¹ÇÉË¿ÆÂÛÎÄ

Äúµ±Ç°µÄλÖãºÑ§ÊõÌà > ҽѧÂÛÎÄ > ÖÐҽѧÂÛÎÄ > ¹ÇÉË¿ÆÂÛÎÄ >

Ï¥¹Ç¹Ø½ÚÑ×¾­½î²¡±äÖÎÁÆ×ÛÊö

À´Ô´£º¹ãÖÝÖÐÒ½Ò©´óѧѧ±¨ ×÷Õߣºº«ÇåÃñ;ÕÅî¸è¤;¹ù˹ӡ
·¢²¼ÓÚ£º2019-03-13 ¹²9630×Ö

¡¡¡¡Õª    Òª£º¡¡¶ÔÏ¥¹Ç¹Ø½ÚÑ× (KOA;ÖÐÒ½¹éÊôΪ“Ï¥±Ô”) ¾­½î²¡±äµÄÀíÂÛ»ù´¡¡¢KOAµÄ½î±ÔÓë¹Ç±ÔµÄ¹ØÁª¡¢KOA¾­½î²¡±äʵÖʵÄÏÖ´úÑо¿¡¢KOA¾­½î²¡±äµÄÖÎÁƵȽøÐÐÁË×ÛÊö¡£KOA¾­½î²¡±äÖ÷񻃾¼°×ãÌ«Ñô¾­½î¡¢×ãÉÙÑô¾­½î¡¢×ãÑôÃ÷¾­½îºÍ×ãÈýÒõ¾­¾­½î¡£KOA½î±ÔÓë¹Ç±ÔµÄ¹ØÏµ±íÏÖΪϥ±Ô²¡ÇéµÄÇáÖØ, ½î±ÔÉÐδ¼°¹Ç, ¶ø¹Ç±Ô±Ø¶¨°éÓнî±Ô, ½î±ÔÖÁ¹Ç±ÔµÄ·¢Õ¹¹ý³ÌÊÇKOA²¡±ä½øÕ¹µÄ¹ý³Ì¡£KOA¾­½î²¡±äʵÖʵÄÏÖ´úÑо¿Éæ¼°²¡ÔîÃüÃû¼°·Ö²¼¡¢Ï¥¹Ø½ÚÖÜΧÈí×éÖ¯µÄ±ä»¯¡¢ÉúÎïÁ¦Ñ§¸Ä±ä¡¢Ó°Ïñѧ¸Ä±ä¼°»¼Õß²½Ì¬²îÒìµÈ¡£KOA¾­½î²¡±äµÄÖÎÁÆ·½Ê½ÓжàÖÖ, °üÀ¨°¬¾Ä¡¢µãѨ¡¢¾­½î´Ì·¨¡¢¾­½îÊÖ·¨¡¢¾­½îÌù·óÁÆ·¨¡¢¾­½î΢´´ÁÆ·¨µÈ¡£ÒÔÉÏÑо¿³É¹û¿ÉΪ¾­½îÁÆ·¨ÔÚKOAÁÙ´²ÖÎÁƵÄÍÆ¹ãÔËÓÃÌṩÀíÂÛÒÀ¾Ý¡£

¡¡¡¡¹Ø¼ü´Ê£º¡¡Ï¥¹Ç¹Ø½ÚÑ×; Ï¥±Ô; ¾­½î±æÖ¤; ×ÛÊö;

¡¡¡¡Abstract£º¡¡This article reviewed the theoretical foundations of knee osteoarthritis (KOA;knee-blockage syndromein traditional Chinese medicine) muscle-along meridian affections, association of muscle-blockage (Jinbi) andbone-blockage (Gubi) in knee-blockage syndrome, the achievements in the modern research of the essence ofKOA muscle-along meridian affections, therapies for KOA muscle-along meridian affections, etc. KOA muscle-along meridian affections involve the muscle-along Foot-Taiyang Meridian, the muscle-along Foot-Shaoyang Meridian, the muscle-along Foot-Yangming Meridian and the muscle-along Foot Triple-Yin Meridians. Jinbi and Gubi reflect the illness severity of knee-blockage syndrome, Jinbi has not affected the bone, while Gubi wasdefinitely companied by Jinbi. Jinbi developing into Gubi is the progression of KOA. The modern research of theessence of KOA muscle-along meridian affections covered the nomination and distribution of the foci of KOAmuscle-along meridian affections, the pathological changes in soft tissues around the knee, biomechanicalmodification, medical image features, gait variation, etc.. Therapies for KOA muscle-along meridian affectionsvaried, including moxibustion, acupoint pricking, muscle-along meridian needling, muscle-along meridianmanipulations, muscle-along meridian herbal application, and muscle-along meridian minimally-invasivetherapy. The research achievements will supply theoretical evidence for the clinical popularization of muscle-alongmeridian therapies for KOA.

¡¡¡¡Keyword£º¡¡knee osteoarthritis; knee-blockage syndrome; muscle-along meridian syndrome differentiation; review;

¡¡¡¡Ï¥¹Ç¹Ø½ÚÑ× (knee osteoarthritis, KOA) ÊÇÒ»ÖÖÒÔÏ¥¹Ø½ÚÈí¹ÇµÄ±äÐÔ¡¢ÆÆ»µ¼°¹ÇÖÊÔöÉúÎªÌØÕ÷µÄÂýÐԹؽڲ¡, ±¾²¡¶à·¢ÉúÓÚÖÐÀÏÄêÈË, Ò²¿É·¢ÉúÓÚÇàÄêÈË;¿Éµ¥²à·¢²¡Ò²¿ÉË«²à·¢²¡¡£Ï¥¹Ø½ÚÌÛÍ´¡¢Ï¥¹Ø½ÚÖ״󡢹ؽÚÄÚĦ²ÁÒô¡¢¹Ø½Ú»î¶¯ÊÜÏÞΪÆäÖ÷ÒªÖ¢×´¼°ÌåÕ÷, ²¡ÇéÑÏÖØÕß¿ÉÑÏÖØÓ°Ï컼ÕßµÄÉú»îÖÊÁ¿¡£Ä¿Ç°KOAµÄÒ©ÎïÖÎÁÆÉÐÎÞÌØÐ§Ò©¡£ÖÐÒ½ÖÐÒ©¡¢Õë¾ÄÍÆÄõÈÌØÉ«ÁÆ·¨ÔÚ¸ÄÉÆKOAÖ¢×´·½ÃæÁÆÐ§½ÏÏÔ×Å¡£ÖÐÒ½ÈÏΪKOAÊǽî¹ÇʧºâµÄ½á¹û, ×ñÑ­ÏȽîºó¹ÇµÄ²¡±ä¹æÂÉ, ¾­½î²¡±ä³ÖÐøKOAÕû¸ö²¡±äµÄ¹ý³Ì¡£KOA¾­½îÂÛÖÎÊÇÖ¸ÔÚ¾­½îÀíÂÛÖ¸µ¼ÏÂÖÎÁÆKOAµÄ¾­½î²¡±ä, ¾­½îÂÛÖοÉÓÐЧËɽâð¤Á¬×éÖ¯¡¢¸ÄÉÆ¾Ö²¿ÑªÒºÑ­»·ºÍ»Ö¸´½î¹Çƽºâ¡£ÒÔ϶ÔKOAµÄÖÐÒ½¾­½î±æÖ¤ÀíÂÛ»ù´¡¡¢½î±ÔÓë¹Ç±ÔµÄ¹ØÁª¡¢ÁÙ´²Ñо¿³É¹ûµÈ·½ÃæµÄÑо¿½øÕ¹½øÐÐ×ÛÊö¡£

¡¡¡¡1 KOA¾­½î±æÖ¤ÀíÂÛ»ù´¡

¡¡¡¡¾­½î×îÔç¼ûÓÚ¡¶»ÆµÛÄÚ¾­¡·¡£ÏÖ´úÖÐҽѧÕßÉÐȱ·¦¶Ô¾­½îµÄͳһÈÏʶ, ÓÐѧÕßÈÏΪ“¾­½î”ÊǼ¡Èâ¡¢ÈÍ´øµÈÈí×éÖ¯¼°Éñ¾­ÏµÍ³[1], »òÈÏΪ¾­½îÓëĤԭÔÚ·Ö²¼¡¢À´Ô´¼°¹¦ÄÜÉÏÓëÏÖ´ú½âÆÊѧÖеĽîĤÓи߶ÈÏàËÆÐÔ[2]¡£Ê®¶þ¾­½îµÄÉúÀí¹¦ÄÜÎªÔ¼Êø¹Ç÷À, Ö÷˾Ô˶¯, ±£»¤Ôอ¾­Âç¼°È«Éí¸÷×éÖ¯Æ÷¹Ù¡£ÓÉÓÚÊ®¶þ¾­ÂöÖ®Æø½á¾ÛÉ¢ÂäÓÚ½îÈâ¹Ø½Ú, ËùÒÔ¾­½î²¡±ä³£·¢ÉúÓÚËÄÖ«¹Ø½ÚÖ®´¦¡£

