基于髌骨稳定性探讨髌股关节炎的手法治疗策略

Manipulation Treatment Strategy of Patellofemoral Osteoarthritis Based on Stability of Patella

髌股关节炎是膝骨关节炎根据疼痛的部位和解剖划分的一种,临床较为常见。髌骨是髌股关节稳定的关键,其是否稳定关系到髌股关节炎的发生发展。髌骨的稳定性依靠髌骨股骨髁的几何形状,周围关节囊、肌腱、筋膜、韧带及髌韧带的静力平衡系统和股四头肌的动力平衡系统。因此,手法治疗应基于髌骨的稳定性,结合中医理论,从髌骨稳定性的动静力平衡系统入手,着力恢复髌骨稳定性,从而恢复髌股关节的稳定性,以达到治疗目的。手法治疗策略:注重动静力平衡系统的平衡,整体施治;辨筋施治,柔筋为本;医患合作,治养结合。

Patellofemoral arthritis is a clinical common type of knee osteoarthritis distinguished by its pain and anatomical position.The stability of patella is crucial to the stability of the patellofemoral joint and is related to the occurrence and development of osteoarthritis.Patella stability depends on the structural geometry of patellofemoral condyle,the static mechanics of the surrounding joint capsule,tendon,fascia,ligament and patellar ligament and the dynamic mechanics of the quadriceps.Therefore,manipulation therapy should be based on the considerations on the stability of the patella as well as TCM theory.Starting from maintaining the balance of the dynamic and static mechanical system and focusing on the restoration of the stability of patella,the ultimate goal of the treatment is to restore the stability of patellofemoral joint.The main aspects of manipulation treatment strategy include the balancing of dynamic and static mechanical system,the idea of holism treatment,differentiation treatment based on tendons injury identification,fundamental principle of softening tendons,cooperation between doctors and patients,and combination of therapy and convalesce.