膝关节骨关节炎的磁共振成像

目的：探讨膝关节骨关节炎患者运用MRI发现膝关节各结构病变的价值以及与疼痛症状之间的关系。方法：搜集本院已确诊或拟诊为膝关节骨关节炎的患者28例（男12例,女16例,平均年龄61.4岁）共31个膝关节为研究对象,运用主诉疼痛分级法对疼痛程度进行分级。运用1.5T磁共振仪对上述膝关节行多序列扫描,观察各研究对象磁共振图像中各种病变的出现率。运用统计软件（SPSS13.0;SPSS,Chicago,Ⅲ）分别计算本研究对象中上述关节各种结构病变的出现率,并行多组独立样本间Fisher精确检验比较不同疼痛程度患者组间出现上述征象的差别,以P〈0.05为差异有显著性意义。结果：所有31例膝关节骨关节炎患者中磁共振成像显示关节软骨异常、半月板异常、前交叉韧带异常、软骨下骨骨髓水肿样改变、骨赘形成、滑膜增厚、关节积液的出现率分别为37.1%、32.3%、38.7%、45.2%、100%、15.1%和67.7%。其中轻、重度疼痛患者两组间有无关节积液及关节积液Ⅰ级和Ⅱ级的出现率差异均有显著性意义（P=0.004,0.001）。结论：磁共振可对膝关节骨关节炎患者行全关节各结构的评价,能很好地显示关节多方面的病理改变。患者的疼痛症状与关节积液有关。     

膝关节骨关节炎的肌力状态和疼痛的关系

目的了解膝关节骨关节炎（膝OA）的肌力状态和疼痛之间的相互关系,同时对疼痛和关节源性肌肉抑制的关系作出解释。方法等速测定66个膝OA肢体（33例患者）的肌肉功能,分析其肌力参数和疼痛程度之间的相互关系。结果疼痛和伸肌爆发力参数有中等程度负线性相关。结论疼痛能导致一些特殊形式的肌肉抑制。     

关节腔内透明质酸钠注射治疗膝关节骨关节炎

目的:探讨骨关节炎关节清理术后透明质酸的疗效。方法:本组26例骨关节炎患者32膝关节,男17例,女9例,平均年龄62岁,左侧18例,右侧14例,治疗前经临床表现、X线和MRI诊断明确,给予行膝关节清理术,术后置管冲洗7~10 d,拔管后给予关节腔注射透明质酸钠,每周一次,共3~5次。结果:随访3~10个月,26例患者32膝关节肿胀消失,疼痛明显减轻,活动度显著改善。结论:关节清理术后持续灌洗加透明质酸钠关节腔内注射能有效治疗骨关节炎。     

龟鹿二仙汤治疗膝关节骨关节炎的中医临床研究

目的 研究中药汤剂龟鹿二仙汤对膝关节骨关节炎的治疗效果.方法 选取治疗的原发性膝关节骨关节炎患者52例,并随机分为对照组和观察组.对照组采用口服双醋瑞因胶囊治疗,观察组采用口服龟鹿二仙汤治疗,疗程都为12周.观察对比两组患者治疗前后的治疗效果.结果 对照组出现1列病例脱落,观察组的总有效率远远优于对照组,有显著性差异,P ＞0.05,具有统计学意义.结论 龟鹿二仙汤对膝关节骨关节炎的治疗具有良好的疗效,能够减轻患者的疼痛症状,改善患者的膝关节运动功能,且无长期服用的不良性反应.     

162例膝关节骨关节炎海沙浴疗效分析

目的:探讨海沙浴疗法对膝关节骨关节炎的治疗效果。方法:选择夏秋季节晴朗天气情况下,在鼓浪屿疗养区海沙滩上利用干热的海沙包埋患肢30～40min,观察沙疗过程中病人生理指标(脉搏、血压)变化和疗程结束后15m行走时间、日常活动能力及对膝关节疼痛的总体评价。结果:沙疗时,病人的下肢被海沙包埋部位跳动感强烈。沙疗可引起脉搏增快、血压下降等反应,但这些变化都在正常生理范围内;沙疗后膝关节疼痛缓解,日常活动能力明显改善。结论:在适当的沙温条件下进行限定时间的沙疗对膝关节骨关节的治疗效果良好,治疗方法是安全的,值得有条件的海滨疗养院推广应用。     