Ï¥¹Ç¹Ø½ÚÑ×¾­½î²¡±äÖÎÁÆ×ÛÊö

¡¡¡¡Ï¥¹Ø½ÚΪÈËÌå×î´óµÄ¹Ø½Ú¡£¡¶ËØÎÊ·ÎåÔàÉú³ÉÂÛ¡·ÔØ:“×ãÌ«ÑôÖ®½î, ……аÉϽáÓÚÏ¥”, “×ãÉÙÑôÖ®½î, ……½áÓÚÏ¥ÍâÁ®”, “×ãÑôÃ÷Ö®½î, ……ÉϽáÓÚÏ¥ÍâÁ®”, “×ãÌ«ÒõÖ®½î, ……ÂçÓÚÏ¥ÄÚ¸¨¹Ç”, “×ãÉÙÒõÖ®½î, ……¶øÉϽáÓÚÄÚ¸¨Ö®Ï”, “×ãØÊÒõÖ®½î, ……ÉϽáÄÚ¸¨Ö®Ï”¡£ÓÉÒÔÉÏÂÛÊö¿ÉÖª, Ñ­ÐÐÓÚÏ¥²¿¾­½îÓÐ6Ìõ, ·Ö±ðΪ×ãÌ«ÑôÖ®½î¡¢×ãÉÙÑôÖ®½î¡¢×ãÑôÃ÷Ö®½îºÍ×ãÌ«ÒõÖ®½î¡¢×ãÉÙÒõÖ®½î¡¢×ãØÊÒõÖ®½î, ¿¼Âǵ½½âÆÊѧºÍÉúÎïÁ¦Ñ§ÌØÐÔ, ĿǰѧÕß½«×ãµÄÈýÒõ¾­½îºÏ²¢ÎªÒ»Ìõ, ¼´×ãÈýÒõ¾­½î¡£ÒÔÏÂ̽ÌÖµÄÏ¥¹Ø½Ú¾­½î²¡±äÖ÷񻃾¼°Õâ4Ìõ¾­½î¡£Õâ4Ìõ¾­½îÔÚÏ¥¹Ø½Ú´¦µÄÑ­ÐзֱðΪ:×ãÌ«Ñô¾­½î½áÓÚÏ¥²¿;×ãÉÙÑô¾­½îÉÏÐÐÑØëÖÍâ²àÔµ, ½áÓÚÏ¥Íâ²à;×ãÑôÃ÷¾­½îбÏòÍâÉϸÇÓÚëè¹Ç, ÉϽáÓÚÏ¥Íâ²à;×ãÈýÒõ¾­½î·Ö±ðÂçÓÚëÖ¹ÇÄÚ÷Á²¿, ½áÓÚëÖ¹ÇÄÚ÷ÁÉÏ¡¢ÏÂ, Èçͼ1Ëùʾ¡£

¡¡¡¡Í¼1 Ñ­ÐÐÓÚÏ¥¹Ø½ÚµÄ¾­½îµÄ·Ö²¼¼°½á¾ÛÖ®´¦Figure 1 Distribution and convergence of muscle-along meridians around the knee joint
ͼ1 Ñ­ÐÐÓÚÏ¥¹Ø½ÚµÄ¾­½îµÄ·Ö²¼¼°½á¾ÛÖ®´¦Figure 1 Distribution and convergence of muscle-along meridians around the knee joint

¡¡¡¡´ø“´Î”µÄ²¡ÔîÃûÊÇÒѹ淶¶¨Î»µÄ½á½î²¡Ôîµã, ÕâЩ½á½î²¡Ôîµã³£ÔÚëòѨÅԵļ¡ÈâÈÍ´øÆðÖ¹µã´¦, ÆäÔÚ½î¹ÇÖ®ÉÏÓÐÍ´ÐÔÌõË÷, ÓбðÓÚëòѨ, ¹ÊÒÔÁÚ½üëòѨÃû¼Ó“´Î”ÃüÃû

¡¡¡¡Ê®¶þ¾­½îÈçͬʮ¶þ¾­ÂöÆðÔ´ÓÚËÄÖ«Ä©¶Ë, ÄÚÐÐÓÚÐØ¸¹Ö®ÖÐ, ²»ÈëÎåÔàÁù¸­, µ«²¢²»Òâζ×ÅÊ®¶þ¾­½îÓëÎåÔàÁù¸­Ã»ÓÐÁªÏµ¡£Ê®¶þ¾­½îÓëÔอµÄÁªÏµÖ÷ÒªÌåÏÖÔÚÎåÔà¶Ô¾­½îµÄå¦Ñø×÷Óü°ÎåÔàÖ®Ð°ÆøÍ£ÁôÓÚ¾­½î½á¾ÛÖ®²¿Î»¡£

¡¡¡¡“¸ÎÉö—¾­½î”ÀíÂÛÊǾ­½îÀíÂÛÌåϵµÄ·á¸»ÓëÍØÕ¹, Ìáʾϥʹ½øÐо­½î±æÖ¤µÄÍ¬Ê±Ò²Òª×¢ÖØÔอ±æÖ¤¡£¡¶ÕÅÊÏҽͨ¡·Ô»:“ϥʹÎÞÓв»Òò¸ÎÉöÐéÕß”, Ö¸³öKOAµÄÄÚÒòÊǸÎÉö¿÷Ðé¡£¸ÎÉö¿÷Ðé, Ï¥¹Ø½ÚÖÜΧ¼¡ÈâºÍ¹Ç÷ÀµÃ²»µ½³ä·ÖµÄå¦Ñø, ¼´ÉöÐéÄÑÒÔÖ÷¹Ç, ¸ÎÐéÎÞÒÔÑø½î, ½î¹ÇÊ§Ñøµ¼ÖÂÏ¥¹Ø½ÚËáÍ´²»ÊÊ¡£¡¶Öвؾ­¡·Ô»:“¹Ç±ÔÕß, ……ÉöÆøÄÚÏû……Ôò¾«ÆøÈÕË¥……Ð°ÆøÍýÈë”, Ö¸³ö¹Ç±Ô¸ÐÊÜÍâÀ´Ð°ÆøÊÇÓÉÓÚÉö¾«¿÷Ðé¡£¡¶ËØÎÊ·±ÔÂÛ¡·Ô»:“·çº®ÊªÈýÆøÔÓÖÁ, ºÏ¶øÎª±Ô¡£Æä·çÆøÊ¢ÕßΪÐбÔ, º®ÆøÊ¢ÕßΪʹ±Ô, ÊªÆøÊ¢ÕßΪ×űԔ, ˵Ã÷ÍâÀ´Ö®Ð°¿ÉÒÔÖ±½ÓÈëÇÖ»úÌå, µ¼ÖÂÌÛÍ´, ÆäÌÛÍ´µÄÐÔÖʺÍËùÊÜÐ°ÆøµÄÀàÐÍÓйء£Ð°ÆøÇÖ·¸¾­½î¡¢¹Ø½Ú, µ¼ÖÂÏ¥¹Ø½ÚÌÛÍ´, ´Ó¶øÒýÆðÏ¥±Ô¡£Íâа²»³ý, ¾­Â粻ͨ, ¾ÃÔòÄÚÉú̵×ÇðöѪ, ÖÂÏ¥²¿¾­½îÂÎËõ¾Ð¼±, ¹Ø½Ú»î¶¯ÊÜÏÞ¡£¸ÎÉö¿÷ÐéÓëÍâ¸ÐÐ°Æø¿ÉÒÔÏ໥ӰÏì:¸ÎÉö¿÷Ðé, »úÌåµÖ¿¹Á¦Ï½µ, ÍâÀ´Ö®Ð°¸üÒ×ÈëÇÖ;·ç¡¢º®¡¢ÊªÈýаÈëÇÖÏ¥¹Ø½Ú, ¾ÃÔòÖ½î¹ÇËðÉË, ¸ÎÉö¿÷Ðé¡£

