不均匀沉降理论与膝骨关节炎筋骨失衡的关系
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摘要
膝骨关节炎病在筋骨,病位在肝肾,以肝肾亏虚、筋骨失养为根本病理变化,以筋骨失衡引起膝关节内侧间隙变窄与内翻畸形为常见临床表现,为膝骨关节炎病理过程中发生不均匀沉降提供了有力的佐证。膝骨关节炎是在正常内翻基础上发生发展,又因胫骨平台内侧比外侧负重大,且外侧腓骨的支撑作用为胫腓骨在增龄衰老引起骨质疏松的过程中形成不均匀沉降提供有利条件。膝关节骨性结构的不均匀沉降继发筋性结构的失衡,加速膝关节力线内移。因此,通过宗中医"筋-骨"理论之精髓,承膝骨关节炎肝肾亏虚则筋骨失养之论述,以膝关节不均匀沉降引发力线异常为切入点,探讨膝骨关节炎筋骨失衡的病理基础,为从新的视角揭示膝骨关节炎的中医病理特点提供理论依据。
The knee osteoarthritis is along with the pathological change of tendon and bone, and located in liver and kidney, that the insufficiency of liver and kidney leads to the malnutrition of tendon and bone as the underlying pathology. It provides powerful proof for the uneven settlement during the pathologic process of knee osteoarthritis that the malnutrition of tendon and bone results in the inside gap narrow and the varus deformity of knee joint as the common clinical manifestations.The knee osteoarthritis forms on the basis of normal varus, loading a greater on the tibia platform inside than the outside, and but-tress of the lateral fibula. These provide advantage for the formation of uneven settlement during the process of aging cause osteoporosis of tibia and fibula. The bony structure uneven settlement of knee joint develops secondary the tendon imbalance leading to the ingression of knee joint force line. Therefore, the knee joint uneven settlement causing abnormal force line as the breakthrough point, explore the pathological basis of the imbalance of tendon and bone with knee osteoarthritis by extracting the soul of tendon and bone theory of traditional Chinese medicine and inheriting the viewpoint of the insufficiency of liver and kidney leading to the malnutrition of tendon and bone. It provides the theoretical foundation for revealing the knee osteoarthritic pathological characteristics of traditional Chinese medicine from the new perspectives.
The knee osteoarthritis is along with the pathological change of tendon and bone, and located in liver and kidney, that the insufficiency of liver and kidney leads to the malnutrition of tendon and bone as the underlying pathology. It provides powerful proof for the uneven settlement during the pathologic process of knee osteoarthritis that the malnutrition of tendon and bone results in the inside gap narrow and the varus deformity of knee joint as the common clinical manifestations.The knee osteoarthritis forms on the basis of normal varus, loading a greater on the tibia platform inside than the outside, and but-tress of the lateral fibula. These provide advantage for the formation of uneven settlement during the process of aging cause osteoporosis of tibia and fibula. The bony structure uneven settlement of knee joint develops secondary the tendon imbalance leading to the ingression of knee joint force line. Therefore, the knee joint uneven settlement causing abnormal force line as the breakthrough point, explore the pathological basis of the imbalance of tendon and bone with knee osteoarthritis by extracting the soul of tendon and bone theory of traditional Chinese medicine and inheriting the viewpoint of the insufficiency of liver and kidney leading to the malnutrition of tendon and bone. It provides the theoretical foundation for revealing the knee osteoarthritic pathological characteristics of traditional Chinese medicine from the new perspectives.
