tag:blogger.com,1999:blog-47161414414473901682024-02-07T02:42:17.255-08:00台北醫學大學附設醫院 骨科部 運動醫學科主任 吳家麟 醫師哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comBlogger20125tag:blogger.com,1999:blog-4716141441447390168.post-72551228419545975522020-06-20T22:26:00.000-07:002016-04-22T08:21:44.730-07:00吳家麟 / 保留關節 膝關節截彎取直術適合年輕患者<h2 id="story_art_title" style="background-color: white; border: 0px; color: #222222; font-family: 'Microsoft YaHei', 微软雅黑体, 'Microsoft JhengHei', 微軟正黑體, Arial, Helvetica, sans-serif; font-size: 32px; font-weight: normal; letter-spacing: 1px; line-height: 1.3; margin: 0px; padding: 0px 135px 0px 0px; text-align: justify; vertical-align: baseline;">
保留關節 膝關節截彎取直術適合年輕患者</h2>
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2015-07-29 12:08:20 <span style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">元氣網 文/吳家麟</span></h3>
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<dt style="background-image: none !important; border: 0px; color: #60a557; float: left !important; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; height: 20px; line-height: inherit; list-style: none; margin: 0px !important; max-width: 150px; overflow: hidden; padding: 0px !important; text-overflow: ellipsis; vertical-align: baseline; white-space: nowrap; width: auto !important;"><a href="http://health.udn.com/search/result/1005/%E9%97%9C%E7%AF%80%E7%BD%AE%E6%8F%9B" rel="86661" style="border: 0px; color: #60a557; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px 3px; outline: none medium; padding: 0px; text-decoration: none; vertical-align: baseline;">關節置換</a></dt>
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您是否已經厭煩吃止痛藥、維骨力、軟骨素? 醫師建議您打玻尿酸、復健、改變運動或生活型態,但仍無法減少因關節炎造成的疼痛不適呢?</div>
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年長者產生膝關節炎多因關節軟骨退化;年輕患者常因意外受傷或運動傷害,如車禍、半月軟骨損傷破裂、骨軟骨分離、前後十字韌帶斷裂或關節軟骨損傷,而造成不可逆的傷害,通常可透過醫師檢查及核磁共振(MRI)檢查得到正確的診斷。</div>
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如果經過保守治療如消炎止痛藥、玻尿酸或血小板注射、退化性膝關節炎護具或甚至關節鏡手術皆無法緩解症狀時,經醫師確定為關節軟骨損傷造成的關節變形,而患者仍然年輕(< 60歲),我會建議採取關節保留手術,即所謂矯正截骨手術來治療患者,也是所謂的「截彎取直手術」。</div>
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不論是創傷性關節炎或退化性關節炎的嚴重程度都是以X光檢測來做分類,關節間隙愈小代表關節炎愈嚴重,當上下骨頭都已經接觸,沒有關節間隙時即屬重度關節炎,通常關節內側退化會造成膝關節內翻(O型腿)、關節外側退化會造成膝關節外翻(X型腿),ㄧ般人身體重心會平均分配於兩腳,所以身體重力線會通過膝關節中心偏內側,因此關節炎多為膝內翻變形。</div>
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所以當產生膝內側關節炎時,內翻會更嚴重,導致行走疼痛、僵硬、甚至跛行,但此時膝關節外側反而沒有被使用到,所以我們可以利用外科技術將下肢脛骨沿內側切開,將O型腿截彎曲直到有點輕度外翻,即將重心從內側轉移到之前少使用的外側,再予以鋼板固定,這樣一來即可減少內側關節壓力,達到緩解疼痛症狀,也達到關節保留的目的;但對於膝關節外翻變形,截骨部位要在遠端大腿骨(股骨),將偏移至外側的重心轉移至關節內側,達成減壓目的。</div>
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這技術其實已行之多年,為何未被大量推廣?是因為人工膝關節置換術的成功,被喻為20世紀最成功的手術發明,但關節置換術仍有術後活動及使用年限上的限制,且由於近來人均壽命的延長,導致關節再置換的患者增加,但人工關節再置換的效果通常不如第一次置換,所以對於相對年輕的患者或年長者只有膝關節單一部份退化,可請骨科醫師評估是否適合先施行膝關節矯正截骨手術來延緩患者未來需接受人工膝關節置換的時間,減少未來再置換的機會。</div>
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再加上近來鈦合金鎖合式鋼板及人工代用骨的發展及進步,術後可以不需要石膏固定,大幅縮短術後恢復時間,也可以減少手術後發生併發症的機會,最大優點是術後還可以從事各種運動,比較沒有限制。</div>
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缺點是對於疼痛的緩解程度比較無法預期,但根據我個人多年手術經驗,只要慎選符合手術條件的患者,大部分術後都可得到相當程度的症狀緩解,對於相對年輕罹患關節炎的患者實為相較於人工關節置換術的另一種選擇。</div>
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<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">(本文作者為台北醫學大學骨科學系助理教授、台北醫學大學附設醫院骨科部主治醫師)<a href="http://health.udn.com/health/story/5967/1085992" target="_blank">http://health.udn.com/health/story/5967/1085992</a></strong></div>
哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-37312711175465709512016-11-16T01:06:00.000-08:002016-07-08T02:43:12.852-07:00吳家麟/誰說跑步傷膝蓋? 骨科醫師告訴你真相<span style="background-color: white; color: #222222; font-family: "helvetica" , "heiti tc" , "segoe ui" , "meiryo" ,; font-size: x-large; letter-spacing: 1px; text-align: justify;"><b>誰說跑步傷膝蓋? 骨科醫師告訴你真相</b></span><br />
<span style="background-color: white; color: #222222; font-family: "helvetica" , "heiti tc" , "segoe ui" , "meiryo" ,; font-size: 18px; letter-spacing: 1px; text-align: justify;"><br /></span>
<span style="background-color: white; color: #222222; font-family: "helvetica" , "heiti tc" , "segoe ui" , "meiryo" ,; font-size: 18px; letter-spacing: 1px; text-align: justify;">身為一名專業骨科醫師同時也是一名跑者,在外人眼中,經常覺得我的角色很衝突。</span><br />