¡¡¡¡ÏÖ´úҽѧÈÏΪ, ¹ÉËÄÍ·¼¡µÄÇ¿¶ÈÓëÏ¥¹Ø½ÚÑײ¡³ÌºÍÏ¥¹Ø½Ú²»ÎÈÃÜÇÐÏà¹Ø[3], KOA»¼Õß¹ÉËÄÍ·¼¡Á¦¼õÈõ, Ï¥ÍâÕ¹¼¡Á¦Ã÷ÏÔСÓÚÄêÁ䯥Å䵫ÎÞÖ¢×´µÄ¶ÔÕÕ×é[4,5]¡£¹ÉËÄÍ·¼¡¼¡Á¦¶ñ»¯ÌåÏÖÔڿ켡ÏËάÉÏ[6], ¹ÉÄڲ༡±È¹ÉÖ±¼¡¼¡ÈâήËõ¸üÃ÷ÏÔ[7]¡£¼¡ÈâÊÕËõÓÉ¢ñÐͽºÔ­½ÏÈõµÄ³é´¤Á¦¿ªÊ¼, Ëæ×ÅÊÕËõÂʵÄÔö¼Ó, ¢òÐͽºÔ­±»¼¤»î[8]¡£¹ÉËÄÍ·¼¡ÔÚ˲¼äÔ˶¯Ê±, ¢òÐͽºÔ­Ê×Ïȱ»¼¤»î, ¿ÉÄÜÊÇÓ°Ïì˲¼äÓÃÁ¦µÄÔ­Òò[9]¡£KOA»¼Õß¼¡Èâ×î´óµÈ³¤ÊÕËõ¹ý³ÌÖÐ, ¼¡ÏËά´«µ¼ËٶȼõÂý, ƽ¾ù¹¦Âʼ°ÆµÂÊϽµ[5]¡£KOA»¼Õߵļ¡ÈâÊÕËõģʽ¿ÉÄܸıä, ´Ó¶øÒýÆðÄÜÁ¿×ªÒÆÐ§Ó¦µÄ¼õÉÙ, Õâ½âÊÍÁËKOA»¼ÕßÏÂÖ«¼¡ÈâÎÞÁ¦µÄÔ­Òò¡£ÄNÉþ¼¡µÄÖ÷Òª¹¦ÄÜÊÇÇüÇúÏ¥¹Ø½Ú, ÔÚ±ÕÁ´Ô˶¯ÖÐЭͬ¹ÉÖ±¼¡Éìֱϥ¹Ø½Ú, ÕâÖÖЭͬ×÷ÓÃÓÐÀûÓÚ±£»¤Ï¥¹Ø½ÚµÄÎȶ¨ÐÔ[10]¡£Ñо¿±íÃ÷, ¹ÉËÄÍ·¼¡¡¢Ð¡ÍÈÈýÍ·¼¡ºÍÄNÉþ¼¡ÈáÈÍÐԵĸıä¿ÉÄÜÔö¼ÓKOAµÄ·¢Éú·çÏÕ, ÄNÉþ¼¡ÈáÈÍÐԵĸıä¿ÉÄÜÊÇ×ãÌ«Ñô¾­½î²¡±äÏ¥¹Ø½Úºó²àÇ£³¶Í´µÄÔ­Òò[11,12,13,14]¡£

¡¡¡¡Ï¥¹Ø½ÚµÄÎȶ¨ÐÔ¿¿ÖÜΧÈí×éÖ¯ºÍ¹ÇÐԽṹά³Ö, Èí×éÖ¯°üÀ¨Ï¥¹Ø½ÚÄÚÍâ²à¸±ÈÍ´ø¡¢÷ÆÈÍ´ø¡¢¹Ø½ÚÄÒ¡¢½»²æÈÍ´ø¼°ÄÚÍâ²à°ëÔ°åµÈ, ¹ÇÐԽṹ°üÀ¨¹É¹Ç»¬³µ¡¢ëÖ¹ÇÆ½Ì¨¼°÷ƹǡ£Õý³£Ï¥¹Ø½ÚÖÜΧµÄÈí×éÖ¯¼°¹ÇÐԽṹά³ÖÁËÏ¥¹Ø½Ú¶¯¾²Ì¬Á¦Ñ§Æ½ºâ, ÊÇÖÐҽѧ“½î¹Çƽºâ”µÄ½âÆÊѧ»ù´¡, ÈôÕâÖÖÆ½ºâ±»´òÆÆ, Ôò¿Éµ¼Ö½î¹Çʧºâ, ¸Ä±äÏÂÖ«ÉúÎïÁ¦Ïß, ´Ó¶ø·¢ÉúKOA¡£ÏÂÖ«Á¦ÏߵĸıäʹÖÜΧÈí×éÖ¯ÊÜÁ¦²»¾ù, ÔÚ¼¡ëì¡¢ÈÍ´øÆðÖ¹µã´¦ÍùÍù³öÏÖ¾­½î²¡Ôîµã[15]¡£KOAÔçÆÚ±íÏÖΪËáÍ´¡¢½©Ó², ¼±ÐÔÆÚ±íÏÖΪÌÛÍ´¡¢½©Ó²¡¢Ö×ÕÍ, ÍíÆÚ±íÏÖΪÌÛÍ´¡¢¹¦ÄܻÊÜÏÞ¡¢»ûÐΡ£KOA²»Í¬²¡±ä½×¶Î²ÉÓþ­½î´¥Õï¼ì²é·¨½Ô¿É´¥¼°¾­½î²¡Ôîµã, ˵Ã÷Ï¥¹Ø½Ú¾­½î²¡±äÉæ¼°KOAÕû¸ö²¡±ä¹ý³Ì¡£KOAÓ°Ïñѧ·ÖÆÚÓëÁÙ´²Ö¢×´Í¨³£²»Ò»ÖÂ[15], ¹Ø½ÚÈí¹ÇµÄ²¡±ä²»»áÒýÆðÌÛÍ´, ÒýÆðÌÛÍ´µÄÔ­Òò¿ÉÄÜÊÇÖÜΧÈí×éÖ¯²¡±ä¡£¸ÎÉö¿÷Ðé, Ï¥¹Ø½ÚÍ˱ä¼Ó¿ì, ¼ÓÖ®·çº®ÊªÐ°ÇÖÏ®, ¼Ó¾çÏ¥¹Ø½Ú¾­½î²¡±ä¡£Ëæ×ż²²¡µÄ·¢Õ¹, ºóÆÚÏÂÖ«¼¡ÈâȺºÍÏ¥¹Ø½ÚÖÜΧÈí×éÖ¯ÕÅÁ¦¸Ä±ä, ½î¹ÇϵͳÊܵ½ËðÉË, ³öÏֹؽڻûÐμ°»î¶¯ÊÜÏÞ¡£

¡¡¡¡2 KOA (Ï¥±Ô) ²¡±ä¹ý³ÌÖнî±ÔÓë¹Ç±ÔµÄ¹ØÁª

¡¡¡¡ÖÐÒ½ÈÏΪKOAÊôÓÚ“Ï¥±Ô”·¶³ë, Æä²¡»úÑÝ±ä¹æÂÉΪ:½îÉËÊÇÆðÒò, ½î²¡Ëð¹ÇÊDz¡±ä¹ý³Ì, ½î¹Çͬ²¡ÊÇ×îÖÕ½á¹û¡£¡¶ÕÅÊÏҽͨ¡·ÔÆ:“ϥΪ½îÖ®¸®, ϥʹÎÞÓв»Òò¸ÎÉöÐéÕß, ÐéÔò·çº®ÊªÆøÏ®Ö®”¡£´ËÂÛÊöÖ¸³öÁËÏ¥±ÔµÄ²¡ÒòΪ¸ÎÉö¿÷Ðé, ¾­Âç¿ÕÐé, ·çº®ÊªÐ°³ËÐéÇÖÏ®, Æä²¡»ú¾ßÓб¾Ðé±êʵµÄÌØÐÔ¡£¡¶ËØÎÊ·ðôÂÛ¡·Ìá³öµÄ“×Ú½îÖ÷Êø¹Ç¶øÀû»ú¹ØÒ²”, ˵Ã÷Á˽î¾ßÓÐÔ¼Êø¹Ç÷À¡¢Ö÷˾¹Ø½ÚÔ˶¯µÄ×÷Óá£Àú´úÒ½¼Ò¶Ô“½î”²¢ÎÞͳһÈÏʶ, ¹éÄÉÆðÀ´¶àÖ¸¼¡ëì¡¢½îĤ¡¢¹Ø½ÚÄÒ¡¢ÈÍ´ø¡¢¼¡ÈâµÈÈí×éÖ¯¡£Õý³£Ï¥¹Ø½Ú“½î”Ó듹ǔ´¦ÓÚÆ½ºâ״̬, ÈôÕâÖÖÆ½ºâ±»´òÆÆÔò¿ÉÄܳöÏÖ½î±Ô»òÕ߹DZԡ£