膝关节骨性关节炎的综合治疗与护理

膝骨骨性关节炎（OA）亦称膝关节增生性、退行性骨关节炎。关节软骨的退变是本病最直接的原因。软骨退变磨损、骨质硬化、囊变、骨赘形成,关节肥大变形,构成了骨关节炎的病理核心,导致一系列与之相关的临床症状。表现为膝关节疼痛、肿胀、关节积液、关节软骨损伤和不同程度的功能障碍。     

膝关节骨关节炎及其应对策略

<正>1膝关节骨关节炎的诊断标准本文所涉及的膝关节骨关节炎(knee osteoarthritis,KOA)的诊断标准符合中华医学会骨科学分会的"骨关节炎诊治指南(2007版)"[1],即将KOA的诊断从6个要素考虑:(1)近一个月膝关节反复疼痛;(2)X线片(站立或负重位)示关节间隙变窄、软骨下骨硬化和(或)囊性变、关节缘骨赘形成;(3)关节液(至少2次)清亮、黏稠,WBC<2000个/ml;(4)中老年患者(≥40岁);(5)晨僵≤3     

膝关节骨关节炎继发胫骨软骨下囊肿

作者报告2例膝关节骨关节炎继发于胫骨软骨下囊肿。X线照片显示胫骨内侧平台异常的软骨下大病灶,边缘清楚,位于胫骨内侧皮质附近,长轴位于矢状面,2例均伴有内侧骨关节炎改变。CT指出这些病灶是继发于骨关节炎的软骨下囊肿而非肿瘤和肿瘤样病变。软骨下囊肿在髋关节骨关节炎是常见征象,但在膝关节相对少见,在Ablback’s的234例膝关节骨关节炎中,X线照片显示软骨下囊肿仅9%。作者结合文献报告提出变性软骨下囊肿的特征:①病变为溶骨性,位于胫骨内侧皮质附近;②有提示膝关节内侧骨关节炎的其他变化存在;③病变椭圆形,长轴位于矢状面。CT可提供     

高龄患者人工膝关节置换术48例

人工膝关节置换术是治疗重度膝关节骨关节炎的有效方法。对于高龄患者,其全身重要脏器功能减退,手术疼痛耐受力差,易发生局部及全身的术后并发症,甚至危及生命。我科于2008-01至2013-01对48例高龄患者行人工膝关节置换术,通过采取完善术前评估,术后严密观察,控制并发症等综合措施,取得了满意疗效。     

膝关节置换术治疗膝关节骨关节炎患者的综合护理

对21例膝关节骨关节炎患者施行膝关节置换术的综合护理，即充分的术前准备、有效的心理疏导、术后预防感染、正确的康复指导是保证手术成功的关键。     

Intra-articular knee injuries in patients with knee extensor mechanism ruptures

The knee extensor mechanism is composed of the quadriceps tendon, patella and patellar tendon. Rupture of either the quadriceps tendon or patella tendon is a rare but significant injury. The purpose of our study is to determine if there are any associated injuries with these ruptures necessitating the need for further evaluation such as MRI or arthroscopy. We retrospectively reviewed all patients with ruptures of the knee extensor mechanism who required operative repair at our institution over the last 10 years. We reviewed the chart for any documented associated injury. The type and incidence of associated injuries were recorded. We further divided these patients into two groups: low energy indirect mechanism or high-energy direct impact mechanism. Sixty-four patients met our requirements for inclusion in this study. Thirty-three patients with patellar tendon ruptures and thirty-one patients with quadriceps tendon ruptures were included. Ten out of 33 (30%) patients with a patellar tendon rupture had an associated injury. Four out of 25 (16%) patients with patellar tendon ruptures in the low energy mechanism category had an associated injury. Six out of 8 (75%) patients with a high-energy direct impact patellar tendon rupture had an associated injury. Three out of 31 (10%) patients with quadriceps tendon rupture had an associated injury. The most common associated injuries in the patellar tendon rupture patients were anterior cruciate ligament tears (18%) and medial meniscus tears (18%). We found almost one-third of all patients with a patellar tendon rupture had an associated intra-articular knee injury. We found 10% of patients with quadriceps tendon rupture had an associated intra-articular knee injury. We also found an even higher incidence of associated injuries in patients with high-energy direct impact mechanism patellar tendon ruptures (75%). The most common associated injuries in patients with patellar tendon ruptures were tears of the anterior cruciate ligament (18%) and medial meniscus (18%). We recommend that consideration be given in obtaining a MRI or diagnostic arthroscopy in patients with patellar tendon ruptures especially those with high-energy direct impact mechanism. To our knowledge this has not previously been documented in the literature.     