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跑步傷膝蓋嗎?骨科醫師常跟民眾衛教跑步傷膝蓋,而我同時是跑步運動的愛好者,這問題也困擾我很久了,在這裡提出科學的證據來跟大家說明:</div>
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<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-caps: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="color: #0074ad;">跑步可延壽 但不是跑越多活越久</span></strong></div>
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根據最新研究資料顯示,跑步1分鐘約等於3~4分鐘的步行運動,證明跑步運動對於忙碌的現代人而言,其實是一個劇烈且有效率的運動。</div>
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最近美國骨科權威醫院梅約醫學中心集合美國的心臟病專家、運動生理學家、和流行病學專家,提出一份研究報告,文獻參考資料都包含至少500位以上跑者和至少5年的追蹤訪問,總結報告指出的跑步優點,不外乎可以改善體重、控制血壓和血糖、降低癌症風險、呼吸系統疾病、中風、性前列腺肥大與心血管和死亡的風險。ㄩ</div>
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研究也發現,<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-caps: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">跑步的量其實不需要非常多,</strong>大約每週10公里或約52分鐘,相較於沒有跑步的人,即可延長3至6年的壽命,並降低多種慢性疾病的風險;另外,較高的里程數或跑步距離並無法延長更多的壽命,卻也不至於帶來更高的運動風險;其中有一點特別有趣的發現是<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-caps: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">,跑步者有比較低的骨關節炎和接受髖關節置換手術的比例。</strong></div>
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<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-caps: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="color: #0074ad;">跑者膝關節炎比例 較非跑者來得低</span></strong></div>
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斯坦福大學一份自1984年持續追蹤跑者18年的長期研究發現,從來自45位跑者和53位非跑者的X光片中,跑者產生關節炎比例是20%,非跑者產生膝蓋關節炎的比例則是32%;此外,年長的跑者相較於同年齡的非跑者,有更強健的骨骼肌肉系統。</div>
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生物力學實驗也發現,跑步過程中,膝關節的最大負荷是走路步行時的3倍。但是若以固定距離來看,兩種運動造成膝關節負荷是一樣的,因為跑步過程中與地面的接觸時間比較短,造成的負擔也比較少。</div>
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從上述研究可以得到一個初步結論:「<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-caps: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">跑步並不會增加膝關節炎產生的機會,反而可以從跑步過程中促進軟骨的代謝、強化骨質,進而強化我們的關節</strong>」。</div>
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<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-caps: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="color: #0074ad;">預防關節炎 先避跑步運動傷害</span></strong></div>
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相對的,最近的研究發現急性膝關節損傷常造成膝關節炎,因此如何預防急性膝關節損傷的發生,才是預防關節炎發生的首要任務。以我個人的臨床經驗,跑步受傷常是因為:<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-caps: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">1.跑太快、2.跑太多、3.鍛鍊不足、4.場地不對、5.穿了不適合的跑鞋</strong>,造成關節軟骨或肌腱韌帶的損傷。因此,雖然證據顯示跑步並不會增加關節炎產生的機會,但也需量力而為。</div>
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去年我赴歐洲擔任訪問學者,也與各國專家討論到跑步到底會不會傷膝蓋,統一大家的結論就是:「如果您有健康的膝關節,不會因為跑步造成膝關節損傷,但如果您的膝關節已經有受傷,請諮詢專業骨科醫師是否適合跑步」。<br />
<a href="http://health.udn.com/health/story/5967/1410829" target="_blank">http://health.udn.com/health/story/5967/1410829</a></div>
哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-30812319290011443532016-10-02T19:51:00.000-07:002016-10-02T19:51:11.747-07:00如何挑選合適的加壓帶護具
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<span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">近來運動風氣盛行,因為運動傷害來求診的病患越來越多了,特別是在下肢傷害的部分更是顯著成長,尤其以膝關節韌帶或肌腱損傷最多,在治療期間除了給予消炎藥物、類固醇或<span lang="EN-US">PRP</span>注射,甚或手術關節鏡治療外,我還能給予他們甚麼樣的處置? 讓患者可以縮短治療的時程,提早回到運動場上或是未來預防降低運動傷害的再發生。功能性護具的選擇似乎扮演了一個很重要的角色,目前市面上護具琳瑯滿目,設計理念也不盡相同
因此也常困擾病患 不知如何挑選適當的護具,所以我就從解剖學與生物力學的角度來探討「<b><u>加壓於組織上<span lang="EN-US">(</span>肌腱或韌帶<span lang="EN-US">)</span>以減緩患處牽張的加壓帶」</u></b>這一類護具的使用方法與適應症。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;"> </span><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">在探討加壓帶護具選擇之前先讓我我們從膝蓋解剖構造上來了解膝部有哪些容易發生的病症<span lang="EN-US">?</span>首先我們將膝蓋從髕骨<span lang="EN-US">(</span>膝蓋中間的圓形膝蓋骨<span lang="EN-US">)</span>中心點畫上延長線剖成兩半<span lang="EN-US">:</span>分為內側、外側與中間部,外側最常發生所謂的跑者膝、外側韌帶、外側半月板損傷、髕骨外移造成的髕骨股骨磨損等症狀,而內側常見的就是所謂的內側大腿拉傷、內側半月板損傷、內側韌帶損傷與鵝足炎,中間則常看到跳躍膝等病症,當然這都需要專業醫師詳細的診斷才能確認,今天我們就針對加壓帶會使用到的病症做說明,分別是<span lang="EN-US">:</span>髂脛束症候群、髕骨肌腱炎、大腿拉傷等。<span lang="EN-US"><o:p></o:p></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3V5LRFHaky4IypWmYsyZnXbJdT6dICDNvmAfkt2jiMG0pCNZyqztwdNbEmZd7UP0ttXm_VnOMAfLDwOYce1uxqeUHxq0z37lEUiGnnUAI8Da3PRtRhSXAWbN8sGztgYlByMeJ9FfkBkQB/s1600/IMG_8135.