¡¡¡¡¡¶ËØÎʷƤ²¿ÂÛ¡·Ô»:“ƤÕßÂöÖ®²¿Ò², а¿ÍÓÚÆ¤ÔòëíÀí¿ª, ¿ªÔòаÈë¿ÍÓÚÂçÂö, ÂçÂöÂúÔò×¢ÓÚ¾­Âö, ¾­ÂöÂúÔòÈëÉáÓÚ¸®²ØÒ²”¡£ÒÔÉÏÂÛÊöÖ¸³öÁ˼²²¡µÄ·¢²¡¹ý³ÌÊÇÓÉ±í¼°Àï¡¢ÓÉdzÈëÉî¡£·çº®ÊªÐ°Ê×ÏÈÇÖϮϥ¹Ø½ÚÖÜΧµÄ¼¡·ô;Èô¸ÎÉö²»×ã, ÂöÂç¿ÕÐé, Íâа½«½øÒ»²½ÈëÇÖ¾­½î;ÈôÕýÆøÎÞÁ¦¿¹Ð°Íâ³ö, Ð°ÆøÉîÏÝÈëÀï, Ôò×îÖÕ·¢Õ¹Îª¹Ç±Ô¡£ÔÚKOA·¢Õ¹¹ý³ÌÖÐ, ¹Ç±ÔÊǽî±Ô·¢Õ¹¹ý³ÌµÄÑÓÉì, ÊÇKOA×îÖÕ±íÏÖÐÎʽ, ½î±ÔÊÇKOA·¢Éú·¢Õ¹¹ý³ÌÖеıؾ­½×¶Î¡£¡¶ËØÎÊ·³¤´Ì½ÚÂÛ¡·Ìá³öµÄ“²¡ÔÚ¹Ç, ¹ÇÖØ²»¿É¾Ù, ¹ÇËèËáÍ´, º®ÆøÖÁ, ÃûÔ»¹Ç±Ô……²¡ÔÚ½î, ½îÂνÚÍ´, ²»¿ÉÒÔÐÐ, ÃûÔ»½î±Ô”, ˵Ã÷¹Ç±ÔºÍ½î±ÔÔÚÁÙ´²±íÏÖÉϾßÓвîÒì¡£¹Ç±ÔÖ÷Òª±íÏÖΪ¹Ç÷ÀËáÍ´¡¢ÖØÍ´, Óöº®¼ÓÖØ;½î±Ô±íÏÖΪ¾·Âξм±, ÇüÉìÊÜÏÞ, ²»ÄÜÐÐ×ß¡£Ñо¿±íÃ÷, KOA»¼Õß¹ÉËÄÍ·¼¡µÄ¼¡Á¦¼õÈõÓë¹Ø½Ú»î¶¯·¶Î§½µµÍÏà¹Ø[4], Ö¤Ã÷Á˽îÓë¹ÇÖ®¼äµÄ¹ØÏµ¡£¡¶»ÆµÛÄÚ¾­¡·ÔÆ:“Öî½îÕß, ½ÔÊôÓÚ½Ú……¹ÇΪ¸É, ÂöΪӪ, ½îΪ¸Õ, ÈâΪǽ, Ƥ·ô¼á¶øÃ«·¢³¤¡£”Õâ˵Ã÷½î¸½×ÅÓÚ¹Ç, ÁªÂçÖ«Ìå¸÷¹Ø½Ú, ¹ÇÖ§³Å׎î, ½î¹ÇÏ໥ΪÓÃ, ά³ÖÈËÌåÉúÀí¹¦ÄÜ¡£ËùÒÔ, ½î±ÔÓë¹Ç±ÔµÄ¹ØÏµ±íÏÖΪϥ±Ô²¡ÇéµÄÇáÖØ, ½î±ÔΪÍâаÈëÇÖ¾­½î, ÉÐδ¼°¹Ç, ¶ø¹Ç±Ô±Ø¶¨°éÓнî±Ô, ½î±ÔÖÁ¹Ç±ÔµÄ·¢Õ¹¹ý³ÌÊÇKOA²¡±ä½øÕ¹¹ý³Ì¡£

¡¡¡¡3 KOA¾­½î²¡±äʵÖʵÄÏÖ´úÑо¿

¡¡¡¡KOA¾­½î²¡±äʵÖʵÄÏÖ´úÑо¿Éæ¼°²¡ÔîÃüÃû¼°·Ö²¼¡¢»¼Õß²½Ì¬²îÒ졢ϥ¹Ø½ÚÖÜΧÈí×éÖ¯µÄ±ä»¯¡¢ÉúÎïÁ¦Ñ§¸Ä±ä¡¢Ó°Ïñѧ¸Ä±äµÈ¡£

¡¡¡¡¶ÔKOA»¼ÕßÏ¥¹Ø½ÚÖÜΧ¾­½î³ÊÉ¢ÔÚ·Ö²¼µÄ²¡Ôî, ²ÉÓþ­½î´¥Õï¼ì²é·¨¿ÉÒÔÕÒµ½¡£¶ÔÈ·¶¨µÄ²¡Ôî¹éÈëÏàÓ¦µÄ¾­½î, ¶øºó¿ÉÈ·¶¨ÄÄÌõ¾­½î²úÉú²¡±ä¡£Ï¥¹Ø½ÚÖÜΧ¾­½î²¡±ä³£¼ûÓÚ4Ìõ¾­½î, ·Ö±ðΪ×ãÑôÃ÷¾­½î¡¢×ãÌ«Ñô¾­½î¡¢×ãÉÙÑô¾­½îºÍ×ãÈýÒõ¾­½î, ¿Éµ¥Ìõ¾­½î²¡±ä, Ò²¿É±íÏÖΪ¶àÌõ¾­½î¸´ºÏ²¡±ä¡£

¡¡¡¡¶ÔÑôÐÔ¾­½î²¡ÔîµãµÄÃüÃû²ÎÕÕ¡¶Öйú¾­½îѧ¡·¡£Ñо¿[16,17]±íÃ÷, ×ãÑôÃ÷¾­½î²¡±äµÄ¾­½î²¡Ôî³£¼ûÓں׶¥´Î (15.94%) ¡¢÷ÆÍâÉÏ (69.56%) ¡¢÷ÆÍâ (37.68%) ¡¢÷ÆÍâÏ (55.07%) ¡¢ëÖ¹ÇÍâ÷Á (44.93%) ¡¢÷ÆÄÚÉÏ (15.94%) ¡¢÷ÆÄÚ (14.49%) ¡¢÷ÆÄÚÏ (100%) ¡¢ëÖ¹ÇÄÚ÷Á (100%) ¡¢÷ÆÏ (26.09%) ;×ãÌ«Ñô¾­½î²¡Ôî³£¼ûÓÚºÏÑô´Î (100%) ¡¢ºÏÑôÄÚ (26.67%) ¡¢ºÏÑôÍâ (10%) ¡¢Î¯Ñô´Î (93.33%) ¡¢Î¯ÖдΠ(53.33%) ¡¢Òõ¹È´Î (46.67%) ;×ãÉÙÑô¾­½î²¡Ôî³£¼ûÓÚÁêÏ´Π(7.14%) ¡¢Áêºó´Î (3.57%) ¡¢ÑôÁê´Î (31.11%) ¡¢³É¹Ç´Î (10.71%) ¡¢ëè¹ÇСͷ (14.29%) ¡¢³Éëè¼ä (71.43%) ;×ãÈýÒõ¾­½î²¡Ôî³£¼ûÓÚÒõÁêÉÏ (21.21%) ¡¢Ï¥¹Ø´Î (39.39%) ¡¢ósÏ¥¼ä (48.48%) ¡¢ósós´Î (24.24%) ¡¢Ñªº£´Î (100%) ¡£ÔçÆÚ, KOAÔÝÎÞ¹ÇÖʵĸıä, ½ö±íÏÖΪÌÛÍ´¡¢ËáÈí¡¢½©Ó², ÍùÍù»á³öÏÖ“½î½á”, ͨ¹ý¾­½î´¥Õï·¨¿ÉÒÔÕÒ³öÏ¥²¿¾­½î²¡Ôî, ´Ó¶øÈ·¶¨ÊôÓÚÄÄÌõ¾­½î²¡±ä;ÍíÆÚ, KOA³öÏÖ¹ÇÖʸıä, ÁÙ´²±íÏÖÎªÑØ¾­½îÑ­Ðв¿Î»Ç£³¶Í´, ¿¼ÂÇΪ“½î¹Çʧºâ”µÄ½á¹û, ´Ë½×¶Îͨ¹ýÎÊÕï¼°´¥Õï·¨¿ÉÃ÷È·ÄÄÌõ¾­½î²¡±ä¡£

¡¡¡¡Óɴ˿ɼû, KOA»¼Õß´æÔÚÏ¥¹Ø½ÚÖÜΧ¾­½î²¡±ä, ÔçÆÚ²¡±äÖ÷ÒªÒÔ¾­½î²¡ÔîµÄÐÎʽ³öÏÖ, ¼´µãµÄ±ä»¯;ÍíÆÚ, Ñ­¾­½î·Ïß³öÏÖÇ£³¶Í´, ¼´Ïߵı仯, Õû¸ö²¡±ä¹ý³Ì³ÊÏÖ“Óɵ㼰Ïß”µÄ±ä»¯¡£