引文
[1]李西海,梁文娜,叶蕻芝,等.骨关节炎软骨潮线漂移与软骨退变的相关性研究.风湿病与关节炎,2014,3(1):10-15
[2]李西海,党传鹏,杨世奎,等.软骨潮线漂移调控骨关节炎软骨下骨重建的机制探讨.风湿病与关节炎,2014,3(9):51-53
[3]Bowland P,Ingham E,Jennings L,et al.Review of the biomechanics and biotribology of osteochondral grafts used for surgical interventions in the knee.Proc Inst Mech Eng H,2015,229(12):879-888
[4]Kim C W,Seo S S,Kim J H,et al.Factors affecting the osteolysis around the components after posterior-stabilized total knee replacement arthroplasty.Knee Surg Sports Traumatol Arthrosc,2015,23(6):1863-1869
[5]齐玮,刘玉杰.高屈曲状态下膝关节静力稳定结构的生物力学研究进展.医用生物力学,2013,28(2):240-244
[6]Culvenor A G,Crossley K M.Accelerated return to sport after anterior cruciate ligament injury:a risk factor for early knee osteoarthritis?.Br J Sports Med,2016,50(5):260-261
[7]Sandau M,Heimbürger R V,Villa C,et al.New equations to calculate 3D joint centres in the lower extremities.Med Eng Phys,2015,37(10):948-955
[8]Teichtahl A J,Morris M E,Wluka A E,et al.Foot rotation:a potential target to modify the knee adduction moment.J Sci Med Sport,2006,9(1-2):67-71
[9]Landry S C,Mckean K A,Hubley-Kozey C L,et al.Knee biomechanics of moderate OA patients measured during gait at a self-selected and fast walking speed.J Biomech,2007,40(8):1754-1761
[10]Hein C N,Deperio J G,Ehrensberger M T,et al.Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement.Knee,2011,18(3):189-192
[11]Freutel M,Seitz A M,Galbusera F,et al.Medial meniscal displacement and strain in three dimensions under compressive loads:MR assessment.J Magn Reson Imaging,2014,40(5):1181-1188
[12]Pauly H M,Larson B E,Coatney G A,et al.Assessment of cortical and trabecular bone changes in two models of post-traumatic osteoarthritis.J Orthop Res,2015,33(12):1835-1845
[13]Jacobs C A,Christensen C P,Karthikeyan T.Subchondral bone marrow edema had greater effect on postoperative pain after medial unicompartmental knee arthroplasty than total knee arthroplasty.J Arthroplasty,2016,31(2):491-494
[14]Sharkey P F,Cohen S B,Leinberry C F,et al.Subchondral bone marrow lesions associated with knee osteoarthritis.Am J Orthop(Belle Mead N J),2012,41(9):413-417
[15]张英泽,李存祥,李冀东,等.不均匀沉降在膝关节退变及内翻过程中机制的研究.河北医科大学学报,2014,35(2):218-219
[16]Smith P N,Refshauge K M,Scarvell J M.Development of the concepts of knee kinematics.Arch Phys Med Rehabil,2003,84(12):1895-1902
[17]刘爱峰,马剑雄,魏强,等.膝关节生物力学模型研究进展.中国矫形外科杂志,2012,20(19):1774-1776
[18]Borotikar B S,Sipprell W H,Wible E E,et al.A methodology to accurately quantify patellofemoral cartilage contact kinematics by combining 3D image shape registration and cine-PC MRI velocity data.J Biomech,2012,45(6):1117-1122
[19]Baka N,Kaptein B L,Giphart J E,et al.Evaluation of automated statistical shape model based knee kinematics from biplane fluoroscopy.J Biomech,2014,47(1):122-129
[20]Kim K,Feng J,Nha K W,et al.Improvement of the knee center of rotation during walking after opening wedge high tibial osteotomy.Proc Inst Mech Eng H,2015,229(6):464-468
[21]Rauh M A,Boyle J,Mihalko W M,et al.Reliability of measuring longstanding lower extremity radiographs.Orthopedics,2007,30(4):299-303
[22]Hunter D J,Wilson D R.Role of alignment and biomechanics in osteoarthritis and implications for imaging.Radiol Clin North Am,2009,47(4):553-566
