通过检索2003年1月一2013年12月中国期刊全文数据库(CNKI)全部医学期刊，对所筛选出的55篇临床文献的操作方法、硏究过程和结论进行归纳和分析。 结果表明温针不但能起到针刺效果还能作用到深层组织温通经络，消炎镇痛；温针对所有四型的膝痹（风寒湿阻型、阳虚寒凝型、瘀血阻滞型和肾虚髓亏型）均有治疗的作用，但对阳虚寒凝型的作用较弱；温针治疗膝痹常用犊鼻和膝眼等局部穴位，并可结合辨证配1-2穴；针刺常用普通剌法，平补平泻；施以何种灸量，要根据患者的身体状况而定，一般2壮适中。 在文献中多用温针治疗与其他疗法进行对比，对比发现：温针缓解关节僵硬的作用明显；电针则侧重于抗炎镇痛；中频治疗可以解除软组织的粘连，同时修复损伤组织；局部阻滞能减小关节软骨间的摩擦，较快起效，减轻疼痛症状；口服中药可以从内而外的改善关节病变；西药口服能较快缓解疼痛和部分临床症状;推拿、康复、运动训练等疗法的配合，有助于缓解肌肉痉挛，同时减少膝关节软骨之间的压力等等。由于众多疗法起效的侧重方向不同，因此在临床治疗中，为了提高治愈率常将温针与电针、中频、局部阻滞、口服中药或西药等疗法联合应用。但采用何种疗法还要根据患者的实际情况，切勿使用过多种手法，增加患者的关节负担。 虽然温针治疗膝痹的作用已经得到较多的临床试验验证，但其作用机制的探讨仍然不足。接下来的硏究应注重临床硏究方法的改进，规范温针灸的操作过程，重视温针治疗膝痹的作用机制，从而提高温针治疗的膝痹的临床疗效和理论依据。 关键词：温针 膝痹 临床试验 综述文献

No description available.

M.Tech. / PURPOSE: To compare the effectiveness of Traumeel®S in combination with specific knee joint mobilisation with Traumeel®S tablets and ointment, or specific knee joint mobilisation alone, in the chiropractic treatment of knee osteoarthritis. By comparing the objective and subjective results obtained from this comparison, the most effective treatment protocol for knee osteoarthritis may be determined. STUDY DESIGN: A random sample of thirty patients, radiographically diagnosed with Grade 2 or Grade 3 knee osteoarthritis, were selected to participate in this study. These patients were randomly assigned to three equal groups of ten patients each. Monitoring examinations were conducted on the initial, third, sixth and final (ninth) consultations.

This document only includes an excerpt of the corresponding thesis or dissertation. To request a digital scan of the full text, please contact the Ruth Lilly Medical Library's Interlibrary Loan Department (rlmlill@iu.edu).

Knee osteoarthritis (OA) is a debilitating and costly chronic health condition affecting approximately 10% of Canadians. Total Knee Arthroplasty (TKA) is an effective procedure restoring quality of life and providing pain relief for patients with knee OA. The benefits of TKA are well established for patients with knee OA, but determining those who would most benefit is a challenging task. Physical functioning in patients with knee OA has been shown to be a key factor for appropriateness for TKA. The Lower Extremity Functional Scale (LEFS) and the Oxford Knee Score (OKS) are two patient-reported outcome measures (PROMs) measuring physical function that can be utilized to assist health care professionals in determining the need for TKA among this population. The LEFS is a regional PROM consisting of 20 questions asking about activities relating to lower extremity functioning. Questions are scored on a 5-point descriptive scale from 0 (extreme difficulty or unable to perform the activity) to 4 (no difficulty) with a total score of 80. Higher scores represent higher functioning. The OKS is a site-specific PROM that asks questions about pain and function and consists of 12 items ranked on a 5-point descriptive scale. Scores range from 1 to 5 (total score of 60) for each item with lower scores representing higher function. The purpose of this thesis was to determine the diagnostic accuracy for the LEFS and the OKS for determining appropriateness for TKA in people with primary knee OA. The hypothesis for the current study was that the LEFS would have higher diagnostic accuracy for appropriateness for TKA compared to the OKS. A cross-sectional retrospective study of patients with knee OA attending a Regional Joint Assessment Program (RJAP) from January to September 2013 was conducted. Classification of appropriateness for TKA was determined by the attending orthopedic surgeon’s decision at the end of the assessment. Diagnostic accuracy for the OKS and the LEFS were determined using the area under the curve (AUC) of the receiver operator characteristic (ROC) curve. Cut-off scores were calculated for both outcome measures. Four hundred and twenty one patients eligible for the study (41.8% males; 66.9 years old) completed the OKS and the LEFS. The diagnostic accuracy for the OKS and the LEFS was determined using the AUC of the ROC curve for each patient-reported measure using Stata ® version 12.1. The cut-off scores were determined as the point on the ROC curve yielding the best sensitivity and specificity for the two outcome measures. The results showed the LEFS did not have higher diagnostic accuracy (LEFS AUC = 0.686 (95% CI = 0.636 – 0.736); OKS AUC = 0.674 (95% CI = 0.623- 0.724)) for determining appropriateness for TKA in patients with primary knee OA in isolation. The best cut-off score for those deemed appropriate for TKA among patients with knee OA was 26 out of 80 LEFS points and 42 points out of 60 OKS points. The results of this thesis agree with previous research reporting that decision-making regarding the need for TKA in patients with knee OA is multi-factorial. Our data confirm that this decision cannot be based on patient-reported physical function alone. Factors other than or in addition to patient-reported lower limb physical functioning should be considered when determining which patients with knee OA would most benefit from TKA. Further research evaluating these factors is warranted to improve triage services for patients with knee OA most likely to benefit from TKA. / Thesis / Master of Science Rehabilitation Science (MSc)