¡¡¡¡²»Í¬¾­½îÖ¤ÐÍKOA»¼Õß²½Ì¬´æÔÚ²îÒì¡£²ÉÓÃFootscan7ÐÍ×ãµ×ѹÁ¦²âÁ¿ÏµÍ³¶Ô²»Í¬¾­½îÖ¤ÐÍKOA»¼Õß²½Ì¬½øÐвâÁ¿, ÆÀ¹ÀÖ¸±ê°üÀ¨:²½½Ç¡¢×ã¸ú²¿³åÁ¿¡¢ÐýÄÚÐýÍâ¾ùÖµ¡£²½½ÇÊÇ×ãµÄ³¤ÖáÓëǰ½ø·½ÏòÖ®¼äµÄ¼Ð½Ç, ×ã¸ú²¿³åÁ¿²»Ó¦´óÓÚ×ܳåÁ¿20%, ÐýÄÚÐýÍâ¾ùÖµ»®·ÖΪ×ã¸ú²¿´¥µØ¡¢Ö§³ÅÖÐÆÚºÍÍÆÀëÆÚ¡£ÓëÕý³£Ï¥¹Ø½Ú±È½Ï, KOA»¼Õß×ãÉÙÑô¾­½î²¡±ä²½½ÇºÍ×ã¸ú²¿³åÁ¿´óÓÚÕý³£Öµ, ×ãÑôÃ÷¾­½î²¡±äÖ§³ÅÖÐÆÚÐýÍâ¾ùÖµ´óÓÚÕý³£Öµ, ×ãÉÙÑô¾­½î²¡±äÍÆÀëÆÚÐýÄÚ¾ùÖµ´óÓÚÕý³£Öµ, ×ãÈýÒõ¾­½î²¡±äÍÆÀëÆÚÐýÍâ¾ùÖµ´óÓÚÕý³£Öµ;×ãÑôÃ÷¾­½î²¡±äµØÃæ×î´ó´¹Ö±·´Á¦³öÏÖʱ¼äÏÔ×ÅÍÆ³Ù[18]¡£

¡¡¡¡KOA»¼ÕßÏ¥¹Ø½ÚÖÜΧµÄÈÍ´ø¡¢¼¡Èâ¼°»¬ÄÒµÈ×éÖ¯´æÔÚ²»Í¬³Ì¶ÈµÄ±ä»¯¡£ÓëÕý³£ÈËÏà±È, KOA»¼ÕßÏ¥¹Ø½Ú»¬ÄÒ»ýÒºÔö¿í, ÷ÆëìÈÍ´ø¡¢Ï¥Íâ²à¸±ÈÍ´øÔö¿í;Ñ­×ãÑôÃ÷¾­½îµÄ÷Æëì¡¢¹ÉËÄÍ·¼¡ëì¡¢Íâ²à¸±Ö§³Ö´ø, Ñ­×ãÉÙÑô¾­½îµÄÍâ²à¸±ÈÍ´ø¡¢×ãÌ«Ñô¾­½îµÄ¸úëì¡¢×ãÌ«Òõ¾­½îµÄÄڲัÈÍ´øÒÔ¼°Ñ­×ãÉÙÒõ¾­½îµÄëֹǺó¼¡ëìµÈ³öÏÖ²»Í¬³Ì¶ÈµÄÔöºñ¡£µ¥²àKOA²¡±äµÄ»¼Õß, Æä½¡²à÷Æëì³Ê±âÌõ×´»ò±âÔ²ÐÎ, »¼²à÷ÆëìÔòÎÆÀíÎÉÂÒ, Ö×ÕÍ, ½Ó½üÔ²ÐÎ[17]¡£KOA×ãÌ«Ñô¾­½î²¡±ä»¼Õß³öÏÖÏ¥ºó²àÇ£À­Í´, ÅųýÑü×µ¼äÅÌÍ»³ö²¡Ê·ºó, ¿É¿¼ÂÇÓëÏ¥¹Ø½ÚÖÜΧÈí×éÖ¯²¡±äÓйء£

¡¡¡¡ÄNÎѽǿÉÓÃÓÚÆÀ¹ÀÄNÉþ¼¡ÈáÈÍÐÔ¡£ÄNÎѽÇÔ½´ó, ÄNÉþ¼¡ÈáÈÍÐÔ¾ÍÔ½²î¡£Ñо¿[15]·¢ÏÖ, Õý³£ÈËȺÖÐÄNÎÑ½ÇÆ½¾ùΪ (5.10±1.16) °, ×ãÌ«Ñô¾­½î²¡±äKOA»¼Õ߯½¾ùΪ (5.68±1.20) °, Á½Õß¼ä²îÒì¾ßÓÐͳ¼ÆÑ§ÒâÒå (P<0.05) , ˵Ã÷×ãÌ«Ñô¾­½î²¡±äKOA»¼ÕßÄNÉþ¼¡ÈáÈÍÐÔ½µµÍ, ¿ÉÄÜÊÇÒýÆðÏ¥ºó²àÇ£³¶Í´µÄÒ»¸öÔ­Òò¡£

¡¡¡¡KOA»¼ÕßÓ°Ïñѧ·Ö¼¶ÓëÁÙ´²Ö¢×´ÎÞÃ÷ÏÔµÄÏà¹ØÐÔ, XÏß¼ì²éÖ»Äܲ¿·ÖµØ·´Ó³KOA²¡±äÌØÐÔ¡£Ï¥¹Ø½ÚXÏß¼ì²é½á¹û³£²ÉÓÃKellgren-Lawrence (K-L) ·Ö¼¶ÆÀ¹À:0ÆÚΪÕý³£, 1ÆÚ¹Ø½Ú¼ä϶¿ÉÒÉÏÁÕ­, ¿ÉÄÜÓйÇ׸, ÆäÓà¸÷ÆÚ²¡±äÏ¥¹Ø½Ú¾ùÓÐÏÁÕ­ºÍÃ÷ÏÔ¹Ç׸¡£Ñо¿[17]·¢ÏÖ, KOA»¼ÕßK-L¸÷ÆÚ¾ùÓйÇ׸·¢Éú, ÆäÖÐ, ÷ƹÉÇø³öÏÖ¹Ç׸×î¶à (81.3%) , Ï¥ÄÚ²àÇø´ÎÖ® (80.7%) , Ö®ºóΪϥÖмäÇø (76.7%) , Ï¥Íâ²àÇø (66.7%) ;¹Ø½Ú¼ä϶±ä»¯·¢ÉúÂÊΪ:Ï¥ÄÚ²àÇø (44.0%) , ÷ƹÉÇø (40.0%) , Ï¥Íâ²àÇø (9.3%) ¡£Ï¥¹Ø½Ú¹Ç׸»áÒýÆðÖÜΧÈí×éÖ¯²¡±ä, ÒýÆð¾Ö²¿Ñ×Ö¢, ´Ó¶øÒýÆðÏ¥¹Ø½ÚÖÜΧ¼¡ÈâµÄÂÎËõ¡£¹Ø½Ú¼ä϶ÏÁÕ­, µ¼ÖÂÄÚÍâ²à¸±ÈÍ´øÕÅÁ¦Ê§ºâ¡£ÈôÏ¥ÄÚ·­, ÔòÄڲัÈÍ´øËɳÚ, Íâ²à¸±ÈÍ´øÕÅÁ¦Ôö´ó, ´Ó¶øÒýÆðÍâ²à¸±ÈÍ´ø¸½×ŵ㴦ÌÛÍ´;ÈôÏ¥Íâ·­, ÔòÍâ²à¸±ÈÍ´øËɳÚ, ÄڲัÈÍ´øÕÅÁ¦Ôö´ó, ´Ó¶øÒýÆðÄڲัÈÍ´ø¸½×ŵ㴦ÌÛÍ´¡£

¡¡¡¡¾­½î±æÖ¤ÀíÂÛÖ¸µ¼KOAÖÎÁÆÏÈÓÚK-L·Ö¼¶, ¿ÉÖ¸µ¼Õë¶ÔÔçÆÚKOA»¼ÕßµÄÖÎÁÆ, ÑÓ»ºKOAÍ˱ä, Ìá¸ßÏ¥¹Ø½Ú¹¦ÄÜ¡£ÔÚK-L²¡±ä¸÷¼¶, ¶¼°éÓÐÏ¥¹Ø½ÚÖÜΧÈí×éÖ¯µÄ±ä»¯, ÌÛÍ´¡¢ÂÎËõ¡¢½î½á¼´ÎªÖÜΧ¾­½î²¡±äµÄ±íÏÖ¡£Òò´Ë, ²ÉÓÃK-L·Ö¼¶¶ÔKOA»¼Õß“¹Ç”½øÐÐÆÀ¹ÀµÄͬʱ, Ò²Ó¦ÖØÊÓ²ÉÓþ­½î±æÖ¤¶Ô½îµÄÆÀ¹À¡£¾­½î±æÖ¤ÌåϵÊǶÔXÏß¼ì²éÆÀ¹ÀKOA²¡±äÌØÐԵIJ¹³ä, ¿É·á¸»ÖÐÒ½Ò©µÄ±æÖ¤Ìåϵ¡£