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3V5LRFHaky4IypWmYsyZnXbJdT6dICDNvmAfkt2jiMG0pCNZyqztwdNbEmZd7UP0ttXm_VnOMAfLDwOYce1uxqeUHxq0z37lEUiGnnUAI8Da3PRtRhSXAWbN8sGztgYlByMeJ9FfkBkQB/s400/IMG_8135.PNG" width="400" /></a></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">市面上常見的加壓帶類型的護具有以下幾種<span lang="EN-US">:<u><o:p></o:p></u></span></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;"><span lang="EN-US"><br /></span></span></b></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">髕腱加壓帶<span lang="EN-US">:</span></span></b><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">在臨床上經常會遇到從事籃球或排球等跳躍性或負重性<span lang="EN-US">(</span>舉重<span lang="EN-US">)</span>運動的選手會發生所謂的髕骨肌腱炎的病症,俗稱跳躍膝或簡稱髕腱炎,這會在膝蓋正中間的髕骨肌腱上發生的炎症,這大多是因為股四頭肌頻繁的離心收縮<span lang="EN-US">(</span>如抬腿<span lang="EN-US">)</span>導致髕腱經常性的產生過度張力所致,也因此在這部位做加壓即能達到舒緩髕腱在產生離心收縮時的張力。<span lang="EN-US"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">髂脛束加壓帶<span lang="EN-US">:</span></span></b><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">髂脛束症候群常發生在長期有跑步習慣的族群身上,致使髂脛束緊張,髂脛束一緊張,在膝關節反覆彎曲的過程中就會反覆與股骨頭的外髁摩擦,以及在脛骨上的附著點處產生過度的張力,所以產生了大腿外側或膝蓋小腿外側會常有發炎疼痛的現象,髂脛束加壓帶能夠加壓在髂脛束上,致使症狀獲得舒緩。<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><o:p></o:p></span></b></span></div>
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</span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">大腿加壓護具<span lang="EN-US">:</span></span></b><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">大腿拉傷在各項運動都有可能發生,在反覆運動或訓練後,疲勞的肌肉就容易產生肌力下降的情況,這也是大腿拉傷的主因;另一方面在有碰撞性的運動,包含籃球或足球等等的運動因高度的衝撞力導致挫傷致使肌肉損傷的例子也屢見不鮮,而在這樣大腿損傷的處置或預防方法就可以用加壓的方式來緩和肌肉的收縮,而市面上的護具也多是利用彈性收縮或局部性的加壓方式產生對大腿肌肉的固定來緩和症狀。<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><o:p></o:p></span></b></span></div>
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<b>台北醫學大學附設醫院骨科部 吳家麟醫師</b></div>
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<!--EndFragment-->哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-65283244931274454402016-10-02T19:15:00.001-07:002016-10-02T19:18:26.910-07:00開始跑步前必須先做好的準備<div class="MsoNormal" style="text-align: center;">
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<span lang="EN-US" style="text-align: justify;">2015</span><span style="text-align: justify;">年,台灣辦了<span lang="EN-US">600</span>多場的路跑活動,路跑已經儼然成了潮流運動,為了健康,大家都動了起來。但隨之而來的是,人們總因為跑步運動過量、錯誤的準備觀念或不好的跑步姿勢造成了運動傷害,膝蓋痛、足部不適,甚至是臀部疼痛的症狀都接踵而來。究竟開始跑步前我們要做好那些準備呢<span lang="EN-US">?</span></span></div>
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<!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">髖關節的活動度與週邊肌群的彈性<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">髖關節的活動動作包括<span lang="EN-US">: (a)</span>屈曲與伸展<span lang="EN-US">(b)</span>外展與內收<span lang="EN-US">(c)</span>外旋與內旋,這些動作對與肌群的彈性有著很重要的關係,假使這些動作的活動角度差,也相對的意味著髖關節肌肉群出了些問題,所以在你跑步前,確認這些肌群的彈性與關節活動度正常是您開始從事長途跑步的第一要務。然而要將這些肌群調整到足以負荷長時間的運動的程度必須花一些時間,趕快找到專業醫師或運動治療師做諮詢吧!<span lang="EN-US"><o:p></o:p></span></span></div>
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</span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">髖關節週邊肌群的肌力<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">由於我們要跑步時,下肢承受了全身大部分的體重,髖關節、膝關節、踝關節在負重期時,如果某一關節的週邊肌群沒有足夠的肌力做支撐並完成協調動作的話,那麼這些重量就會很直接的由其他的關節週邊肌群與關節面來承受這些負重,可想而知,這會加重其他關節的負擔。然而,髖關節就在這運動的過程中扮演了啟動者的角色,如果髖關節週邊肌群無力時,</span><span style="color: #3c3c3c; font-family: 標楷體; mso-bidi-font-family: Arial; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">跛行或骨盆前傾的情況就可能發生,進而膝關節或踝關節呈現代償作用,緊接著從腰部開始、膝關節、踝關節不適的問題也隨之而來,所以在開始跑步前,也要開始準備鍛鍊髖關節週邊的肌群。<span lang="EN-US"><o:p></o:p></span></span></div>
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</span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">下肢肌群的彈性與關節活動度<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">跑步時,下肢的關節們各司其職的扮演好自己的角色,而且互相配合,就好像是齒輪般的環環相扣,相互影響。這其中的關節如果活動度較差或穩定度不足時,就很可能造成其他關節產生代償性動作,因此,時時保持踝關節或膝關節的活動度,並維持鍛鍊下肢肌群<span lang="EN-US">(</span>股四頭肌、腿後肌群、腓腸肌等<span lang="EN-US">)</span>,如此才能讓你的下肢在跑步時有正常的運作。<span lang="EN-US"><o:p></o:p></span></span></div>