Background: Knee osteoarthritis (OA) is a prevalent disease that contributes to lower limb immobility and pain resulting in lost productivity in the work place. Repetitive loading of the knee joint, particularly in occupational settings, significantly increases OA risk. However, rest may promote tissue recovery and increase tissue tolerance to load. Therefore rest should be examined as a mechanism to prevent the development of knee OA. Purpose: The primary objective was to determine if rest can mitigate mechanical deformation of the stifle (knee) joint and articular cartilage damage during loading compared to an unloaded control in an intact porcine stifle model. Methods: A randomized controlled trial was conducted. Among 18 pairs of porcine hind limbs, one limb in each pair was randomly assigned to receive a loading intervention; while the matched pair served as control. Stifles in both groups were dissected, mounted into the loading apparatus, and pre-loaded. Intervention joints were then randomized into one of three loading protocols: no rest, 3:2 work:rest, and 1:1 work:rest; all of these protocols exposed joints to the same amount of cumulative load. Following loading, all joints were dissected to expose the cartilage. Cartilage damage was scored on a categorical scale. Deformation and energy dissipation were calculated for intervention limbs from data obtained from the loading apparatus. Results: Rest did not mitigate displacement or energy dissipation in the stifles exposed to loading. Rest was associated with reduced cartilage damage scores in the lateral femur in the 1:1 condition. Conclusion: Rest had little impact on joint mechanics and cartilage damage in this model. The small sample size may explain these results. Future investigations involving larger samples should assess if longer periods of rest are need to minimize joint damage as a result of loading. / Thesis / Master of Science (MSc) / Repetitive loading of the knee joint is linked to breakdown of knee cartilage leading to the development and progression of knee osteoarthritis (OA). For example, over-exposure to physically demanding tasks in the workplace (i.e. squatting, bending, lifting etc.) increases knee OA risk. However, it is possible that rest breaks can prevent cartilage damage by allowing the tissue to recover and maintain proper function. Therefore, the purpose of this work was to determine the influence of rest on knee joint mechanics and cartilage quality by repetitively loading pig knee joints and exposing them to varying periods of rest. Rest up to sixty seconds did not allow for tissue recovery, nor did it assist with joint function. This work suggests that longer periods of rest may be required to mitigate the damaging effects of loading, or that rest may not mitigate the effects of loading at all.

