甲氨蝶呤关节腔注射治疗伴骨髓水肿的膝骨关节炎疗效观察

目的:探讨关节腔注射甲氨蝶呤对伴骨髓水肿的轻中度膝骨关节炎的疗效。方法:选择非甾体药物联合关节腔注射玻璃酸钠疗效不佳的膝骨关节炎患者40例,行核磁共振(MRI)诊断为BME的膝骨关节炎。在继续原剂量非甾体药物同时,给予患膝关节腔注射甲氨蝶呤10mg/次,1次/周,共5次。40例患者治疗前、治疗结束后及治疗后12周采用视觉模拟评分法(VAS)和WOMAC骨关节炎指数问卷调查进行疼痛和关节功能评分。结果:关节腔注射甲氨蝶呤患者的VAS和WOMAC评分减少(P<0.05),提示对有BME的KOA患者关节腔注射甲氨蝶呤可有效减轻关节疼痛,改善关节功能。结论玻璃酸钠关节腔注射治疗无效的KOA患者,甲氨蝶呤关节腔注射治疗可有效减轻膝骨关节炎疼痛,改善关节功能。

外洗方配合推拿治疗膝关节滑膜炎163例

目的:观察外洗方配合推拿治疗膝关节滑膜炎的疗效。方法:采用外洗方(防风、防己、赤芍、红花、伸筋草、透骨草、制乳香、没药、川乌、草乌等)外洗配合推拿治疗膝关节滑膜炎163例。结果:总有效率91.12%。提示:本方法对本病具有舒筋活络,利水消肿,通利关节,宣痹止痛的功效。

足底外侧楔形垫治疗膝骨性关节炎合并膝内翻的临床研究

为探讨膝骨性关节炎合并膝内翻的有效治疗方法。将55例患者（72个患病膝关节），随机分为足底矫形垫组与对照组进行对照观察。经4～6个月随访，临床疗效评定治疗组优良率为9.96％，有效率为82.93％；对照组优良率为6．46％，有效率为35．48％。治疗组中X线影像分级Ⅱ级者疼痛评分及综合评分改善明显（P〈0．05），有显著性差异；Ⅲ级者有改善，但P〉0．05，无显著差异；Ⅳ级患者症状无改善。对照组Ⅱ、Ⅲ、Ⅳ级治疗前后疼痛评分及综合评分均无明显改变。说明足底外侧楔形垫是治疗膝骨性关节炎合并膝内翻的有效方法。

艾灸治疗对兔KOA软骨损伤及MMP-1和TIMP-1表达调节作用的实验研究

目的:探讨艾灸治疗对膝骨性关节炎(KOA)软骨损伤及MMP-1和TIMP-1的表达调节作用,为艾灸治疗KOA的机理提供实验依据。方法:对兔膝关节注射木瓜蛋白酶制造KOA模型,经艾灸和药物治疗6周后,病理组织评分判断软骨损伤情况,定量图像分析技术检测膝关节软骨中MMP-1和TIMP-1光密度的改变,并计算MMP-1与TIMP-1的比值(MMP-1/TIMP-1)变化情况。结果:艾灸组软骨病理评分和MMP-1光密度均低于模型组,差异有统计学意义(P<0.01,P<0.05),TIMP-1的光密度与模型组比差异无统计学意义(P>0.05),但MMP-1/TIMP-1明显低于模型组,差异有统计学意义(P<0.05),艾灸治疗作用与药物组相似。结论:艾灸能够起到减轻KOA软骨破坏,减轻关节病损的作用,其对KOA的治疗机制可能是通过减轻MMP-1的破坏作用,降低MMP-1/TIMP-1实现的。

Ilizarov技术微创胫骨高位截骨治疗膝骨性关节炎伴膝内翻畸形

目的探讨Ilizarov技术微创胫骨高位截骨治疗膝骨性关节炎伴膝内翻畸形的疗效。方法2000年2月至2013年12月期间，采用Ilizarov技术微创胫骨高位截骨治疗138例（148膝）临床诊断膝骨性关节炎伴膝内翻畸形患者。手术前后拍摄患肢负重位全长X射线片，测量股胫角（FTA）、内侧胫股关节间隙，同时进行美国特种外科医院膝关节评分（HSS评分）比较。结果所有患者随访（66．5±6．6）个月。术后FTA、内侧胫股关节间隙、HSS评分显著优于术前（均P〈0．05），膝关节疼痛明显缓解，优良率为91．2％。结论Ilizarov技术微创胫骨高位截骨是治疗膝骨性关节炎伴膝内翻畸形的有效方法。

人工膝关节置换术后下肢深静脉血栓形成的原因分析及护理

目的探讨人工膝关节置换术后患者下肢深静脉血栓形成的预防及护理方法。方法对120例行膝关节置换患者,术前全面评估、心理护理及指导;术后给予抗凝药物治疗,指导功能锻炼并配合护理等。结果 120例患者均未发生下肢深静脉血栓。结论通过预防治疗和护理干预,对预防人工膝关节置换术后下肢深静脉血栓的形成效果显著。

老年性膝关节半月板损伤伴积液120例综合治疗分析

目的探讨老年性膝关节半月板损伤伴积液的综合治疗方法。方法采用膝关节积液囊腔臭氧冲洗及注射,髌下缘周围温银针疗法,后期关节腔注射玻璃酸钠,配合股四头肌等张训练治疗共120例。结果治疗6周后总有效率为98.3%,1 a后随访,60%未复发。结论综合疗法对老年性膝关节半月板损伤伴积液有显著疗效。

Reinforcing and Reducing Manipulation by Breathing on Yin and Yang Meridian Points for Motor Function of Knee Joints in Patients with Ischemic Stroke

Objective: To observe the effect of reinforcing and reducing manipulation by breathing on yin and yang meridian points for motor function of knee joints in patients with ischemic stroke. Methods: A total of 60 ischemic stroke cases were randomly allocated into an observation group and a control group, 30 in each group. Other than basic and conventional rehabilitation therapies, cases in the observation group were treated with reinforcing and reducing manipulation on yin and yang meridians points for a period of 8 weeks; whereas cases in the control group only received the same basic and conventional rehabilitation therapy as that in the observation group. Then the knee joint energy, support moment and shaking moment were compared between the two groups before treatment, and after 4-week and 8-week treatment respectively. Results: Before treatment, there were no between-group significant differences in knee joint energy, support moment and shaking moment(all P>0.05). After treatment, the knee joint energy, support moment and shaking moment in both groups were significantly improved(P<0.05). After 8 weeks of treatment, the knee joint energy, support moment and shaking moment in both groups were significantly improved than that of 4-week treatment(P < 0.05). In addition, there were between-group statistical significances in comparing knee joint energy, support moment and shaking moment after 4 and 8 weeks of treatment(P<0.05). Conclusion: Reinforcing and reducing manipulation by breathing on yin and yang meridian points can increase the knee joint support and shaking force and moment in stroke patients and improve their walking ability.