My lecture notes on TV - on knee osteoarthritis

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Hi, welcome to the health forum!Today, we are going to talk about the topic of knee joint disease.Before the show starts, I'd like to ask yo


Hi, welcome to the health forum!

Today, we are going to talk about the topic of knee joint disease.

Before the show starts, I'd like to ask you all here. You or your family have had pain in the joints! I saw about 50% of the audience raised their hands. I'm here to tell you that your joint pain may be due to osteoarthritis.

In daily life, we often see some old people walking gait, when walking on the knee joint pain, and even a "O" shaped legs. This is actually the articular cartilage integrity caused by a variety of reasons caused by damage to a group of diseases, osteoarthritis of the symptoms and signs of trouble.

So, let's start with osteoarthritis?

Osteoarthritis is commonly known as "long spur and hyperosteogeny". Although the performance in the "long spur", but the root cause of articular cartilage damage, loss of elasticity, strength loss, and caused the formation of bone sclerosis or cystic degeneration and subchondral osteophyte. Clinical symptoms of knee pain, limitation of motion and joint deformity. The pain occurs when the activity, the prevalence in the elderly in the downstairs, walking and walking long distances will produce pain, rest can alleviate gradually, caused by severe limb disability. At present, the prevalence of osteoarthritis showed an upward trend in the global scope, has become the world's most common joint disease, with the increase of age, the prevalence is rising rapidly; according to the latest statistics in our country for more than 65 years, more than 50% of people have X radiographic evidence of osteoarthritis, but there are 25% there will be symptoms, 75 people over the age of 80% have symptoms appear.

The etiology of osteoarthritis is still under further investigation. At present, it is considered to be related to the factors such as aging, mechanical wear and tear, immune response, free radical, intraosseous pressure and cytokines, and the first two factors are confirmed. Osteoarthritis can occur in any one of the joints, the common joint is knee, hip, ankle, shoulder, wrist, elbow, and finger joints, but the knee osteoarthritis is the most common.

All joints can have osteoarthritis, showing the corresponding joint pain, swelling, friction, deformation and movement limitations. But the incidence of knee osteoarthritis is the highest. About 41% of patients with osteoarthritis of the knee osteoarthritis. This is because the knee joint is negative, major activities and more vulnerable to trauma, fatigue and cold stimulation of the joint. Hip osteoarthritis accounted for 19%. The characteristics of joint pain of osteoarthritis are mostly over activity, which can be alleviated after rest. Knee osteoarthritis is caused by limb squatting, stairs and other obstacles, will produce severe varus and flexion contracture, end joint disease.

There may be some audience friends will ask, get osteoarthritis pain, the disease in the end can not prevent it?

I am telling you that there is no way to completely prevent osteoarthritis from occurring, but some measures can reduce or delay the onset of osteoarthritis.

We often see in the park, some old people do knee function exercise, they repeatedly knee flexion, while rubbing patella, while shaking the knee joint, while doing the dozens, hundreds of fast squats, they are in the prevention of osteoarthritis. But these methods are wrong, and they are very wrong. Why is it wrong? Because the elderly knee began to appear in the articular cartilage degeneration, bone hyperplasia and degenerative change, for knee pain, muscle atrophy, femoral head four stairs pain, after crouching unable to stand, even appear knee joint cavity effusion, knee flexion contracture etc.. For the purpose of the knee joint functional exercise is mainly to reduce the contraction of the femoral head four, reduce and eliminate knee pain. The knee flexion, rubbing the patella, the patellar cartilage shaking knee joint cartilage surface friction repeatedly and femoral condylar cartilage, which aggravate the wear, knee pain worse, even joint effusion, and joint effusion and increase muscle atrophy, muscle atrophy and will make the original symptoms, form a vicious spiral.

In fact, in our daily life, there are many errors like this. For example, some elderly people like to climb mountains, climbing stairs: climbing, climbing stairs is a good exercise, but not conducive to the protection of the knee. Because the mountain climbing stairs or weight-bearing knee, and downhill in addition to its own weight outside the knee but also the burden of power down, it will increase the impact of knee injury. When climbing stairs, the knee joint's curvature increases, and the pressure between patella and femur increases accordingly, which results in knee joint pain. So here I suggest that older people with knee joint disease should try their best to climb and climb stairs. Some old people like to play taijiquan, as we all know, Taijiquan, the body center of gravity is low, and the action to be carried out slowly, will make the knee joint weight is too large, cause knee pain, accelerate the wear of articular cartilage. The technical characteristics of Taijiquan is always in the knee joint static squat position support, if long time excessive single exercise, the articular surface of the patella is often friction, extrusion, collision and twist fault, which will accelerate the patellar cartilage degeneration caused by joint pain. That Taijiquan should be combined with the actual situation of the elderly, if the knee joint pain, should not overdo sth..

So, what kind of exercise for the elderly is more appropriate?

