膝骨关节炎患者的关节稳定性研究进展_West China Medical Journal

Authors：

陈瑶 , 黄凤兰 ,  马锦富

四川大学华西第四医院骨质疏松科（成都 610041）;

Corresponding author：

马锦富, Email: hxsymajingfu@126.com

Keywords：

膝骨关节炎; 关节稳定性; 本体感觉

DOI：

10.7507/1002-0179.201602068

Video：

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骨关节炎是慢性积累性劳损所致的以关节软骨退变及继发骨质增生、骨质疏松为主要表现的疾病。好发于负重关节，以髋、膝关节多见，主要表现为退行性变。膝骨关节炎（knee osteoarthritis，KOA）好发于中老年，病理变化主要为关节软骨及软骨下骨的软化，继发关节囊、关节韧带、周围肌群的松弛退变，临床症状以关节疼痛、关节功能障碍及关节稳定性下降为主。其中关节稳定性的下降是膝骨关节炎患者跌倒损伤及进一步导致残疾、残障的主要因素，也是目前骨科医师及康复科医师关注的重点。过去认为膝关节稳定性的维持依赖于关节周围组织的机械性稳定装置的作用，近年来学者们开始逐渐认识到广泛分布于关节内部的本体感受器在关节运动中维持膝关节稳定性的作用。本体感受器的分布、作用的传导机制及临床恢复得到了越来越多的重视，该文对 KOA 患者的关节机械性稳定装置及关节内本体感受器作用的研究进展进行了综述。

Citation： 陈瑶, 黄凤兰, 马锦富. 膝骨关节炎患者的关节稳定性研究进展. West China Medical Journal, 2017, 32(7): 1097-1099. doi: 10.7507/1002-0179.201602068 Copy

