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下肢的关节保护计划

Authors
Sharon Alzner, MPT
Zacharia Isaac, MD
Section Editor
Robert H Shmerling, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH
Translators
鲁静, 主任医师，教授

引言

发生关节炎的关节如果受到过度应力和过重的负担会加重炎症及退变，因此所有慢性关节病变患者都应接受关节保护原则的相关教育[1]。下肢关节保护的目标是避免易损伤关节/组织受到过度负荷，预防反复扭伤及劳损，减少疼痛和炎症，从而保护关节完整性。

通过教育患者、改善行为、节约能量；在特定病例中使用矫形器械、夹板，适应性装置，以及在下肢保护病例中选择合适的鞋子，是获得关节保护的最佳方法。保守治疗包括预防性治疗，关节保护是预防性关节治疗的基础。

本专题将总结下肢的关节保护。关节保护的概述以及上肢和颈部的关节保护将在别处讨论。 (参见“关节保护的概述”和“Joint protection program for the upper limb”和“Joint protection program for the neck”)

关节保护的原则

关节保护的原则来源于符合生理的人体力学、姿态，和关节位置的简单实际应用。关节保护减少了局部关节应力并保护关节完整性。一般首选方法是指导患者在进行某种活动时采取措施，使关节承受的应力更小，而不是避免这种活动[2,3]。

关节保护的原则包括：

        

