The study was carried out on patients who referred to the outpatient clinics of the Department of Orthopedics, Physiotherapy and Rehabilitation at Bozok University Research and Application Hospital, and were diagnosed with osteoarthritis. A total number of 95 patients were included in the study, and of those, 33 were allocated to aromatherapy massage group, 30 were allocated to conventional massage group, and 32 were allocated to the control group. The study data were collected using the Patient Identification Form, visual analogue scale, the Western Ontario and McMaster University Osteoarthritis Index. Repeated measures analysis of variance test was used to analyze the outcomes in the aromatherapy, conventional massage and control groups, according to the weeks of follow-up. Bonferroni test was used for further analysis. Baseline mean visual analogue scale score and the Western Ontario and McMaster University Osteoarthritis Index were not significantly different between the groups (p > .05). Visual analogue scale (rest-activity) scores and the scores in the Western Ontario and McMaster University Osteoarthritis Index in the aromatherapy massage group were lower, and the difference compared to the control group was statistically significant (p < .001). Aromatherapy massage performed in patients with osteoarthritis reduced knee pain scores, decreased morning stiffness, and improved physical functioning status. Thus, as long as specific training is provided for aromatherapy massage, aromatherapy can be recommended for routine use in physical therapy units, hospitals and homes.     

Effectiveness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study

[Purpose] To assess the effects of different numbers of platelet-rich plasma (PRP) applications on pain and physical function in grade 3 knee osteoarthritis (OA). [Subjects and Methods] A total of 102 patients with grade 3 knee OA were randomly divided into three groups: Group 1 received a single injection of PRP, Group 2 received two injections of PRP two weeks apart, Group 3 received three injections of PRP at 2-weeks intervals. All patients were evaluated with a visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the Timed-Up and Go test (TUG) before the treatment and at 1, 3 and 6 months after the treatment. [Results] Ninety-eight patients (15 males, 83 females) completed the study. The mean ages of the patients were 53.5±6.6, 54.9±5.3, and 55.1±5.6 years in Group 1, Group 2, and Group 3, respectively. Statistically significant improvements were noted in all of the evaluated measures in all of the groups. The mean differences of Group 1-Group 2 and Group 1-Group 3 WOMAC total, WOMAC pain, WOMAC stiffness, and WOMAC function scores were statistically significant. [Conclusion] PRP is an effective treatment for functional status and pain in moderate knee osteoarthritis and a minimum of two injections is appropriate.Key words: Platelet-rich plasma effectiveness, Moderate, Knee osteoarthritis     

Gait cycle time variability in patients with knee osteoarthritis and its possible associating factors

[Purpose] Knee osteoarthritis can alter gait variability; however, few studies have investigated the associating factors with gait cycle time variability. The first objective was to compare gait cycle variability between female patients with knee osteoarthritis and healthy elderly females and to determine gait characteristics in patients with knee osteoarthritis. The second objective was to identify the associating factors with gait cycle time variability. [Participants and Methods] The participants included 24 female patients diagnosed with knee osteoarthritis and 12 healthy elderly females. Gait cycle variability (coefficient of variation of gait cycle time), knee extension range of motion, knee extension strength, 5-m walk test, Timed Up & Go Test, and Western Ontario and McMaster Universities Osteoarthritis Index were measured. All assessment results were compared between the knee osteoarthritis and healthy groups. [Results] Gait cycle time variability was significantly higher in the knee osteoarthritis group than in the healthy group. Further, it showed a significant positive correlation with the 5-m walk test and the Western Ontario and McMaster Universities Osteoarthritis Index. [Conclusion] Patients with knee osteoarthritis presented greater gait cycle variability than that of healthy individuals. Therefore, rehabilitation to improve gait variability might enhance the quality of life of patients with knee osteoarthritis.