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</span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">跑步的協調性<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">在各個關節與肌群都準備好了以後,將它們組合起來,靈活運作絕對是另一項大工程,建議可以在跑步前,做一些</span><span lang="EN-US"><a href="https://youtu.be/QtRFACcwxuE"><span lang="ZH-TW" style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">馬克操</span></a></span><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">的練習,馬克操是田徑選手在接受專業訓練前的必修項目,他能讓你的跑步更加敏捷且協調,雖然馬克操本來是用在訓練短跑選手的訓練菜單,但在跑步前把它當作熱身,將這些關節透過馬克操串聯起來,這絕對是有效率的方法之一。<span lang="EN-US"><o:p></o:p></span></span></div>
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</span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">正確的跑步姿勢<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">跑步姿勢一直是跑步愛好者或運動教練專家們不斷在探討的問題,但這問題並沒有定論,而跑步的項目與目的也將影響跑步時的策略,但今天單就傷害預防與健康運動的議題來討論跑步姿勢的話,我會有幾個建議。首先是,骨盆不要有骨盆前傾或骨盆下落的跑步姿勢出現,當然,這可能跟你肌肉無力有關,但也可能是你並不知道該如何在跑步時使用這些肌群。第二,保持重心微微前傾。第三,重心要完整的在足部轉移。<span lang="EN-US"><o:p></o:p></span></span></div>
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</span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">輕鬆舒適的心情<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<span style="font-family: 標楷體; mso-bidi-font-size: 12.0pt;">如果你將以上所敘述的事情都準備好了,那就請你穿著舒適的運動裝備,以愉快的心情去跑步吧<span lang="EN-US">!</span>如果沒有愉快的心情從事運動,那麼,緊張的心情可能會影響生理表現,那運動的效果也會大打折扣喔<span lang="EN-US">!<o:p></o:p></span></span></div>
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<span style="font-family: 標楷體;"><b>台北醫學大學附設醫院骨科部 吳家麟醫師</b></span></div>
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哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-58749558573149066162016-07-08T02:39:00.000-07:002016-07-08T02:45:27.803-07:00瘋深蹲 一定要注意這幾件事<br />
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【健康問蘋果】 瘋深蹲 一定要注意這幾件事</h1>
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<time class="" datetime="2016/06/10/" style="color: #616161; display: inline; vertical-align: middle !important;">2016年06月10日</time><br />
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<figure class="lbimg sgimg sglft" style="border: 0px; color: #505050; float: left; font-size: 15px; line-height: 1.2em; margin: 0px 1.5em 1em 0px; outline: 0px; padding: 0px 0px 0.75em; position: relative; width: 160px;"><a href="http://twimg.edgesuite.net//images/twapple/640pix/20160610/_Other/0114.jpg" style="border: 0px; cursor: pointer; display: block; height: 160px; margin: 0px; outline: none; overflow: hidden; padding: 0px; position: relative; text-decoration: none; width: 160px;" title="台北醫學大學附設醫院骨科主治醫師吳家麟說明正確的深蹲方式。胡瑞麒攝
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<BR>"><img src="http://twimg.edgesuite.net/images/thumbnail/20160610/37262560_ceeb73a296e995cec312fe4921d121d1_160x160.jpg" style="border: 0px; display: block; margin: 0px; outline: 0px; padding: 0px;" /><span style="background-image: url(http://twimg.edgesuite.net/appledaily/images/core/mggi.png); background-position: 0% 0%; background-repeat: no-repeat no-repeat; border: 0px; bottom: 0px; display: block; height: 46px; margin: 0px; outline: 0px; padding: 0px; position: absolute; right: 0px; width: 46px;"></span></a><span class="cpt" id="caption" style="border-bottom-color: rgb(157, 158, 166); border-bottom-style: solid; border-width: 0px 0px 1px; display: block; line-height: 1.3em; margin: 0px; outline: 0px; padding: 0.5em 0px;">台北醫學大學附設醫院骨科主治醫師吳家麟說明正確的深蹲方式。胡瑞麒攝<br /></span></figure><br />
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網友David問:想讓臀部及腿部線條更美,最近開始瘋深蹲健身,請問深蹲對塑形線條真的有幫助嗎?有沒有什麼需要注意的地方?</div>
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台北醫學大學附設醫院骨科主治醫師吳家麟答:深蹲健身最近十分流行,因深蹲須用到腰部、臀部、腿部等下半身力量,對於塑形臀部、腿部曲線相當有效。但深蹲健身時,一旁應有專業健身教練監督動作是否標準,因若腰部、腿部沒有足夠肌耐力,還是硬要深蹲,恐引發運動傷害。<br />
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一旦深蹲蹲的過深或過度用力,均造成膝關節疼痛、急性下背痠痛,甚至導致膝蓋後方的肌腱、關節囊發炎,或是膝蓋內側的韌帶發炎等。若要避免深蹲造成膝蓋、腰部傷害,建議深蹲時應注意姿勢,下背部要挺直。<br />
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尤其深蹲時,臀部下緣不應低於膝蓋高度,且膝蓋前緣的膝蓋骨不要超過腳趾頭,以防膝蓋承受太大壓力,當深蹲出現膝蓋、下背疼痛等不適,應立即以毛巾包覆冰塊,或用冰敷袋冰敷疼痛處,並休息7到10天,若症狀尚未緩解或疼痛越來越嚴重,應速就醫治療。(生活中心╱台北報導)</div>
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哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-77020985932084960922016-04-22T08:20:00.001-07:002016-04-22T09:08:04.969-07:00愛穿窄版運動鞋 跑到拇趾外翻<table align="center" border="0" cellpadding="5" cellspacing="0" style="background-color: white; color: black; font-family: Arial, Helvetica, sans-serif; font-size: 15px; line-height: 25px; width: 630px;"><tbody>