Purpose: Pediatrics and adolescents are at a higher risk to suffer an anterior cruciate ligament (ACL) injury in comparison to their adult counterparts. As well, the rate of injury is increasing. While some of this increased injury rate may be attributed to increased participation in sport, it remains unknown why only some children suffer an ACL injury. Traditionally, surface marker- based motion-capture would be used to determine this difference; however, due to the presence of soft tissue artifact, marker translation may exceed the physiological range of the knee itself. Using OpenSim, the range of motion of the knee was constrained to allow for soft tissue artifact to be reduced. Therefore, the two objectives of this thesis are 1) to create and validate a new OpenSim knee model, and 2) to use this knee model to determine whether differences in knee kinematics and ligament lengths exist between ACL injured and non-injured control pediatrics. Methods: Manuscript 1 (Chapter 5), focused on the first objective of creating and validating a new OpenSim knee model. Thirty-two healthy pediatric females performed squats, countermovement jumps, and drop-vertical jumps. OpenSim models were made and scaled to each participant and featured a 6-degree-of-freedom knee. Each knee was allowed to move in a manner dictated by published in vivo biplanar fluoroscopy studies. These resultant biplanar fluoroscopy-constrained knee kinematics were then compared to another series of in vivo constraints: bone pin-constrained kinematics. Finally, the length of the four main ligaments of the knee were tracked and compared to existing literature on healthy ligament lengths from extension to deep flexion. Manuscript 2 (Chapter 6) sought to answer the second question: Are there differences in kinematics and ligament lengths between ACL-injured and uninjured control participants? Forty ACL-injured (20 male, 20 female) and 40 uninjured control (20 male, 20 female) participants completed a countermovement jump, which drove inverse kinematics for the OpenSim model created in Manuscript 1. Knee kinematics and ligament lengths were compared between male injured to male control, and female injured were compared to female control. To isolate the effect of injury, males were not compared to females. Results: Starting with Manuscript 1, the squat task had the best agreement between biplanar fluoroscopy and bone pin kinematics, during periods of low knee flexion. At high flexion, the ACL length was shorter than literature data, for all tasks. For Manuscript 2, during the countermovement jump, female control participants obtained greater knee flexion and internal rotation when compared to female ACL-injured participants. For males, there were only small differences in countermovement jump kinematics. For ligament lengths, female controls had longer posterior cruciate ligament lengths, whereas for males, male ACL-injured participants presented with longer ligament lengths for all 4 ligaments. Conclusion: The thesis results identified how to use deep flexion biplanar fluoroscopy constraints to minimize soft tissue artifact. In comparison to previously established knee bone pin constraints, the biplanar fluoroscopy knee relied more on internal-external rotation and anterior-posterior translation to obtain the required bone positions in OpenSim. This additional anterior-posterior translation also led to the increased shortening of the ACL, as the linear distance between ligament insertion points decreased. Next, this thesis identified small differences in kinematics between ACL-injured and control pediatric females during a countermovement jump, where control participants obtained greater knee flexion in the preparatory and landing phase of the task. Few differences in kinematics were found in males. Differences in ligament lengths between injured and control groups were based on differences in knee kinematics, or by participant anthropometrics; taller participants had longer ligaments.

No description available.

Osteoarthritis is the 12th leading cause of years lived with disability globally and by 2040 more than 10 million Canadians will have knee osteoarthritis (KOA). Pain in persons with KOA is well-recognized, persistent and chronic with central sensitization (CS) being prevalent in ~30%. CS is measured by psychophysical testing and patient-reported methods such as the Central Sensitization Inventory (CSI). The CSI was developed using subgroups of people with chronic pain, but not those with KOA. Therefore, validity of the CSI in people with KOA is lacking. CS as indicated by psychophysical tests is associated with CSI scores lower than the recommended cut score. Therefore, we aimed to evaluate the validity of the CSI through Rasch analysis in persons with KOA. We then sought to determine the agreement of the Rasch calibrated (RC-CSI) version of the CSI with the original and to evaluate the validity of the RC-CSI with psychophysical tests in people with KOA. In the first study, the CSI was able to fit Rasch model. After iterative analysis, we found the CSI to be a singular construct with acceptable unidimensionality while retaining all 25 items. Only two items - frequent urination (item 21) and Skin problems (item 19) showed a pattern of uniform differential item functioning by age and sex respectively. Moreover, we generated a RC-CSI cut score of 31.37 that we used to compare with the original cut score of 40. In second study, the findings suggested a lack of agreement between the two versions of the CSI demonstrating small bias. When exploring sensitivity and specificity with psychophysical tests, the RC-CSI showed little clinical value over the original CSI. We therefore recommend that the original CSI should be used with individual clients as our preliminary findings suggest that there is no added benefit to using the RC- CSI. / Thesis / Master of Science Rehabilitation Science (MSc)

No description available.