¡¡¡¡4 KOA¾­½î²¡±äÁÆ·¨

¡¡¡¡KOA¾­½î²¡±äµÄÖÎÁÆ·½Ê½ÓжàÖÖ, °üÀ¨°¬¾Ä¡¢µãѨ¡¢¾­½î´Ì·¨¡¢¾­½îÊÖ·¨¡¢¾­½îÌù·óÁÆ·¨¡¢¾­½î΢´´ÁÆ·¨µÈ¡£

¡¡¡¡°¬¾ÄÁÆ·¨[19]²ÉÓûØÐý¾Ä»òȸ׾ķ½Ê½, ѡȡѨλ°üÀ¨÷ÆÏ¡¢÷ÆÍâ¡¢÷ÆÄÚÏ¡¢³Ðɽ´Î¡¢³ÐɽÍ⡢ίÑô´Î¡¢ósós´Î¡¢ëè¹ÇСͷ¡¢ëÖ¹ÇÄÚ÷Á¡¢Ï¥¹Ø´ÎµÈ¡£°¬ÌõÀëÆ¤Ôµ3¡«5 cm, ÓÉÉÏÏòÏÂ, ÏÈ×óºóÓÒÊ©¾Ä, ÿѨʩ¾Äʱ¼äΪ10¡«15 min, ÿÌì1´Î, 5 dΪ1¸öÁƳÌ, ¹²ÖÎÁÆ4¸öÁƳ̡£4¸öÁƳ̺ó, Ñ­¾­½î°¢ÊÇѨÖÎÁÆ»¼ÕßµÄ×ÜÓÐЧÂʿɴï96.7%¡£Æä×÷ÓûúÖÆ¿ÉÄÜΪµ÷½ÚÆÆ¹Çϸ°û·Ö»¯Òò×Ó (RANKL) ¼°ÆÆ¹Çϸ°û·Ö»¯ÒÖÖÆÒò×Ó (OPG) µÄ±í´ï, ½µµÍ¾Ö²¿Ñ×Ö¢·´Ó¦, ´Ó¶øÆðµ½ÕòÍ´µÄ×÷ÓÃ[20]¡£

¡¡¡¡µãѨ¾­½îÁÆ·¨[21,22]°üÀ¨7¸ö²½Öè, ·Ö±ðΪ:Êæ½î¡¢Í¨Â硢ֹʹ¡¢Ëɽ⡢ÎüË®¡¢Ç£À­ºÏ·ì¡¢ÔÙ´ÎÊæ½î¡£Êæ½îÖ÷Òª²ÉÓ÷¨¡¢Èà·¨¡¢Ä÷¨µÈÊÖ·¨Ëɽâ¾Ö²¿¾·Âεî;ͨÂçʱ²ÉÓõ㷨¡¢°´·¨µÈÊÖ·¨¶ÔÏ¥¹Ø½ÚÖÜΧµÄѨλ (ÈçÁºÇð¡¢Ñªº£µÈ) ½øÐд̼¤ÒÔͨ¾­»îÂç;ֹʹ²½Öè²ÉÓ÷ֽÀí½îÊÖ·¨¶Ô½î½á½øÐзÖÀëÒÔ´ïµ½½â½îֹʹ֮¹¦Ð§;ËɽâʱÖ÷Ҫͨ¹ýÇüÉìÏ¥¹Ø½ÚÒÔËɽâð¤Á¬×éÖ¯;ÎüË®²½Öè¼´²ÉÓÃÄóÄ÷¨´Ù½øÏ¥¹Ø½Ú»ýÒºµÄÎüÊÕ;Ç£À­ºÏ·ì¿Éµ÷ÕûÏ¥²¿½î¹Çʧºâ״̬;ÔÙ´ÎÊæ½îʱ²ÉÓÃÈà·¨¡¢Ä÷¨¡¢¿Û·¨·ÅËÉÏ¥²¿ÖÜΧÈí×éÖ¯¡£µãѨ¾­½îÁÆ·¨Äܹ»Ôö¼Ó¹Ø½ÚÈí¹Çºñ¶È, ½µµÍKOAÑÏÖØÐÔÖ¸Êý[21], ´Ù½ø¹Ø½ÚÇ»»ýÒºµÄÎüÊÕ[22]¡£

¡¡¡¡¾­½î´Ì·¨[23,24,25,26,27,28]²ÉÓúÁÕë¶ÔÏ¥¹Ø½ÚÖÜΧ¾­½î²¡Ôî½î½á²¿Î»Õë´Ì, ²¢ÔÚ¾­½îÑ­ÐзÏß²¡ÔîµãÉÏϸ÷´ÌÒ»Õë»ò½øÐÐÅÅ´Ì, Ê©ÓÚÄíתµÈƽ²¹Æ½ÐºÊÖ·¨, ÒÔ¾Ö²¿³öÏÖËá¡¢Âé¡¢ÕÍ¡¢Í´¸ÐΪÒË, ¿ÉͬʱÅäºÏ»òÕß²»ÅäºÏ°¬¾Ä¡¢µçÕë¡¢ÖÐÒ©µÈÖÎÁÆ¡£È¡Ñ¨²¿Î»²ÎÕÕѦÁ¢¹¦¡¶ÖÐÒ½¾­½îѧ¡·, ѡȡëÖ¹ÇÄÚ÷Á¡¢ëÖ¹ÇÍâ÷Á¡¢º×¶¥´Î¡¢÷ÆÏ»ò°¢ÊÇѨµÈѨλ¡£ÖÎÁÆ6´ÎΪ1¸öÁƳÌ, ÿÌì1´Î, Á¬ÐøÖÎÁÆ3¸öÁƳ̡£Ñо¿·¢ÏÖ, ¾­½î´Ì·¨ÖÎÁÆKOAÄܹ»½µµÍÌÛÍ´ÊÓ¾õÄ£ÄâÁ¿±í (VAS) ÆÀ·Ö¡¢Ï¥¹Ø½Ú¹¦ÄÜÆÀ·ÖºÍÎ÷°²´óÂÔºÍÂó¿ËÂíË¹ÌØ´óѧ¹ÇÐԹؽÚÑ×Ö¸Êý (WOMAC) ÆÀ·Ö, ÖÎÁÆ×ÜÓÐЧÂʿɴï90%ÒÔÉÏ[25]¡£

¡¡¡¡¾­½îÊÖ·¨ÖÎÁÆÖ÷Òª·ÖΪ2¸ö²½Öè¡£µÚÒ»²½ÊáÀí¾­½î, ÑØ¾­½îÑ­Ðз½Ïò²ÉÓð´¡¢Èà¡¢µã¡¢µ¯¡¢²¦µÈÊÖ·¨ÓÉÖ«ÌåÔ¶¶ËÏò½ü¶Ë¶ÔÏ¥¹Ø½ÚÖÜΧÈí×éÖ¯½øÐÐËɽâ, ËɽâµÄ·¶Î§ÎªÐ¡ÍÈÖв¿ÖÁ´óÍÈÖв¿¡£µÚ¶þ²¿ÎªËɽâ½î½áµã, ²ÉÓþ­½î´¥Õï·¨ÕÒ³öÏ¥¹Ø½ÚÖÜΧ½î½á²¡Ôîµã, Ö÷ÒªËɽâºÏÑô´Î¡¢ºÏÑô¡¢ºÏÑôÍ⡢ίÑô´Î¡¢Î¯ÖдΡ¢Òõ¹È´ÎµÈ²¡Ôîµã¡£ËɽâʱÊÖ·¨Ó¦´ÓÈݺͻº¡¢ÈáºÍÓÐÁ¦¡£Ã¿´Î²Ù×÷20 min¡£Ñо¿·¢ÏÖ, ¾­½îÊÖ·¨ÖÎÁÆKOA×ãÌ«Ñô¾­½î²¡±äÄܹ»½µµÍWOMACÆÀ·Ö, ¸ÄÉÆÌÛÍ´Ö¢×´, ÓÐЧÂÊ´ï90%ÒÔÉÏ[29]¡£