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<span style="font-size: large;">愛穿窄版運動鞋 跑到拇趾外翻</span></h2>
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不是只有高跟鞋會造成拇指外翻,小心跑步鞋也有可能!醫生指出亞洲人的前腳較寬,但是購買運動鞋時,卻常挑選細長窄板歐美規格的跑步鞋,長期擠壓下,就容易造成拇指外翻。<br />
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東挑西選,每個人對跑步鞋的選擇有一套自我哲學。<br />
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民眾:「我會穿寬一點,不會穿那個太窄的,這個厚度要稍微高一點點這樣子。」<br />
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顏色鮮豔的跑步鞋款式多樣化,然而要是選錯了,跑起步來不僅不舒服,嚴重還有可能傷害腳趾頭。日前一位民眾,因為長期穿著窄板運動鞋跑馬拉松,導致拇指嚴重外翻,痛到不能走路。<br />
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北醫附醫骨科醫師 吳家麟:「你有時候在穿的時候,大家就是會將就那個樣式,所以長時間,你的前足受到的壓力比較大,進而你的大拇指就受到壓迫,那長時間穿下來之後,你的腳慢慢隨著時間,它會慢慢會有輕微,會有拇指外翻的症狀。」 </div>
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到底跑步鞋要怎麼選,醫生建議,鞋底要比腳板寬一點點,或是手放近鞋子後方保留下一根手指的空隙,確保自己的腳能舒適的走動。<br />
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業者:「在設計的部分,有很大的部分在你的楦頭,像亞洲人的腳型,是比較屬於寬一點,可能在這個腳背的部分,肉是比較厚的所以當你去選到,歐規或是美規,不太合腳的這個楦頭,你可能穿起來就會覺得不太舒服。」<br />
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醫生提醒只要發現大拇指微凸,或是容易磨到鞋子,就要特別留意鞋子是否合適,千萬別為了鞋子好看而苦了自己的腳。<br />
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雷雅 鄧應忠 台北報導(2015.12.07)</div>
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<a href="http://www.daai.tv/daai-web/news/content.php?id=968023" target="_blank">http://www.daai.tv/daai-web/news/content.php?id=968023</a></div>
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哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-73643725304480041682016-04-21T22:16:00.001-07:002016-04-22T04:04:48.294-07:00吳家麟/最原始跑法:赤腳跑,更能減少運動傷害?<span style="background-color: white; color: #222222; font-family: "helvetica" , "heiti tc" , "segoe ui" , "meiryo" ,; font-size: x-large; letter-spacing: 1px; line-height: 30px; text-align: justify;"><b>最原始跑法:赤腳跑,更能減少運動傷害?</b></span><br />
<span style="background-color: white; color: #222222; font-family: "helvetica" , "heiti tc" , "segoe ui" , "meiryo" ,; font-size: x-large; letter-spacing: 1px; line-height: 30px; text-align: justify;"><b><br /></b></span>
<span style="background-color: white; color: #222222; font-family: "helvetica" , "heiti tc" , "segoe ui" , "meiryo" ,; font-size: 18px; letter-spacing: 1px; line-height: 30px; text-align: justify;">前陣子看上一雙跑鞋,只注意到它的圖樣及配色非常吸引我,當下就喪失理智結帳離開。回家打開一看,才發現買到了所謂的競技鞋款:鞋子很輕、底很薄,以及前後足的高度落差很小。興奮地穿上它跑了10K,發現小腿酸痛、前足部不適,然而隨著使用次數增加,不適感漸漸趨緩,而且跑步速度加快了;之後改穿幾次厚底跑鞋,避震功能好,跑起來也舒適,但覺得有拖累感,無法加速。</span><br />
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<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="color: #0074ad;">選鞋如選車 求速度或舒適度</span></strong></div>
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這經驗令我聯想起超級跑車。超級跑車需要速度和操控性,就必須犧牲舒適度,使用輕量化車身結構、低扁平比的跑胎及優異的懸吊,提供清晰的路感回饋。再以房車來說,房車強調舒適性,所以就使用厚胎。這跟選擇跑鞋的觀念不謀而合。在參加慢跑活動時,偶爾會看到有人打赤腳跑,或穿著所謂的極簡跑鞋(Minimalist Shoes)— 輕量化、薄底、充裕足趾空間及很小的前後足高度落差,<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">這些情況都是想要盡量減少足下重量,以及增加足部的感覺回饋性。</strong></div>
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回顧赤腳跑或極簡跑鞋的歷史,早在1960年,衣索匹亞選手比基拉(Abebe Bikila)就是第一個登上國際舞台的赤腳跑者,並獲得羅馬奧運馬拉松冠軍(2:15:16);日本跑者 Shigeki Tanaka於1951年穿著自製的足趾分開襪鞋,贏得波士頓馬拉松;英國Tim Johnston 於1967 赤腳贏得國際越野大賽; 來自南非的赤腳天使Zola Budd贏得1985及1986年的國際越野大賽冠軍,還破了多次世界紀錄,這些都是赤腳跑或薄底跑鞋的先驅,也確實為赤腳跑步或極簡跑鞋提供了相當有利的實證。</div>
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<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="color: #0074ad;">穿跑鞋更傷?運動傷害高達79%</span></strong></div>
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超乎一般人預期,穿跑鞋跑步造成的相關運動傷害高達79%。學理上,大家認為具避震功能或足跟較高的跑鞋有如下缺點:</div>
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1、<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">鞋跟較高的跑鞋相對於鞋底比較薄的跑鞋,會使得足部活動性變少</strong>,阿基里氏腱、足底筋膜和小腿肌肉也相對變短,不利於產生強大的推力;也因高鞋跟會使得後足先著地,造成足部負荷壓力增加,進而導致受傷。</div>
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2、跑步時,<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">你的腳長度可能會增加1公分以上,寬度會增加原來的15%</strong>。因此不當的鞋子大小和形狀,容易造成如甲溝炎、拇囊炎、雞眼、錘狀趾或拇趾外翻等毛病,但現今大多數跑鞋的設計都會限制足趾的靈活度。不適合的鞋子也可能導致你的身體肌肉不平衡,進而造成足部、膝關節和髖關節的損傷。</div>