Now I recommend to you some of the old age, especially the joint pain of the elderly harmless and healthy exercise:

The first is swimming, relatively speaking, the best sport in patients with osteoarthritis is swimming, especially breaststroke. Because swimming body floating in the water, the joint does not bear the pressure of body weight, the minimum load; at the same time the breaststroke kicking and other movements and can guarantee the full exercise of muscle strength and joint activity. In addition, the process of swimming, other organs of the body function is also exercise, effectively enhance the disease resistance of patients. If conditions permit, to swim 2 per week to 3 times the length of time should be gradual, slowly increase, the elderly every time not more than 1 hours, the speed can be.

Some viewers may say, I can not swim ah?! Then I recommend you: slowly walking and cycling, knee pain remission after first walking training, walking slowly began to slow, leg lift gently to avoid knee bone surface impact, aggravation. Walking speed can be controlled in 60 steps / minutes, daily 20~30 minutes. Gradually increase the exercise time, within 3 weeks to reach the standard of 20~30 minutes per exercise can be maintained. There is a daily 30~40 minutes of cycling exercise, you can make the knee pain elderly receive unexpected results.

In addition, the knee symptoms are not very serious in the elderly, jogging is a good way to strengthen the joint ligament elasticity. When running, it is best to use the first half of the foot to the ground in order to cushion the shock of the legs to prevent knee injury. Running after not immediately stopped, and slowly walking or standing still.

There are two kinds of exercise is more simple and effective method, is a high horse and supine leg, high horse is? Below I ask an audience to come up with me to do: two knees slightly bent (10~30 degrees), to the knee pain is appropriate. Static squat motionless, hands flat, straight ahead, to a few minutes, and gradually increase the time. Generally reached about 10 minutes each time, every morning and evening to do each of the 1. That's fine. Thank you! Supine leg movements are relatively simple, lying in bed, with legs straight up 15 degrees, hold for 10 seconds for the time to do at the beginning of may exercise 60 times a day, after a while practicing with their feet to pick a pillow, increase strength, every day more than 100 times, in order to practice after the end the thigh with mild soreness appropriate.

There are many ways to prevent osteoarthritis of the knee, but there are some fundamental problems that we must follow:

First of all, to maintain an optimistic mood. Cheerful, aloof character can make us more friends, broad-minded and can make us avoid too much trouble. Happy every day, don't worry too much because of the lock, it can also provide us with better disease resistance. Even if suffering from arthritis, do not have too much psychological pressure, excessive pressure will lead to the deposition of acidic substances, affecting the normal metabolism. Proper regulation of mood and self stress can maintain alkaline constitution, thereby preventing the occurrence of arthritis.

Second, the old man to serve old. Often see old people dissatisfied with the old "speech in the media, in admire these old comrades of the old but vigorous spirit at the same time, I entered the ranks of the old sunset to Comrades or be realistic: old people should wear old. Although the "sunset infinite good", but in any case than the splendor of the sun, it is difficult than the sun at eight or nine, and also not very influential sun compared to old people, physical decline, poor memory, Laoyanhunhua, this is the objective things clear, how to avoid it and he said? Perhaps some of the old comrades have just come down and feel that their energy is not bad, so still as hard as ever, and even do some overdraft body, the result is often hurt their bodies. Old people should wear old, specific performance should be paid attention to in the basic necessities of life: If winter comes, should wear a warm point; eat, preferably with a little bad advisable; sleeping berth should be very comfortable; go out to walk, also have to be careful, especially morning, not too early, especially it is winter, should avoid cold dawn to sunrise after exercise too late, the amount of exercise is not too intense, not overdo sth.. The constitution of different ages, different activities, the Chinese say to life is the truth, do whatever things.

The third is to avoid injury. Almost all of the damage will have different degrees of sequelae, especially the joints of the damage is often to accelerate the onset of degenerative arthritis incentives. A new research report pointed out that the risk of knee injury will make the rest of my life when young had knee arthritis increased to 3-5 times of normal people. The new study collected the relevant data, more than 1 thousand and 300 graduated from John Hopkins Medical College during 1948 and 1964 staff study shows that in more than and 10 or more than and 20 years old when the injury of the knee joint, no knee injury risk than peers occurred knee arthritis in this life increased by 3 times. In addition, the researchers found that people who had a knee or hip injury after adulthood had a 5 fold increase in risk of knee osteoarthritis or more than 3 times.

Fourth joints to keep warm. The winter generally wear more, pay more attention to the summer, but often in short sleeved shorts, power, air conditioning, fan under the work and life, at this time should pay more attention to the joint part to keep warm, avoid cold air blowing directly. But patients do not use warm method for dressing, because hot compress will make joint overheating instead, causing joint pain aggravated the body. Don't use kneepad to warm the knee, because the knee pads are very flexible, with the knee tightening dredge blood circulation around the knee, the activity is more difficult.

Fifth, a balanced diet. In addition to pay attention to the disease, a variety of food collocation, not picky eaters or partial eclipse. Eat high calcium foods to ensure the normal needs of bone metabolism in the elderly. The old calcium intake should be compared with the general adults increased by about 50%, which is not less than 1200 milligrams of calcium daily composition, therefore, should eat milk, eggs, soy products, vegetables and fruits, when necessary to add calcium. Overweight should control diet, increase activity, reduce weight, in order to reduce joint weight. Protein intake should be limited, excessive protein in food will promote calcium excreted from the body. To increase the intake of a variety of vitamins, such as vitamin A, B1, B6, B12, C and D, etc..