¡¡¡¡¾­½îÌù·óÁÆ·¨ÊDzÉÓðͲ¼¼ÁÑØ¾­½îÑ­Ðв¿Î»»òÕ߹ؽÚ×îÍ´´¦Ìù·ó, ÿÈÕ1Ìû, ÿÌû¿ÉʹÓÃ24 h, ¸ù¾ÝƤ·ôÇé¿ö×ÔÐе÷ÕûÌù·óʱ¼ä, 6 dΪ1¸öÁƳ̡£²¢ÇÒ, Ò²¿ÉÑØ¾­½î´«±ä²¿Î»Ìù·ó, ¾ßÓзÀÖ¹¾­½î´«±äµÄ×÷Ó᣾­½îÌù·óÁÆ·¨¿ÉÒÔÕë¶Ô²»Í¬Ö¤ÐÍKOA»¼Õß½øÐÐÖÎÁÆ, Èç·çº®Êª±ÔÐÍKOA¿ÉÑ¡ÓÃÒ©Îï³É·ÖΪÎÂÐԵİͲ¼¼Á, ·çʪÈȱÔÐÍKOAÑ¡ÓÃÁ¹ÐԵİͲ¼¼Á¡£Ñо¿·¢ÏÖ, ¾­½îÌù·óÁÆ·¨ÖÎÁÆKOA¿ÉÒÔ½µµÍÌÛÍ´VASÆÀ·ÖºÍWOMACÆÀ·Ö, ÓÐЧÂʿɴï85%ÒÔÉÏ[30,31]¡£

¡¡¡¡¾­½î΢´´ÁÆ·¨[32]Ö÷Òª²ÉÓÃÕëµ¶¾µºÍ¾­½îµ¶ÖÎÁÆKOA¡£Ê×ÏȲÉÓÃÑÎËáÀû¶à¿¨Òò×¢ÉäÒºÔÚÏ¥¹Ø½ÚÖÜΧ¾Ö²¿½þÈóÂé×í, ȡǰÍâ²àÈë·ÖÃÈëÕëµ¶¾µ, ̽²é÷ÆÉÏÄÒ¡¢÷ƹɹؽڼä϶ºó, ÓÉÏ¥¹Ø½ÚÄÚ²à¼ä϶ÏòÍâ²à¼ä϶Öð²½Ì½²é¹Ø½ÚÇ», Èô·¢ÏÖð¤Á¬×éÖ¯Ëæ¼´¶ÔÖ®Ëɽâ, ·´¸´³åÏ´¹Ø½ÚÇ», Ö±ÖÁ¹Ø½ÚÇ»ÄÚ³åÏ´ÒºÃ÷ÁÁ¡£Õëµ¶¾µÊõºóµÚ3¡¢6Ìì²ÉÓþ­½îµ¶ÖÎÁÆ:²ÉÓþ­½î´¥Õï·¨ÞѼ°ÌõË÷×´»ò½á½Ú×´½î½á²¿Î», ¼×±½°·À¶±ê¼ÇºóÎÞ¾úÌõ¼þϲÉÓþ­½îµ¶¶Ô½î½á²¡Ôîµã½øÐÐËɽâ, ¾­½îµ¶Ó¦Éî´ï¹ÇÃæ, ×ÝÏò¡¢ºáÏò°þÀ뼡½îĤ¡£¾­½îµ¶´ÌÈëÆ¤·ôʱעÒâÓëѪ¹Ü¡¢Éñ¾­¼°¼¡ÏËά·½Ïò±£³ÖÒ»ÖÂ, ²Ù×÷Íê³ÉºóÓÃÃÞÇòѹÆÈֹѪ, ÎÞ¾ú·óÁϰüÔú¡£Ñо¿·¢ÏÖ, ²ÉÓþ­½î΢´´ÁÆ·¨ÖÎÁÆKOA¾­½î²¡±äÄܹ»»º½â¹Ø½ÚÌÛÍ´ºÍ½©Ó², ¸ÄÉÆ»î¶¯¹¦Äܼ°½µµÍWOMACÆÀ·Ö[32]¡£

¡¡¡¡ÁíÍâ, Ò²ÓÐÁ¢×ã¾­½î²¡±ä²ÉÓÿڷþ²¹Éö»îѪÖÐÒ©ÖÎÁÆKOAµÄÁÙ´²Ñо¿¡£Ñо¿½á¹ûÏÔʾ, ²¹Éö»îѪÖÐÒ©ÄÜÓÐЧ¸ÄÉÆ»¼ÕßµÄÁÙ´²Ö¢×´ºÍÏ¥¹Ø½Ú¹¦ÄÜ[33]¡£

¡¡¡¡×ÛÉÏ, Óþ­½î±æÖ¤Ìåϵָµ¼KOAÖÎÁÆ¿ÉÈ¡µÃÁ¼ºÃÁÙ´²ÁÆÐ§, ÆäÖÎÁÆ·½Ê½Ò²½Ï¶à¡£½ñºóKOAµÄÁÙ´²ÖÎÁÆÓ¦×¢Òâ¶àÖÖ·½Ê½ÁªºÏÔËÓÃ, ×ÛºÏÖÎÁÆ, ÒÔÌá¸ßKOAµÄÁÆÐ§¡£