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3、經常被大家忽略的還有<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">對於神經肌肉系統的控制,</strong>特別是大腳趾的屈肌腱,負責積極協調站立、走路和跑步的運作。舉例來說,當你穿的鞋子因過度避震或過度增加舒適性,減少了腳部接受到的地面回饋反應,隨著時間推移,會漸漸讓腳部神經敏感度變得遲鈍,導致你無法即時調整跑步時的姿勢與狀況。</div>
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<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">那麼,赤腳跑步真的可以降低受傷的風險嗎?</strong></div>
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普遍認為,赤腳跑步可以產生前中足先著地的跑步姿勢,強化足踝的肌肉強度,進而減少受傷的情況。2015年英國運動醫學雜誌收集201位有經驗的赤腳及穿鞋跑者進行為期一年的追蹤研究,報告指出,赤腳跑步並不會提高整體運動傷害的發生率,同時可以保護膝關節,減少足底筋膜炎的發生。但赤腳跑步有時會造成小腿後肌腱的拉傷,因此強調必須充分加強這些肌肉群。同時,赤腳跑也有較高比例的足底傷害,如穿刺傷、水泡、瘀傷、足趾碰撞傷等。</div>
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2016美國運動醫學期刊則利用前瞻性研究發現,26位跑者在經過8週赤腳跑步訓練,約有25%的跑者有正面的評價,數據顯示這群跑者訓練後足部負荷率下降、足踝往下活動的角度增加,而且腿後肌群的力量增強了,如股二頭肌及臀中肌;反應不佳的跑者(約23%)訓練後,反而造成足部負荷率上升。</div>
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所以目前來看,對於赤腳跑步的優點或是哪類型的跑者適合做此種訓練,在科學證據上尚沒有定論。但是根據文獻資料報告總結,赤腳跑步對於經常受傷或曾經受傷的跑者,在經過適當的過渡訓練後,不失為另一種選擇。</div>
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<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">那要如何判斷自己適不適合赤腳跑步呢?</strong></div>
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根據國外權威期刊建議,首先必須先測量你的足踝部的柔軟度來決定。如踝關節活動度、大足趾活動度、站立時對大足趾的控制度及單腿站立的平衡狀況,若測試狀況不佳,表示阿基里氏腱或足底筋膜太緊繃,或身體還無法具體有效地支配你的足部肌肉。建議你可以先從事拉筋或肌肉強化運動。</div>
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<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="color: #0074ad;">如果真的想嘗試赤腳跑,又要如何開始呢?</span></strong></div>
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建議可以先從赤腳走路開始。隨著時間或公里數的增加,慢慢的換成薄底運動鞋,最後再轉換成赤腳或極簡跑鞋。也許最終你仍無法達成赤腳跑步的目標,<strong style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">但這過程可以讓你對跑步運動有更深的體會,並學習如何控制足部的肌肉</strong>,進而調整跑步姿勢,減少運動傷害,最後找到一種真正適合自己的跑法。</div>
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根據我多年的觀察,每個人的身體結構、肌耐力、足型及走路方式(步態)都不同,所以用少數幾種鞋子的型態並無法滿足所有人的需求。客製化的產品也許可以解決個體間的差異性,但成本又太高;所以我認為提倡赤腳跑或穿所謂的極簡跑鞋的觀念,是以對足部最自然、最原始、最少干擾的方法,來達成跑步這個原本就是種本能的運動。<strong style="border: 0px; margin: 0px; padding: 0px; vertical-align: baseline;">但我認為這只是一種選項,</strong>也許可以透過交叉訓練的方式,來增加適應性。我也建議從已經有過中長距離經驗的跑者開始嘗試,方能減少訓練期間造成的傷害。當然,運動同時也要兼顧安全,慎選跑步的環境及場地品質,以免造成足部的傷害,那就得不償失了。<a href="http://health.udn.com/health/story/9268/1502551" target="_blank">http://health.udn.com/health/story/9268/1502551</a></div>
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哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-73728466001695802942016-04-21T20:56:00.002-07:002016-04-21T21:49:01.735-07:00上班族久坐不動亞洲第一 恐致早死<div class="separator" style="clear: both; text-align: center;">
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http://tube.chinatimes.com/20160421004094-261403哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-53283632862328291162015-10-05T23:21:00.002-07:002016-04-21T23:22:47.756-07:00為一生必跑馬拉松 打針吞藥止痛拚圓夢?<br />
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為一生必跑馬拉松 打針吞藥止痛拚圓夢?</h1>
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<time datetime="2015/05/19 00:00" style="display: inline-block; line-height: 1.5; margin: 15px 3px 0px 0px; padding-right: 0px;">2015年05月19日 04:10</time><br />
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<img alt="為一生必跑馬拉松 打針吞藥止痛拚圓夢?" class="h" data-aspect-ratio="1.6197530864197531" data-height="405" src="http://img.chinatimes.com/newsphoto/2015-05-19/656/bd0300_p_05_02.jpg" data-width="656" style="border: 0px; display: block; height: auto; margin: 0px auto; max-width: 645px; outline: none 0px; padding: 0px;" title="為一生必跑馬拉松 打針吞藥止痛拚圓夢?" /></div>
<figcaption style="background-color: #efefef; border: 0px none; color: #6d6d6d; font-size: 0.9em; margin: 0px; outline: none 0px; padding: 10px 15px; word-break: break-all;">民眾瘋路跑,有人還吞胃藥、打止痛針上陣,醫師認為將影響身體健康,疾呼不該仿效。(本報資料照)</figcaption><div>
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登玉山、單車環島、泳渡日月潭不夠看,台灣人瘋路跑,現在完成一趟全程馬拉松,更被列為人生必做的10件事之一,為了順利達標,不少網友分享路跑祕訣及心得,其中竟有人提到自己為了順利完成「全程馬拉松」,賽前吞止痛藥、到醫院裝病打止痛針,就是要緩解腸胃、膝蓋痛感,成功完成全馬紀錄。</div>
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不少醫師承認有民眾前來諮詢,想了解用哪種止痛藥比較有效,即便勸阻他們,也堅持要做,強調「我只是為了圓夢想一次,不會長期依賴,醫師你就別阻止我了。」</div>
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醫師透露,透過吃止痛藥完成比賽的人,多數會選擇4小時短效的非類固醇抗發炎藥物,約賽前30分鐘吃,可讓自己身體各部位的發炎反應延緩,進而完成比賽,多數選手一場半馬比賽約2小時即可完賽,全馬則要5小時左右。</div>
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2005年國內僅辦理42場路跑賽</div>
