膝关节疼痛别大意！

h2span style="font-size: 16px;"膝关节疼痛别大意！/spanbr//h2div/divdivpspan style="font-size: 16px;"俗话说“人老先老腿”，/spanspan style="font-size: 16px;"这话可一点都不假。/spanspan style="font-size: 16px;"王阿姨就曾经遭受过/spanspan style="font-size: 16px;"膝盖疼痛的困扰/spanspan style="font-size: 16px;"那后来她又是如何治疗的呢？/spanspan style="font-size: 16px;"我们一起来看看br//span/psectionbr//sectionpspan style="font-size: 16px;"王阿姨今年63岁，2009年，她因长期劳累忙碌于工作及家庭生活事务，逐渐出现了双膝关节疼痛，以右膝症状较重，右膝关节活动受限，上下楼梯时加重明显。/span/psectionsectionsectionsectionbr//section/sectionsectionsectionsectionsectionpspan style="font-size: 16px;"我当时觉得右边膝盖疼痛严重，已经影响到日常生活了，于是2011年的时候在深圳市中医院进行了右膝关节手术治疗，此后病情有了一定的改善。/spanspan style="font-size: 16px;"2020年5月，王阿姨再次因劳累后出现右膝疼痛明显，行走后疼痛加重，无法完成下蹲动作，经过了多次物理治疗，都没有明显的缓解。/span/p/section/section/section/section/section/sectionsectionsectionsectionsectionbr//section/section/section/sectionpspan style="font-size: 16px;"深圳市中医院骨伤科王立新主任对王阿姨进行了详细问诊和初步检查，发现王阿姨右膝关节屈曲挛缩内翻畸形俗称“O型”腿，体检压痛主要集中在膝关节内侧间隙，右膝关节活动度10-90°。王立新主任让王阿姨拍DR右膝全长位片，再评估膝骨关节炎的严重程度。/spanbr//psectionsectionsectionsectionsectionbr//section/section/section/section/sectionpspan style="font-size: 16px;"经评估，王立新主任建议王阿姨手术治疗。/spanspan style="font-size: 16px;"在骨一科王立新主任、谭锐泉主任医师带领的手术团队的精心安排下，王阿姨完善了术前相关检查。考虑到王阿姨今年63岁，右膝关节内翻畸形，髌股关节面间隙基本消失，骨关节炎症状明显，单纯行单髁置换术或胫骨高位截骨术、股骨远端截骨术难以解决目前情况，遂建议行全膝关节置换术。/span/psectionsectionsectionsectionsectionsectionbr//section/section/section/section/section/sectionsectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"经过和手术团队的详细沟通后，我和家人都同意了手术方案。/spanspan style="font-size: 16px;"手术过程非常顺利，术后待王阿姨生命体征稳定后便返回骨一科病房休息。/span/p/section/section/section/section/section/sectionpbr//psectionsectionsectionsectionsectionsectionsectionspan style="font-size: 16px;"王立新主任医师当时完成了美国哥伦比亚大学及康奈尔大学附属纽约长老会医院的访问、交流学习，主要进修关于人工关节置换及翻修方面，充分的吸取了国外关节置换的经验，并结合国内自身围手术期的情况，对患者在关节置换加速康复方面，给出了许多建议。/spanbr//section/section/section/section/section/section/sectionpbr//ppspan style="font-size: 16px;"王立新主任从以下几个方面进行考虑：/span/pul class=" list-paddingleft-2" style="margin: 0px 16px; padding: 0px 0px 0px 2.2em; max-width: ; box-sizing: border-box !important; word-wrap: break-word !important; overflow-wrap: break-word !important;"lipspan style="font-size: 16px;"镇痛措施。/span/p/lilipspan style="font-size: 16px;"止血和抗凝之间的平衡问题。/span/p/lilipspan style="font-size: 16px;"预防手术感染的处理措施。/span/p/lilipspan style="font-size: 16px;"术后术口及患者身体的康复。/span/p/li/ulpbr//psectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"01、/spanspan style="font-size: 16px;"首先，王立新主任将病人的镇痛处理分为手术前、中、后三个阶段，术前采取预防性镇痛，多使用非甾体类消炎止痛药以提高患者疼痛的阈值，术中多据麻醉医提供的镇痛方案镇痛，术后则以抗焦虑及镇静结合镇痛。/span/p/section/section/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"br/02、/spanspan style="font-size: 16px;"其次，止血和抗凝之间的平衡问题上，王立新主任熟练掌握术中减少出血的措施，包括：电刀电凝减少术区小血管出血、建议麻醉医师控制性降压、术中静滴及局部应用氨甲环酸。/spanspan style="font-size: 16px;"在如何达到与抗凝之间的平衡问题上，王立新主任主张术后6h抗凝，对于无引流患者，术后6h开始抗凝；对于放置引流管患者，6h后据引流量变化，出血趋于停止开始抗凝。/span/p/section/section/section/section/section/sectionsectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"br/03、/spanspan style="font-size: 16px;"关于预防术口感染方面，王立新主任建议在术前30分钟内静滴头孢类药物，在术中多次使用脉冲冲洗枪冲洗术口冲洗液为头孢呋辛钠注射液+生理盐水按比例调制，术口多余皮下脂肪的清理，术后预防用抗生素，抗菌敷料的应用等等。/span/p/section/section/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"br/04、/spanspan style="font-size: 16px;"患者的营养问题极为重要，王立新主任多次建议患者应在术后进食高蛋白、高热量、高维生素食物，术前应将白蛋白纠正≥40g/L。术前需指导患者行功能锻炼，患者术后即可据指导及康复情况，行不同类型的功能锻炼。/spanbr//p/section/section/section/section/section/sectionpbr//psectionsectionsectionsectionsectionspan style="font-size: 16px;"膝骨关节炎是什么/span/section/section/section/section/sectionpbr//ppspan style="font-size: 16px;"骨性关节炎是一种以关节软骨的变性、破坏、骨质增生为特征的慢性关节病，其主要病理改变是软骨退行性变性和消失，以及关节边缘韧带附着处和软骨下骨质反应性增生形成骨赘，并由此引起关节疼痛、僵直畸形、功能障碍。