Stride-to-stride variability of knee motion in patients with knee osteoarthritis

PURPOSE: Individuals with knee osteoarthritis (OA) experience pain, frontal plane joint laxity and instability. Co-contraction can control laxity and instability but may place constraints on the variability of the knee's motion during gait. Slight variation among gait cycles is normal, but reduced variability of joint motions could be detrimental. The purpose of this study was to quantify knee motion variability during gait and assess the influence of muscle activity, frontal plane laxity, and pain on knee movement variability in patients with medial knee OA. METHODS: Fifteen subjects with unilateral medial knee OA and 15 age and gender matched uninjured subjects underwent gait analysis, with electromyography to compute co-contraction. Stress radiographs were obtained for measuring frontal plane laxity. Knee motion variability was assessed from the phase angle (knee angle versus angular velocity) during early stance. RESULTS: Despite altered involved side knee kinematics and kinetics, individuals with knee OA showed involved side frontal plane variability which was not significantly different from the control group, but was significantly lower than the variability of the uninvolved knee's motion. Laxity and medial co-contraction influenced the amount of joint motion variability in the involved knee of the OA subjects. Pain did not influence variability. CONCLUSION: Patients with medial knee OA displayed altered involved knee kinematics and kinetics, although stride-to-stride variability of knee motion was unchanged. Evidence of excessive joint motion variability on the uninvolved side, however, may provide insight into the development of OA in the contralateral cognate joint.     

可旋转稳定型膝关节假体治疗严重膝关节损伤

目的 分析采用人工全膝关节置换术治疗严重膝关节损伤的效果及影响因素。方法 对采用可旋转稳定型膝关节假体的13例（14膝）进行分析。结果 人工全膝关节置换术后疼痛、功能及活动度分别较术前改善67．0％、52．3％和34．4％，手术优良率为84．6％（11／13）。无一例感染及深静脉血栓形成发生。结论 可旋转稳定型膝关节假体治疗严重膝关节疾病效果满意，手术适应证应从严掌握。     

Dynamic knee joint stiffness and contralateral knee joint loading during prolonged walking in patients with unilateral knee osteoarthritis

BackgroundLong duration walking, a commonly recommended treatment option for knee osteoarthritis (OA), may lead to increased knee joint loading.Research questionTo evaluate the effects of prolonged walking on dynamic knee joint stiffness and contralateral knee joint contact forces (KCFs) in individuals with unilateral symptomatic knee OA.MethodsTwenty-six older adults with knee OA completed a 45-minute bout of walking on a treadmill. Dynamic knee joint stiffness, estimated KCFs, measured ground reaction forces (GRFs), and simulated muscle forces were evaluated for both the symptomatic and asymptomatic limbs at 15-minute intervals using repeated measures, analysis of variance (ANOVA).ResultsDynamic knee joint stiffness during the early weight-acceptance phase of gait was significantly higher for the symptomatic limb throughout the 45-minute bout of walking. A significant increase in peak KCFs and simulated muscle forces were also observed during the weight-acceptance phase of gait for both limbs after 30 and 45 min of walking. Additionally, significantly elevated peak KCFs and muscle forces were observed during the late-stance phase of gait for the contralateral asymptomatic limb throughout the 45-minute bout of walking.SignificanceWalking durations of 30 min or greater lead to increased knee joint loading. Additionally, the elevated dynamic knee joint stiffness observed for the symptomatic knee during the weight acceptance phase of gait appears to be unrelated to the knee joint loading profile. Finally, the greater KCFs during the late-stance phase of gait observed for the asymptomatic limb are consistent with previously demonstrated risk factors for OA development and progression.     