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,2011年成長到約150場,到了2014年已經增加到448場,短短10年內成長逾10倍。除了基礎組的5公里、9公里組外,許多民眾還會挑戰42公里的全程馬拉松或是21公里的半程馬拉松。</div>
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自己也跑馬拉松的亞東醫院急診部主任洪芳明說,一般人突然挑戰半馬或是全馬,會對膝蓋、腳踝、腸胃造成極大負擔,甚至發炎,對身體有很嚴重的傷害,因為痛覺是發炎部位對大腦所發出的求救訊號,如果使用止痛藥忽略痛感,等到完成賽事後,受傷部位會更嚴重,民眾要花更多力氣休養。</div>
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台北醫學大學骨科部主治醫師吳家麟表示,曾有40多歲的男性跳戰日前的烏來峽谷半馬賽事,上上下下的路程,讓膝蓋承受十分大的壓力,最後該患者忍耐至賽事結束後才來檢查,竟發現膝蓋的半月軟骨已經破損,必須馬上開刀治療,休息好幾天後才能上班,得不償失。</div>
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醫師提醒,馬拉松是相當激烈的運動,對心肺、膝蓋、腳踝都有相當程度的負擔,民眾應量力而為,而不是為了圓夢,把自己的健康賠進去。</div>
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<a href="http://www.chinatimes.com/newspapers/20150519000905-260113" target="_blank">http://www.chinatimes.com/newspapers/20150519000905-260113</a></div>
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</article>哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-3571104042395490972015-10-05T23:18:00.002-07:002016-04-21T22:03:43.978-07:00小心!天天穿慢跑鞋 腳趾挫傷吃蘿蔔<div class="separator" style="clear: both; text-align: center;">
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<a href="http://www.chinatimes.com/newspapers/20150930000373-260114"></a>哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-44449263585653716132015-10-05T23:06:00.003-07:002016-07-08T02:50:29.140-07:00膝關節炎不需換關節 <!--EndFragment--><br />
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<span style="font-family: inherit;"><span style="font-size: 18pt;"> 膝關節截彎取直</span><span lang="EN-US" style="font-size: 18pt;">-</span><span style="font-size: 18pt;">矯正截骨術</span> </span></h2>
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<div style="text-align: center;">
<span style="font-family: inherit;"> 台北醫學大學附設醫院骨科部 吳家麟 醫師</span></div>
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<span style="font-family: 新細明體; font-size: 16.0pt; mso-ascii-theme-font: minor-fareast; mso-bidi-font-family: Arial; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-font-kerning: 0pt; mso-hansi-theme-font: minor-fareast;">您是否已經厭煩吃止痛藥、維骨力、軟骨素<span lang="EN-US">? </span>醫師建議您打玻尿酸、復健、改變運動或生活型態,但仍無法減少因關節炎造成的疼痛不適呢?年長者產生膝關節炎多因膝關節軟骨退化;年輕患者常因意外受傷或運動傷害,如車禍、半月軟骨損傷破裂、骨軟骨分離、前後十字韌帶斷裂或關節軟骨損傷,而造成不可逆的傷害,通常可透過醫師檢查及核磁共振<span lang="EN-US">(MRI)</span>檢查得到正確的診斷。</span><span lang="EN-US" style="font-family: 新細明體; font-size: 16.0pt; mso-ascii-theme-font: minor-fareast; mso-bidi-font-family: Times; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-font-kerning: 0pt; mso-hansi-theme-font: minor-fareast;"><o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_XbNIzyNl12RaVcXq-63GsaxmJtFYz5-fWdTUZfbizOui2AxCKwMs5XIhNtYUV6HrhUD8vglNDE4IDhl7zqv-bSN1K87ubnWzoSSPRcyVt-K93O2ViBe3RL0o2ih_7ayO7cgXFFUapiLv/s1600/HTO.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black; font-family: "arial" , "helvetica" , sans-serif;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_XbNIzyNl12RaVcXq-63GsaxmJtFYz5-fWdTUZfbizOui2AxCKwMs5XIhNtYUV6HrhUD8vglNDE4IDhl7zqv-bSN1K87ubnWzoSSPRcyVt-K93O2ViBe3RL0o2ih_7ayO7cgXFFUapiLv/s640/HTO.jpg" width="640" /></span></a></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"> </span><span style="font-family: 新細明體; font-size: 16pt; text-align: center;">圖一</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: 11.0pt;"><b><u>若有任何相關問題
請洽台北醫學大學附設醫院骨科部 吳家麟 醫</u></b></span><span style="font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b><u>師</u></b></span><span lang="EN-US" style="font-family: "biaukai"; font-size: 11pt;"><o:p></o:p></span></span></div>
</div>
哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-30635369249800246152015-10-05T22:27:00.000-07:002016-04-22T09:06:52.884-07:00足底筋膜炎<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<h2 style="text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="color: #1a1a1a; font-family: "biaukai"; font-size: x-large; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">足底筋膜炎</span></b></h2>
<div style="text-align: center;">
<span style="mso-bidi-font-weight: normal;"><span style="color: #1a1a1a; font-family: "biaukai"; font-size: 14.0pt; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">吳家麟醫師</span></span></div>