/span/ppbr//psectionsectionsectionsectionsectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"膝骨关节炎的成因：/spanbr//p/section/section/section/section/section/section/section/section/sectionsectionsectionsectionsectionpspan style="font-size: 16px;"在膝关节的三个间室中，膝骨关节炎的特点是一个间室受累严重，其他两个间室只轻度受累或病变发展缓慢，而受累严重的大部分为内侧间室。/span/ppspan style="font-size: 16px;"br/内侧间室的受累会产生关节内的持重应力分布改变，导致力线不平衡，这种内翻畸形会增加内侧间室软骨上的压强，超过软骨承受的范围，引发一系列软骨磨损和炎症的**循环，形成内侧骨关节炎。/span/p/section/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"br/膝骨关节炎早期症状：/spanbr//p/section/section/section/section/sectionsectionsectionsectionsectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"1、膝关节僵硬：尤其在晨起时僵硬感明显。/spanbr//p/section/section/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"2、关节肿大变形：关节退化时，关节滑膜发炎，关节间隙积液增多，造成肿胀，使疼痛加重。/spanbr//ppspan style="font-size: 16px;"3、膝关节活动受限，运转不自如。/span/p/section/section/section/section/section/section/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"br/膝骨关节炎晚期症状：/spanbr//p/section/section/section/section/sectionsectionsectionsectionsectionpspan style="font-size: 16px;"1、膝关节活动会发出喀嚓声或其他的摩擦音。/spanbr//ppspan style="font-size: 16px;"2、关节畸形，常出现明显的膝关节内翻或外翻畸形。/spanbr//ppspan style="font-size: 16px;"3、膝关节活动受限，屈伸角度进一步减小或出现角度固定。/spanbr//p/section/section/section/section/sectionsectionsectionsectionsectionsectionsectionsectionbr//section/section/sectionsectionspan style="font-size: 16px;"膝骨关节炎的治疗原则/spanbr//section/section/section/section/sectionpspan style="font-size: 16px;"阶梯治疗，包括保守治疗和手术治疗。其中，手术治疗术式多样，需据骨关节炎的严重程度去阶梯型选择外科治疗。/span/psectionbr//sectionsectionsectionsectionsectionsectionspan style="font-size: 16px;"膝骨关节炎的预防措施/span/section/section/section/section/sectionpbr//psectionsectionsectionsectionsectionsectionsectionsectionsectionspan style="font-size: 16px;"01、/spanspan style="font-size: 16px;"尽量避免身体肥胖，防止加重膝关节的负担，控制体重。/span/section/section/section/section/sectionsectionsectionsectionsectionsectionspan style="font-size: 16px;"02、/spanspan style="font-size: 16px;"注意走路和劳动的姿势，避免长时间下蹲，因为下蹲时膝关节的负重是自身体重的3-6倍，工作时下蹲如汽车修理工好改为低坐位坐小板凳，长时间坐着和站着也要经常变换姿势，防止膝关节固定一种姿势而用力过大。/span/section/section/section/section/section/section/section/sectionsectionsectionsectionsectionsectionsectionsectionsectionsectionsectionspan style="font-size: 16px;"03、/spanspan style="font-size: 16px;"走远路时不要穿高跟鞋，要穿厚底而有弹性的软底鞋，以减少膝关节所受的冲击力，避免膝关节发生磨损。/span/section/section/section/section/sectionsectionsectionsectionsectionsectionspan style="font-size: 16px;"04、/spanspan style="font-size: 16px;"参加体育锻炼时要做好准备活动，轻缓地舒展膝关节，让膝关节充分活动开以后再参加剧烈运动。练压腿时，不要猛然把腿抬得过高，防止过度牵拉膝关节。/span/section/section/section/section/section/section/section/sectionsectionsectionsectionsectionsectionsectionsectionsectionsectionsectionspan style="font-size: 16px;"05、/spanspan style="font-size: 16px;"骑自行车时，要调好车座的高度，以坐在车座上两脚蹬在脚蹬上两能伸直或稍微弯曲为宜，车座过高、过低或骑车上坡时用力置车，对膝关节都有不良的影响，应加以克服。/spanbr//section/section/section/section/sectionsectionsectionsectionsectionsectionspan style="font-size: 16px;"06、/spanspan style="font-size: 16px;"膝关节遇到寒冷，血管收缩，血液循环变差，往往使疼痛加重，故在天气寒冷时应注意保暖，必要时戴上护膝，防止膝关节受凉。/span/section/section/section/section/section/section/section/section/section/section/section/section/sectionsectionsectionsectionsectionsectionsectionsectionsectionsectionspan style="font-size: 16px;"07、/spanspan style="font-size: 16px;"有膝关节骨性关节炎的人，既要避免膝关节过度疲劳，又要进行适当的功能锻炼。游泳和散步是好的运动，既不增加膝关节的负重能力，又能让膝关节四周的肌肉和韧带得到锻炼。其次，仰卧起坐、俯卧撑、桥形拱身都是对患者好的运动方式。/span/section/section/section/section/section/section/section/section/section/divpbr//p