摘要
目的:探讨玻璃酸钠关节腔填充配合肌力训练改善膝关节骨性关节炎患者膝关节僵硬、疼痛等关节功能障碍。方法:选择承德医学院附属医院康复医学科2004-02/2005-01收治的膝关节骨性关节炎患者63例(86膝)。膝关节僵硬感者59例,其中膝关节肿胀者17膝,内翻畸形者29膝,活动范围不同程度受限者42膝;髌骨内下方压痛者48膝,髌骨内上方和髌骨下方压痛者16膝,髌骨外下方压痛者9膝。患膝屈曲90°,注射部位选用髌骨下内侧,经严格消毒后,注射针刺入关节腔内,回吸无血后注入玻璃酸钠溶液,注射1次/周,5次为1个疗程。同时配合膝关节股四头肌为主的肌力训练:①仰卧位,双腿伸直并拢抬起,保持足跟距离床面30cm左右,坚持15～30s,放下休息几秒,再抬起,反复训练。②坐位,做向前踢腿动作,踢起时停留15～20s,放下休息几秒,再抬起,反复训练。1个疗程后观察效果。疗效评定参考《中医病证诊断疗效标准》关于膝关节骨性关节炎的疗效评定标准分为优,良,可,差4级;膝关节疼痛程度的评定采用目测类比评分法,0分为无痛,10分为最痛。结果:63例患者(86膝)均进入结果分析。优40膝,良33膝,可11,差2膝。优良率达84.9%,总有效率为97.7%。结论:①透明质酸钠关节腔填充配合肌力训练治疗膝关节骨性关节炎,可以改善膝关节疼痛,使关节僵硬感消失,活动自如。②具有无创伤、无副作用、无并发症、疗效确切、患者乐于接受等特点。配合持之以恒的肌力训练是取得良好疗效的关键。
AIM： To test the effects of intra-articular injection of hyaluronic acid combined with muscle strength training on the joint dysfunctions of knee osteoarthritis, such as stiffness and pain. METHODS： Sixty patients （86 knees） with knee osteoarthritis that received treatment from February 2004 to January 2005 in the Hospital Affiliated to Chengde Medical University were recruited. Among these accepted knees, 59 showed stiffness, 17 joint swelling, 29 varus deformity, 42 mobility limitation of different degree, 48 inner lower pressure pain of the knee cap, 16 inner upper and lower pressure pain, 9 outer lower pressure pain. The knee was bent to 90° and the needle was inserted into the joint space from the inner and lower part of the knee cap after strict sterilization. Solution of hyaluronic acid was injected there was no blood due to resorption of the syringe. This injection was taken once a week and five weeks as a treatment course. At the same time, muscle strength training mainly on quadriceps femoris was undertaken： ①Let patients lie on the back and uplift both legs straightly, keep 30 cm distant to the bed, for 15-30 seconds, then relax for a few seconds and repeat the exercise; ② Let patients sit and kick the legs and maintain them in the air for 15-20 seconds, and then relax and repeat the exercise. Effects were evaluated after one course of treatment according to Diagnosis and Clinical Effects Standard of TCM Diseases and Syndromes in which four grades as excellent, good, moderate and bad are defined. Severity of pain was measured by visual analogue scale, 0 representing no pain and 10 the Worst. RESULTS： All the 63 patients （86 knees） were brought into final data analysis. Excellent effect was in 40 knees, good in 33, moderate in 11, and bad in 2. The results demonstrated that total effective rate was 97.7% and 84.9% patients obtained excellent or good level. CONCLUSION： ①Intra-articular injection of hyaluronic acid combined with muscle strength training can relieve knee pain, reduce stiffness and increase flexibility. ②In the present study, this treatment showed definite curative effects and good compliance. Meanwhile, no injuries, no side effects, no complications were observed. Combination of muscle strength training with intra-articular injection is the key to obtain a satisfactory effect.
出处
《中国临床康复》
CSCD
北大核心
2005年第38期68-70,共3页
Chinese Journal of Clinical Rehabilitation