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Literature review current through: 2017-06 . | This topic last updated: 2016-03-04.
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References
Top
  1. Sheon RP, Orr PM. Appendix B. A Joint protection guide for rheumatic disorders. In: Soft Tissue Rheumatic Pain: Recognition, Management, Prevention, Third Edition, Sheon RP, Moskowitz RW, Goldberg VM (Eds), Williams & Wilkins, Baltimore 1996.
  2. Barlow JH, Turner AP, Wright CC. A randomized controlled study of the Arthritis Self-Management Programme in the UK. Health Educ Res 2000; 15:665.
  3. Streibelt M, Hansmeier T, Müller-Fahrnow W. [Effects of work-related medical rehabilitation in patients with musculoskeletal disorders]. Rehabilitation (Stuttg) 2006; 45:161.
  4. Dufour AB, Broe KE, Nguyen US, et al. Foot pain: is current or past shoewear a factor? Arthritis Rheum 2009; 61:1352.
  5. Farrow SJ, Kingsley GH, Scott DL. Interventions for foot disease in rheumatoid arthritis: a systematic review. Arthritis Rheum 2005; 53:593.
  6. Williams AE, Rome K, Nester CJ. A clinical trial of specialist footwear for patients with rheumatoid arthritis. Rheumatology (Oxford) 2007; 46:302.
  7. Clark H, Rome K, Plant M, et al. A critical review of foot orthoses in the rheumatoid arthritic foot. Rheumatology (Oxford) 2006; 45:139.
  8. Hawke F, Burns J, Radford JA, du Toit V. Custom-made foot orthoses for the treatment of foot pain. Cochrane Database Syst Rev 2008; :CD006801.
  9. Grotle M, Hagen KB, Natvig B, et al. Obesity and osteoarthritis in knee, hip and/or hand: an epidemiological study in the general population with 10 years follow-up. BMC Musculoskelet Disord 2008; 9:132.
  10. Messier SP, Loeser RF, Miller GD, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum 2004; 50:1501.
  11. Minor M. Physical activity and management of arthritis. Ann Behav Med 1991; 13:117.
  12. Backman CL, Village J, Lacaille D. The Ergonomic Assessment Tool for Arthritis: development and pilot testing. Arthritis Rheum 2008; 59:1495.
  13. Miyazaki T, Wada M, Kawahara H, et al. Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis 2002; 61:617.
  14. Pollo FE, Otis JC, Backus SI, et al. Reduction of medial compartment loads with valgus bracing of the osteoarthritic knee. Am J Sports Med 2002; 30:414.
  15. Kemp G, Crossley KM, Wrigley TV, et al. Reducing joint loading in medial knee osteoarthritis: shoes and canes. Arthritis Rheum 2008; 59:609.
  16. Hinman RS, Bennell KL. Advances in insoles and shoes for knee osteoarthritis. Curr Opin Rheumatol 2009; 21:164.
  17. Shakoor N, Lidtke RH, Sengupta M, et al. Effects of specialized footwear on joint loads in osteoarthritis of the knee. Arthritis Rheum 2008; 59:1214.
  18. Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev 2009; :CD002759.
  19. Luukinen H, Lehtola S, Jokelainen J, et al. Pragmatic exercise-oriented prevention of falls among the elderly: a population-based, randomized, controlled trial. Prev Med 2007; 44:265.
  20. McClure R, Turner C, Peel N, et al. Population-based interventions for the prevention of fall-related injuries in older people. Cochrane Database Syst Rev 2005; :CD004441.
  21. Howe TE, Rochester L, Jackson A, et al. Exercise for improving balance in older people. Cochrane Database Syst Rev 2007; :CD004963.
  22. Yip YB, Sit JW, Fung KK, et al. Effects of a self-management arthritis programme with an added exercise component for osteoarthritic knee: randomized controlled trial. J Adv Nurs 2007; 59:20.
  23. Doi T, Akai M, Fujino K, et al. Effect of home exercise of quadriceps on knee osteoarthritis compared with nonsteroidal antiinflammatory drugs: a randomized controlled trial. Am J Phys Med Rehabil 2008; 87:258.
  24. Westby MD. A health professional's guide to exercise prescription for people with arthritis: a review of aerobic fitness activities. Arthritis Rheum 2001; 45:501.
  25. Hinman RS, Heywood SE, Day AR. Aquatic physical therapy for hip and knee osteoarthritis: results of a single-blind randomized controlled trial. Phys Ther 2007; 87:32.
  26. Jenkinson CM, Doherty M, Avery AJ, et al. Effects of dietary intervention and quadriceps strengthening exercises on pain and function in overweight people with knee pain: randomised controlled trial. BMJ 2009; 339:b3170.
  27. de Jong Z, Vliet Vlieland TP. Safety of exercise in patients with rheumatoid arthritis. Curr Opin Rheumatol 2005; 17:177.
  28. de Jong Z, Munneke M, Zwinderman AH, et al. Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Results of a randomized controlled trial. Arthritis Rheum 2003; 48:2415.
  29. van den Ende CH, Breedveld FC, le Cessie S, et al. Effect of intensive exercise on patients with active rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis 2000; 59:615.
  30. Mangione KK, McCully K, Gloviak A, et al. The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis. J Gerontol A Biol Sci Med Sci 1999; 54:M184.
  31. Gregor SM, Perell KL, Rushatakankovit S, et al. Lower extremity general muscle moment patterns in healthy individuals during recumbent cycling. Clin Biomech (Bristol, Avon) 2002; 17:123.
  32. Kerr A, Rafferty D, Moffat F, Morlan G. Specificity of recumbent cycling as a training modality for the functional movements; sit-to-stand and step-up. Clin Biomech (Bristol, Avon) 2007; 22:1104.
  33. Ericson MO, Nisell R. Patellofemoral joint forces during ergometric cycling. Phys Ther 1987; 67:1365.
  34. Ericson MO, Nisell R. Tibiofemoral joint forces during ergometer cycling. Am J Sports Med 1986; 14:285.
  35. Ericson M. On the biomechanics of cycling. A study of joint and muscle load during exercise on the bicycle ergometer. Scand J Rehabil Med Suppl 1986; 16:1.
  36. Breugem SJ, Haverkamp D, Sierevelt IN, et al. The important predictors of cycling use in three groups of knee patients. Disabil Rehabil 2011; 33:1925.
  37. Johnston TE. Biomechanical considerations for cycling interventions in rehabilitation. Phys Ther 2007; 87:1243.