[2]李西海,党传鹏,杨世奎,等.软骨潮线漂移调控骨关节炎软骨下骨重建的机制探讨.风湿病与关节炎,2014,3(9):51-53
[3]Bowland P,Ingham E,Jennings L,et al.Review of the biomechanics and biotribology of osteochondral grafts used for surgical interventions in the knee.Proc Inst Mech Eng H,2015,229(12):879-888
[4]Kim C W,Seo S S,Kim J H,et al.Factors affecting the osteolysis around the components after posterior-stabilized total knee replacement arthroplasty.Knee Surg Sports Traumatol Arthrosc,2015,23(6):1863-1869
[5]齐玮,刘玉杰.高屈曲状态下膝关节静力稳定结构的生物力学研究进展.医用生物力学,2013,28(2):240-244
[6]Culvenor A G,Crossley K M.Accelerated return to sport after anterior cruciate ligament injury:a risk factor for early knee osteoarthritis?.Br J Sports Med,2016,50(5):260-261
[7]Sandau M,Heimbürger R V,Villa C,et al.New equations to calculate 3D joint centres in the lower extremities.Med Eng Phys,2015,37(10):948-955
[8]Teichtahl A J,Morris M E,Wluka A E,et al.Foot rotation:a potential target to modify the knee adduction moment.J Sci Med Sport,2006,9(1-2):67-71
[9]Landry S C,Mckean K A,Hubley-Kozey C L,et al.Knee biomechanics of moderate OA patients measured during gait at a self-selected and fast walking speed.J Biomech,2007,40(8):1754-1761
[10]Hein C N,Deperio J G,Ehrensberger M T,et al.Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement.Knee,2011,18(3):189-192
[11]Freutel M,Seitz A M,Galbusera F,et al.Medial meniscal displacement and strain in three dimensions under compressive loads:MR assessment.J Magn Reson Imaging,2014,40(5):1181-1188
[12]Pauly H M,Larson B E,Coatney G A,et al.Assessment of cortical and trabecular bone changes in two models of post-traumatic osteoarthritis.J Orthop Res,2015,33(12):1835-1845
[13]Jacobs C A,Christensen C P,Karthikeyan T.Subchondral bone marrow edema had greater effect on postoperative pain after medial unicompartmental knee arthroplasty than total knee arthroplasty.J Arthroplasty,2016,31(2):491-494
[14]Sharkey P F,Cohen S B,Leinberry C F,et al.Subchondral bone marrow lesions associated with knee osteoarthritis.Am J Orthop(Belle Mead N J),2012,41(9):413-417
[15]张英泽,李存祥,李冀东,等.不均匀沉降在膝关节退变及内翻过程中机制的研究.河北医科大学学报,2014,35(2):218-219
[16]Smith P N,Refshauge K M,Scarvell J M.Development of the concepts of knee kinematics.Arch Phys Med Rehabil,2003,84(12):1895-1902
[17]刘爱峰,马剑雄,魏强,等.膝关节生物力学模型研究进展.中国矫形外科杂志,2012,20(19):1774-1776
[18]Borotikar B S,Sipprell W H,Wible E E,et al.A methodology to accurately quantify patellofemoral cartilage contact kinematics by combining 3D image shape registration and cine-PC MRI velocity data.J Biomech,2012,45(6):1117-1122
[19]Baka N,Kaptein B L,Giphart J E,et al.Evaluation of automated statistical shape model based knee kinematics from biplane fluoroscopy.J Biomech,2014,47(1):122-129
[20]Kim K,Feng J,Nha K W,et al.Improvement of the knee center of rotation during walking after opening wedge high tibial osteotomy.Proc Inst Mech Eng H,2015,229(6):464-468
[21]Rauh M A,Boyle J,Mihalko W M,et al.Reliability of measuring longstanding lower extremity radiographs.Orthopedics,2007,30(4):299-303
[22]Hunter D J,Wilson D R.Role of alignment and biomechanics in osteoarthritis and implications for imaging.Radiol Clin North Am,2009,47(4):553-566
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