Sixth exercise to strengthen but avoid excessive damage. Usually strengthen the muscles around the joints, joint mobility, flexibility, and other training; unless it is an athlete, does not recommend excessive squat, stair climbing, mountain climbing and other activities. Aerobic exercise and outdoor sports are recommended for exercise. In the long run, strengthening the strength of the leg exercises help to delay the knee arthritis. The researchers conducted a follow-up survey of 221 middle-aged and elderly patients, with the diagnosis of knee arthritis among 57 people, 164 people were randomly selected from the general population, half of them insist on lower extremity strength training, first at the fitness center, later training at home. The other half was used as a control group to do some flexibility training. 67 people failed to complete the training, and the researchers assessed the remaining 154. 30 months later, compared with the control group, the rate of reduction of joint space was delayed by nearly 25%.

The seventh point is when the knee is not timely to keep in mind the 4 "do not". Don't believe the "God and God needle" treatment, otherwise, can not only cure the disease, but also may aggravate the condition; not blind to treatment of rheumatism; do not blindly take "softening spur" drug; not blindly added elements such as calcium, zinc, etc.. I came to find the patients in many patients believe that various remedies, visit the "doctor", make light of travelling a thousand li, it spent a lot of money, did not cure the disease.

Has the method of treatment of osteoarthritis?

The treatment of osteoarthritis can be divided into 3 stages:

The first stage of the conservative treatment, oral Chinese medicine, anti-inflammatory analgesics, vitamins and glucosamine, intra-articular injection of hyaluronic acid and other drugs. In the above drugs, vitamins and glucosamine can be used as a basic and long-term use of drugs. Anti-inflammatory analgesics can be used at any time according to the patient's pain or swelling and other symptoms. Hyaluronic acid supplementation can improve symptoms, improve function and improve quality of life. Although there are many kinds of drugs can be used to treat osteoarthritis, but there is no drug can make the course of osteoarthritis reversal and stop. Drug treatment can only relieve symptoms over a period of time.

The second stage of conservative treatment is invalid when the arthroscopic surgery. The utility of arthroscopic debridement is removed or trimmed by cartilage debris, mechanical joint disorder of meniscus debris and osteophyte, and through a large dose of intraoperative joint lavage, remove inflammatory factors induced synovitis. Arthroscopic debridement relieves symptoms by eliminating mechanical and inflammatory factors. The degeneration of cartilage and meniscus cutting and unable to repair, so the operation is not hope to have new cartilage regeneration, but in order to alleviate the symptoms, it does not change the pathological changes and the process of osteoarthritis.

In the third stage, when the destruction of articular cartilage is serious, and the gap is narrow, it is suggested that the joint surface replacement is recommended. It can be seen from the above treatment, any treatment only temporarily relieve symptoms, and the most effective treatment is artificial joint replacement. The artificial joint is one of the most important advances in the field of Department of orthopedics made in twentieth Century, it makes the past can only rely on crutches, or only amputation patients can walk like a normal person, has greatly improved the quality of life. Some of the patients with severe osteoarthritis of the late stage of the joint with the hope that part of the long-term bedridden patients, through the operation to regain the standing and walking function, partially or completely restored self-care ability. As a mature method, it has been widely used at home and abroad. At present, artificial joint replacement has become one of the main methods for the treatment of severe joint lesions, which is regarded as one of the important milestones in the history of the Department of orthopedics in twentieth Century.

In the selection process of the grading treatment, should be said that the doctor is in the leading position, the first doctor to patient education and counseling, doctors should make sure that the majority of patients, patients with osteoarthritis, can be a normal life, through a series of simple and effective measures, such as rest and exercise, analgesic drugs exercise and weight loss, can relieve symptoms, improve function. Patients should be encouraged to change their unhealthy lifestyle and form of exercise, to avoid inappropriate activities that may aggravate joint degeneration. Second, the need for better patient cooperation, in particular, in terms of weight loss and functional rehabilitation, only patients with full cooperation in order to achieve the purpose of treatment. Third, doctors should fully understand the advantages and disadvantages of various treatments, and attention to clarifying the patient during treatment. Such as the application of analgesics should be measured, excessive use can cause excessive activity of knee joint degeneration, aggravating, also have the risk of peptic ulcer. Intra-articular injection of hormones may cause infection, excessive use of joints, resulting in cartilage nutritional imbalances and hormonal micro crystal on cartilage wear, 1 years, the number of injections can not be more than 3 times. For patients who need surgery to strictly grasp the indications for surgery, to the patient with minimal damage and get the maximum therapeutic effect.

Treatment of knee osteoarthritis is a difficult project, the key is early diagnosis, patient education and timely targeted treatment of classification, the need for different patients to develop comprehensive treatment, although the disease cannot be cured, but through good cooperation between patients and doctors, can relieve pain, maintain and improve the function. To reduce disability, improve the quality of life, and may delay the progress of disease targets.


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