1.	Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med, 2010, 26(3): 355-369.
2.	Murphy L, Schwartz TA, Helmick CG, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum, 2008, 59(9): 1207-1213.
3.	Van Baar M, Assendelft WJ, Dekker J, et al. Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials. Arthritis Rheum, 1999, 42(7): 1361-1369.
4.	Fitzgerald GK, Piva SR, Irrgang JJ. Reports of joint instability in knee osteoarthritis: its prevalence and relationship to physical function. Arthritis Rheum, 2004, 51(6): 941-946.
5.	Meister BR, Michael SP, Moyer RA, et al. Anatomy and kinematics of the lateral collateral ligament of the knee. Am J Sports Med, 2000, 28(6): 869-878.
6.	Martelli S, Pinskerova V. The shapes of the tibial and femoral articular surfaces in relation to tibiofemoral movement. J Bone Joint Surg Br, 2002, 84(4): 607-613.
7.	Makris EA, Hadidi P, Athanasiou KA. The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials, 2011, 32(30): 7411-7431.
8.	Recondo JA, Salvador E, Villanúa JA, et al. Lateral stabilizing structures of the knee: functional anatomy and injuries assessed with Mr imaging. Radiographics, 2000, 20(4): S91-S102.
9.	Coggeshall RE, Hong KA, Langford LA, et al. Discharge characteristics of fine medial articular afferents at rest and during passive movements of inflamed knee joints. Brain Res, 1983, 272(1): 185-188.
10.	Hromada J, Polacek P. A contribution to the morphology of encapsulated nerve endings in the joint capsule and in the periarticular tissue. Acta Anat (Basel), 1958, 33(3): 187-202.
11.	Grigg P, Hoffman AH. Properties of ruffini afferents revealed by stress analysis of isolated sections of cat knee capsule. J Neurophysiol, 1982, 47(1): 41-54.
12.	Halata Z, Rettig T, Schulze W. The ultrastructure of sensory nerve endings in the human knee joint capsule. Anat Embryol (Berl), 1985, 172(3): 265-275.
13.	Matthews BH. Nerve endings in mammalian muscle. J Physiology, 1933, 78(1): 1-53.
14.	Barnett CH, Harding D. The activity of antagonist muscles during voluntary movement. Ann Phys Med, 1955, 2(8): 290-293.
15.	Solomonow M, Krogsgaard M. Sensorimotor control of knee stability. A review. Scand J Med Sci Sports, 2001, 11(2): 64-80.
16.	Hurley MV, Scott DL, Rees J, et al. Sensorimotor changes and functional performance in patients with knee osteoarthritis. Ann Rheum Dis, 1997, 56(11): 641-648.
17.	Hurley MV, Newham DJ. The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early, unilateral osteoarthritic knees. Br J Rheumatol, 1993, 32(2): 127-131.
18.	Hassan BS, Mockett S, Doherty M. Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects. Ann Rheum Dis, 2001, 60(6): 612-618.
19.	Hurley MV. The role of muscle weakness in the pathogenesis of osteoarthritis. Rheum Dis Clin North Am, 1999, 25(2): 283-298.
20.	Mikesky AE, Meyer A, Thompson KL. Relationship between quadriceps strength and rate of loading during gait in women. J Orthop Res, 2000, 18(2): 171-175.
21.	Hurkmans EJ, van der Esch M, Ostelo RW, et al. Reproducibility of the measurement of knee joint proprioception in patients with osteoarthritis of the knee. Arthritis Rheum, 2007, 57(8): 1398-1403.
22.	Roos EM, Herzog W, Block JA, et al. Muscle weakness, afferent sensory dysfunction and exercise in knee osteoarthritis. Nat Rev Rheumatol, 2011, 7(1): 57-63.
23.	Barrett DS, Cobb AG, Bentley G. Joint proprioception in normal, osteoarthritic and replaced knees. J Bone Joint Surg Br, 1991, 73(1): 53-56.
24.	Marks R, Quinney HA, Wessel J. Proprioceptive sensibility in women with normal and osteoarthritic knee joints. Clin Rheumatol, 1993, 12(2): 170-175.
25.	Steultjens MP, Dekker J, van Baar ME, et al. Muscle strength, pain and disability in patients with osteoarthritis. Clin Rehabil, 2001, 15(3): 331-341.
26.	Helmick CG, Felson DT, Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum, 2008, 58(1): 15-25.
27.	Dekker J, Van Dijk GM, Veenhof C. Risk factors for functional decline in osteoarthritis of the hip or knee. Curr Opin Rheumatol, 2009, 21(5): 520-524.
28.	van der Esch M, Steultjens M, Harlaar J, et al. Joint proprioception, muscle strength, and functional ability in patients with osteoarthritis of the knee. Arthritis Rheum, 2007, 57(5): 787-793.
29.	Brandt KD, Heilman DK, Slemenda C, et al. A comparison of lower extremity muscle strength, obesity, and depression scores in elderly subjects with knee pain with and without radiographic evidence of knee osteoarthritis. J Rheumatol, 2000, 27(8): 1937-1946.
30.	Hurley MV. Muscle dysfunction and effective rehabilitation of knee osteoarthritis: what we know and what we need to find out. Arthritis Rheum, 2003, 49(3): 444-452.

1. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med, 2010, 26(3): 355-369.
2. Murphy L, Schwartz TA, Helmick CG, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum, 2008, 59(9): 1207-1213.
3. Van Baar M, Assendelft WJ, Dekker J, et al. Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials. Arthritis Rheum, 1999, 42(7): 1361-1369.
4. Fitzgerald GK, Piva SR, Irrgang JJ. Reports of joint instability in knee osteoarthritis: its prevalence and relationship to physical function. Arthritis Rheum, 2004, 51(6): 941-946.
5. Meister BR, Michael SP, Moyer RA, et al. Anatomy and kinematics of the lateral collateral ligament of the knee. Am J Sports Med, 2000, 28(6): 869-878.
6. Martelli S, Pinskerova V. The shapes of the tibial and femoral articular surfaces in relation to tibiofemoral movement. J Bone Joint Surg Br, 2002, 84(4): 607-613.
7. Makris EA, Hadidi P, Athanasiou KA. The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials, 2011, 32(30): 7411-7431.
8. Recondo JA, Salvador E, Villanúa JA, et al. Lateral stabilizing structures of the knee: functional anatomy and injuries assessed with Mr imaging. Radiographics, 2000, 20(4): S91-S102.
9. Coggeshall RE, Hong KA, Langford LA, et al. Discharge characteristics of fine medial articular afferents at rest and during passive movements of inflamed knee joints. Brain Res, 1983, 272(1): 185-188.
10. Hromada J, Polacek P. A contribution to the morphology of encapsulated nerve endings in the joint capsule and in the periarticular tissue. Acta Anat (Basel), 1958, 33(3): 187-202.
11. Grigg P, Hoffman AH. Properties of ruffini afferents revealed by stress analysis of isolated sections of cat knee capsule. J Neurophysiol, 1982, 47(1): 41-54.
12. Halata Z, Rettig T, Schulze W. The ultrastructure of sensory nerve endings in the human knee joint capsule. Anat Embryol (Berl), 1985, 172(3): 265-275.
13. Matthews BH. Nerve endings in mammalian muscle. J Physiology, 1933, 78(1): 1-53.
14. Barnett CH, Harding D. The activity of antagonist muscles during voluntary movement. Ann Phys Med, 1955, 2(8): 290-293.
15. Solomonow M, Krogsgaard M. Sensorimotor control of knee stability. A review. Scand J Med Sci Sports, 2001, 11(2): 64-80.
16. Hurley MV, Scott DL, Rees J, et al. Sensorimotor changes and functional performance in patients with knee osteoarthritis. Ann Rheum Dis, 1997, 56(11): 641-648.
17. Hurley MV, Newham DJ. The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early, unilateral osteoarthritic knees. Br J Rheumatol, 1993, 32(2): 127-131.
18. Hassan BS, Mockett S, Doherty M. Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects. Ann Rheum Dis, 2001, 60(6): 612-618.
19. Hurley MV. The role of muscle weakness in the pathogenesis of osteoarthritis. Rheum Dis Clin North Am, 1999, 25(2): 283-298.
20. Mikesky AE, Meyer A, Thompson KL. Relationship between quadriceps strength and rate of loading during gait in women. J Orthop Res, 2000, 18(2): 171-175.
21. Hurkmans EJ, van der Esch M, Ostelo RW, et al. Reproducibility of the measurement of knee joint proprioception in patients with osteoarthritis of the knee. Arthritis Rheum, 2007, 57(8): 1398-1403.
22. Roos EM, Herzog W, Block JA, et al. Muscle weakness, afferent sensory dysfunction and exercise in knee osteoarthritis. Nat Rev Rheumatol, 2011, 7(1): 57-63.
23. Barrett DS, Cobb AG, Bentley G. Joint proprioception in normal, osteoarthritic and replaced knees. J Bone Joint Surg Br, 1991, 73(1): 53-56.
24. Marks R, Quinney HA, Wessel J. Proprioceptive sensibility in women with normal and osteoarthritic knee joints. Clin Rheumatol, 1993, 12(2): 170-175.
25. Steultjens MP, Dekker J, van Baar ME, et al. Muscle strength, pain and disability in patients with osteoarthritis. Clin Rehabil, 2001, 15(3): 331-341.
26. Helmick CG, Felson DT, Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum, 2008, 58(1): 15-25.
27. Dekker J, Van Dijk GM, Veenhof C. Risk factors for functional decline in osteoarthritis of the hip or knee. Curr Opin Rheumatol, 2009, 21(5): 520-524.
28. van der Esch M, Steultjens M, Harlaar J, et al. Joint proprioception, muscle strength, and functional ability in patients with osteoarthritis of the knee. Arthritis Rheum, 2007, 57(5): 787-793.
29. Brandt KD, Heilman DK, Slemenda C, et al. A comparison of lower extremity muscle strength, obesity, and depression scores in elderly subjects with knee pain with and without radiographic evidence of knee osteoarthritis. J Rheumatol, 2000, 27(8): 1937-1946.
30. Hurley MV. Muscle dysfunction and effective rehabilitation of knee osteoarthritis: what we know and what we need to find out. Arthritis Rheum, 2003, 49(3): 444-452.

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膝骨关节炎患者的关节稳定性研究进展

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