Arthroscopy in patients with knee endoprostheses

Remarkable advances have been made in knee replacement. Nevertheless, patients and surgeons still face unsolved problems following implantation of an artificial knee joint. In some cases arthroscopy may serve as a diagnostic or surgical tool. Our experience has shown that arthroscopy is helpful in diagnosing polyethylene wear, fractures of prosthetic components and loosening of the endoprosthesis. Moreover, surgical procedures can be synchronously performed, e.g. lateral release for complete or partial patellar dislocation, parapatellar denervation for retropatellar pain and resection of meniscal remnants or a synovial plica in case of interposed tissue. In contrast to knee infections, early prosthetic infections should be treated with an open procedure.     

全膝关节置换术中髌骨置换对骨性关节炎患者早期疗效及膝前痛的影响

目的：探讨全膝关节置换术中是否进行髌骨置换对骨性关节炎患者的临床疗效及术后疼痛的影响。方法笔者采用随机数字表法将骨科2011年5月～2013年7月收治的93例行人工全膝关节置换术患者分为髌骨置换组43例和未置换组50例,比较两组患者治疗前与治疗后不同时间的相关指标变化差异。结果术前髌骨置换组与非置换组的膝关节KSS（美国膝关节协会）评分、Feller评分差异不显著（ P＞0．05）;术后第3、6、12个月髌骨置换组膝关节KSS评分、Feller评分显著高于非置换组（P＜0．05）;术前髌骨置换组与非置换组的膝关节视觉模拟评分（VAS）差异不显著（P＞0．05）;术后第3、6、12个月髌骨置换组膝关节VAS评分显著低于非置换组（P＜0．05）;两组患者术前、术后的胫股角,髌韧带比值,关节活动度ROM屈、伸值在两组间比较差异均不显著（ P＞0．05）;术后第12个月两组患者的胫股角、髌韧带比值,关节活动度ROM屈、伸值较治疗前均显著好转（ P＜0．05）。结论全膝关节置换术中进行髌骨置换对改善膝关节功能评分、髌骨评分、术后疼痛评分均有显著的效果。     

关节镜在膝关节急性损伤中的应用

对21例膝关节急性损伤进行了关节镜下检查、诊断、治疗,其方法可直接观察关节内结构,损伤小,诊断明确,恢复快,治疗效果满意.     

Toe-out angle changes after total knee arthroplasty in patients with varus knee osteoarthritis

Purpose

Toeing-out is a commonly proposed kinematic variable that has been suggested to reduce external knee adduction moment. Analyses of the toe-out angle after total knee arthroplasty (TKA) are useful for obtaining a proper understanding of the abnormal gait caused by varus knee osteoarthritis (OA), as well as performing rehabilitation after arthroplasty. Changes in the toe-out angle after arthroplasty have not yet been defined or analysed.

Methods

The study population consisted of 32 knees in 32 patients with varus knee OA who underwent TKA. The femorotibial angle was evaluated on standing anteroposterior radiographs before and after arthroplasty. The subjects underwent three-dimensional motion capture analyses to measure gait parameters (walking speed, cadence, stride length, step length, step width and the relative length of the single-limb support (SLS) percentage of one gait cycle) and the maximal hip adduction angle in the stance phase, the trunk lean angle in the coronal plane and the toe-out angle before and 4 weeks after arthroplasty.

Results

The femorotibial angle on the side of arthroplasty improved after surgery. Among the measured gait parameters, only the SLS percentage increased significantly. The hip adduction angle and toe-out angle on the side of arthroplasty increased significantly after surgery.

Conclusions

The knee alignment and hip adduction angle in the coronal plane and SLS phase were normalized after arthroplasty. The increase in the toe-out angle after arthroplasty may be attributable to the restoration of a normal knee alignment. These findings contribute to obtaining a proper understanding of the abnormal gait caused by varus knee OA and are useful for orthopaedic surgeons and rehabilitation therapists when treating patients after arthroplasty.

Level of evidence

Prospective study, Level II.