¡¡¡¡²Î¿¼ÎÄÏ×£º

¡¡¡¡[1]ÁõÄ˸Õ, ¹ù³¤Çà.¾­½îʵÖʲûÊÍ[J].½­ËÕÖÐÒ½Ò©, 2010, 42 (8) :7.
¡¡¡¡[2]Îâ½ðÅô.ÖÐÒ½“¾­½î”¼°“Ĥԭ”ʵÖʵĽîĤÀíÂÛ̽ÌÖ[J].±±¾©ÖÐÒ½, 2007, 26 (5) :283.
¡¡¡¡[3] Sharma L, Dunlop D, Cahue S, et al. Quadriceps strength and osteoarthritis progression in malaligned and lax knees[J]. Ann Intern Med, 2003, 138 (8) :613.
¡¡¡¡[4] Anan M, Shinkoda K, Suzuki K, et al. Dynamic frequency analyses of lower extremity muscles during sit-to-stand motion for the patients with knee osteoarthritis[J]. PLoS One, 2016, 11 (1) :e147496.
¡¡¡¡[5] Mchugh M P, Tyler T F, Nicholas S J, et al. Electromyographic analysis of quadriceps fatigue after anterior cruciate ligament reconstruction[J]. J Orthop Sports Phys Ther, 2001, 31 (1) :25.
¡¡¡¡[6] Okada Y. Histochemical study on the atrophy of the quadriceps femoris muscle caused by knee joint injuries of rats[J]. Hiroshima J Med Sci, 1989, 38 (1) :13.
¡¡¡¡[7] Henneman E, Somjen G, Carpenter D O. Functional significance of cell size in spinal motoneurons[J]. J Neurophysiol, 1965, 28:560.
¡¡¡¡[8] Johnson M A, Polgar J, Weightman D, et al. Data on the distribution of fibre types in thirty-six human muscles:An autopsy study[J]. J Neurol Sci, 1973, 18 (1) :111.
¡¡¡¡[9] Lutz G E, Palmitier R A, An K N, et al. Comparison of tibiofemoral joint forces during open-kinetic-chain and closedkinetic-chain exercises[J]. J Bone Joint Surg Am, 1993, 75 (5) :732.
¡¡¡¡[10] Piva S R, Goodnite E A, Childs J D. Strength around the hip and flexibility of soft tissues in individuals with and without patellofemoral pain syndrome[J]. J Orthop Sports Phys Ther, 2005, 35 (12) :793.
¡¡¡¡[11]»ÆÐñ¶«, º«ÇåÃñ.»ùÓÚ¾­½î±æÖ¤¶ÔÏ¥¹Ç¹Ø½ÚÑ×·¢²¡ÖÐÏ¥ºó²àÇ£À­Í´ÁÙ´²Ñо¿[J].ÐÂÖÐÒ½, 2016, 48 (8) :135.
¡¡¡¡[12] Forestier R, Francon A, Briole V, et al. Prevalence of generalized osteoarthritis in a population with knee osteoarthritis[J]. Joint Bone Spine, 2011, 78 (3) :275.
¡¡¡¡[13]»ÆÐñ¶«, º«ÇåÃñ.Ï¥¹Ç¹Ø½ÚÑ××ãÌ«Ñô¾­½îÖ¤ÄNÉþ¼¡ÈáÈÍÐÔµÄÁÙ´²¶ÔÕÕÑо¿[J].¹ãÖÝÖÐÒ½Ò©´óѧѧ±¨, 2016, 33 (4) :502.
¡¡¡¡[14]ÕÅÒàÍ¢, ÁõÅ©ÓÝ.¾­½îÕë·¨ÖÎÁÆÏ¥¹ÇÐԹؽÚÑ×µÄÎÄÏ×Ñо¿[J].ÖйúÕë¾Ä, 2015, 35 (S1) :102.
¡¡¡¡[15]Íõ³£º£, ÀõÑå·¼, Àî·å, µÈ.Ï¥¹ÇÐԹؽÚÑ×¾­½îÖ¤ÐÍ·Ö²¼¹æÂÉÑо¿¼°ÆäÉúÎïÁ¦Ñ§»úÀí·ÖÎö[J].ÖлªÖÐҽҩѧ¿¯, 2010, 28 (5) :970.
¡¡¡¡[16]¶­±¦Ç¿, ÕÅÎľ², Ðì¼ÑÑç, µÈ.Ï¥¹ÇÐԹؽÚÑ׳¬Éù¾­½î¶¨Î»Ñо¿[J].ÖлªÖÐÒ½Ò©ÔÓÖ¾, 2014, 29 (10) :3319.
¡¡¡¡[17]ÍõÔ¾»Ô, º«ÇåÃñ, Áõºé½­, µÈ.Ï¥¹ÇÐԹؽÚÑ×Ó°Ïñѧ·ÖÎöÓë¾­½î±æÖ¤¹ØÏµÑо¿[J].ÐÂÖÐÒ½, 2008, 40 (5) :66.
¡¡¡¡[18]Íõ³£º£, Àî·å, ÕÅÈØ, µÈ.²½Ì¬·ÖÎö¼¼ÊõÔÚÏ¥¹ÇÐԹؽÚÑ×¾­½î±æÖ¤ÖеÄÓ¦ÓÃÑо¿[J].ÖйúÕë¾Ä, 2010, 30 (3) :183.
¡¡¡¡[19]ÕÔæ©æ©, Àî´ºÈÕ, ¶­±¦Ç¿.°¬¾ÄÑ­¾­½î°¢ÊÇѨÖÎÁÆÏ¥¹Ç¹Ø½ÚÑ×ÁÆÐ§ÆÀ¼Û[J].ɽ¶«ÖÐÒ½ÔÓÖ¾, 2012, 31 (1) :40.
¡¡¡¡[20]¶­±¦Ç¿, ÕÅÊé½£, Àî´ºÈÕ, µÈ.°¬¾ÄÑ­¾­½î°¢ÊÇѨ¶ÔÏ¥¹Ç¹Ø½ÚÑ×RANKLºÍOPGµ÷¿Ø»úÖÆÑо¿[J].ÁÉÄþÖÐÒ½Ò©´óѧѧ±¨, 2013, 15 (10) :5.
¡¡¡¡[21]ÂÀÑÇÄÏ, ÀîÈÙ×£, ÍõСÑà, µÈ.µãѨ¾­½îÁÆ·¨¶ÔÏ¥¹Ç¹Ø½ÚÑ×Èí¹ÇËðÉËÐÞ¸´×÷ÓõÄÑо¿[J].¹ãÎ÷ҽѧ, 2014, 36 (3) :297.
¡¡¡¡[22]ÂÀÑÇÄÏ, ÀîÈÙ×£, ÍõСÑà, µÈ.µãѨ¾­½îÁÆ·¨¶ÔÏ¥¹Ç¹Ø½ÚÑ׹ؽڻýÒº×÷ÓõÄÁÙ´²Ñо¿[J].ÖйúÁÙ´²ÐÂҽѧ, 2014, 7 (4) :299.
¡¡¡¡[23]Ô¬Áâ÷, ÀîÑÞÃ÷, ÀîÏ£.¾­½î´Ì·¨½áºÏÎÂÕë¾ÄÖÎÁÆÏ¥¹Ø½Ú¹ÇÐԹؽÚÑ×32Àý[J].Õë¾ÄÁÙ´²ÔÓÖ¾, 2016, 32 (1) :44.
¡¡¡¡[24]ÕÔº£·á, ÕÅÜÔÀò, ¶­±¦Ç¿, µÈ.Ñ­¾­½î°¢ÊÇѨÅÅ´Ì·¨ÖÎÁÆÏ¥¹Ç¹Ø½ÚÑ×µÄÁÆÐ§¹Û²ì[J].º½¿Õº½ÌìҽѧÔÓÖ¾, 2016, 27 (1) :126.
¡¡¡¡[25]ÁõÁ¢»á, ¶­±¦Ç¿, ÍõÊ÷¶«.Õë´ÌÑ­¾­½î°¢ÊÇѨÅäºÏÖÐÒ©ÖÎÁÆÏ¥¹ÇÐԹؽÚÑ×ÁÆÐ§¹Û²ì[J].ÁÉÄþÖÐÒ½Ò©´óѧѧ±¨, 2016, 18 (3) :57.
¡¡¡¡[26]ïúÕ÷ºè, ÌÆÁáÁá, ÂÀÐãÓñ.¾­½îÕë´Ì·¨½áºÏÖÐÒ©Íâ·óÖÎÁÆÏ¥±Ô[J].ÖйúÖÐÒ½Ò©ÏÖ´úÔ¶³Ì½ÌÓý, 2015, 13 (5) :65.
¡¡¡¡[27]ÁõÃô, ½Åô, ºúÓׯ½.Õë´Ì½á½î²¡ÔîµãÖÎÁÆÏ¥¹Ø½Ú¹ÇÐԹؽÚÑ×µÄÁÙ´²Ëæ»ú¶ÔÕÕÊÔÑé[J].Õë¾ÄÁÙ´²ÔÓÖ¾, 2015, 31 (10) :23.
¡¡¡¡[28]¹ËÇà.¾­½î´Ì·¨ÖÎÁÆÏ¥¹Ç¹Ø½ÚÑ×87ÀýÁÙ´²¹Û²ìÌå»á[J].Öйú³õ¼¶ÎÀÉú±£½¡, 2014, 28 (1) :123.
¡¡¡¡[29]·ëѧ·é, ×ÞΰÃñ, ³ÂÓÀÉØ.¾­½îÊÖ·¨ÖÎÁÆÌ«Ñô¾­½îÐÍÏ¥¹Ç¹Ø½ÚÑ×ÁÙ´²¹Û²ì[J].ÐÂÖÐÒ½, 2015, 47 (1) :206.
¡¡¡¡[30]Î⿵Óô, ÖìȺæ·, »ÆÎ°±ó, µÈ.ÎÂÐÔ¾­½îͨÌù¸àÖÎÁƹؽÚÑ×µÄÁÙ´²¹Û²ì[J].ÖÐÒ©²Ä, 2015, 38 (6) :1331.
¡¡¡¡[31]Ò×Ö¾ÓÂ, º«ÇåÃñ, »ÆÐñ¶«.¾­½îÌù·óÁÆ·¨ÖÎÁÆÏ¥¹Ç¹Ø½ÚÑ×ÁÆÐ§¹Û²ì[J].ÉÂÎ÷ÖÐÒ½, 2014, 35 (8) :1067.
¡¡¡¡[32]ºî´º¸£, ΤáÔ, ³ÂÖ¾»Í, µÈ.¾­½î΢´´ÁÆ·¨ÁªºÏÒ©ÎïÖÎÁÆÏ¥¹ÇÐԹؽÚÑ×60ÀýÁÙ´²¹Û²ì[J].ÖйúÖÐÎ÷Ò½½áºÏÔÓÖ¾, 2015, 35 (6) :678.
¡¡¡¡[33]ÔøÒâÈÙ, ·®ÔÁ¹â, ÁõÉÙ¾ü, µÈ.²¹Éö»îѪÖÐÒ©ÖÎÁÆÉöÐéѪðöÐÍÏ¥¹ÇÐԹؽÚÑ×µÄÁÙ´²Ñо¿[J].¹ãÖÝÖÐÒ½Ò©´óѧѧ±¨, 2007, 24 (4) :276.

×÷Õßµ¥Î»£º¹ãÖÝÖÐÒ½Ò©´óѧµÚÈý¸½ÊôÒ½Ôº¹Ç¿Æ ¹ãÖÝÖÐÒ½Ò©´óѧ ¸ÊËàÊ¡ÎäÍþÖ×ÁöÒ½Ôº ¹ãÖÝÖÐÒ½Ò©´óѧµÚÒ»¸½ÊôÒ½Ôº
Ô­Îijö´¦£ºº«ÇåÃñ,ÕÅî¸è¤,¹ù˹ӡ,»ÆÐñ¶«,Ò×Ö¾ÓÂ,ËÕ°²Æ½,»ôÉÙ´¨.Ï¥¹Ç¹Ø½ÚÑ×¾­½î±æÖ¤Ñо¿½øÕ¹[J].¹ãÖÝÖÐÒ½Ò©´óѧѧ±¨,2019,36(03):447-452.
Ïà¹ØÄÚÈÝÍÆ¼ö
Ïà¹Ø±êÇ©£º
·µ»Ø£º¹ÇÉË¿ÆÂÛÎÄ