<div style="text-align: center;">
<span style="mso-bidi-font-weight: normal;"><span style="color: #1a1a1a; font-family: "biaukai"; font-size: 14.0pt; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;"><br /></span></span></div>
<b style="mso-bidi-font-weight: normal;"><span style="color: #1a1a1a; font-family: "biaukai"; font-size: large; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">前言:</span></b></div>
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<span style="font-size: large;"><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">約有<span lang="EN-US">10%</span>的成人會有足跟疼痛的機會,足跟疼痛是常見的骨科疾病,但由於局部解結構複雜,有時要精確的診斷是非常具有挑戰性的,可能的鑑別診斷包括足底脂肪萎縮</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">足底筋膜炎</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">外側足底神經分支嵌制</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">跟骨疲勞性骨折或脛神經嵌制症候群都可能引起足跟疼痛(圖ㄧ),而足底筋膜炎是成人足跟疼痛最常見的原因,每年約影響二百萬美國人,好發於<span lang="EN-US">40</span>至<span lang="EN-US">60</span>歲,常好發于年輕的跑步運動員(約<span lang="EN-US">10%</span>),有三分之一的病人會兩側發生,此時應該要考慮該疾患是由於厲害的發炎反應所產生。</span></span><br />
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<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<b style="mso-bidi-font-weight: normal;"><span style="color: #1a1a1a; font-family: "biaukai"; font-size: large; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">解剖:<span lang="EN-US"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: large;"><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">足底筋膜起源於足跟骨內側並往前扇形展開附著於近端趾骨基部並與周圍組織相連接,特別是當大足趾過度背屈時會加強其絞盤機轉(<span lang="EN-US">windlass mechanism</span>),進而增加足底筋膜壓力及增加內側足弓角上抬角度</span><span style="font-family: "biaukai"; mso-bidi-font-family: Arial; mso-font-kerning: 0pt; mso-hansi-font-family: 標楷體;">;</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">足底筋膜本身也只能延長其本身長度約<span lang="EN-US">4%</span>,故缺乏彈性,所以容易產生足底筋膜炎。<span lang="EN-US"><o:p></o:p></span></span></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<b style="mso-bidi-font-weight: normal;"><span style="color: #1a1a1a; font-family: "biaukai"; font-size: large; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">病理機轉及成因:<span lang="EN-US"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: large;"><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">足底筋膜炎一般認為是由於足底筋膜反覆不斷的微小受傷<span lang="EN-US">(microtrauma)</span>及過度拉扯所致,早期認為它是一種發炎性疾病,最近研究指出它是一種退化的過程而非發炎性疾病,小腿阿基里氏腱或腓腸肌腱過度緊繃以致於減少踝關節的背屈活動範圍也可能跟形成發展足底筋膜炎有關</span><span style="font-family: "biaukai"; mso-bidi-font-family: Arial; mso-font-kerning: 0pt; mso-hansi-font-family: 標楷體;">;</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">肥胖及工作久站著也是好發的危險族群</span><span style="font-family: "biaukai"; mso-bidi-font-family: Arial; mso-font-kerning: 0pt; mso-hansi-font-family: 標楷體;">;</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">其它如老年人</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">穿不適當的鞋子</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">過度訓練及減少距骨下關節的活動性也是可能的誘發原因。<span lang="EN-US"><o:p></o:p></span></span></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<b style="mso-bidi-font-weight: normal;"><span style="color: #1a1a1a; font-family: "biaukai"; font-size: large; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">症狀:<span lang="EN-US"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;"><a href="https://www.blogger.com/blogger.g?blogID=4716141441447390168" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"></a></span></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;"><a href="https://www.blogger.com/blogger.g?blogID=4716141441447390168" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"></a></span></div>
<span style="color: #1a1a1a; font-family: "biaukai"; font-size: large; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">患者通常會有一開始走路疼痛的症狀,內側足跟的疼痛常發生於早晨下床的第一步或長時間休息後的起步時,通常是有如針刺般的劇烈疼痛,但通常只侷限於足跟內側,檢查時在內側足跟骨有明顯壓痛,甚至會擴及整個足底筋膜,尤其將足趾做背屈動作時會令壓痛更加明顯,若有踝關節的背屈活動範圍減少則有可能是由於阿基里氏腱或腓腸肌腱過度緊繃或攣縮所造成。<span lang="EN-US"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<b style="mso-bidi-font-weight: normal;"><span style="color: #1a1a1a; font-family: "biaukai"; font-size: large; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">診斷:<span lang="EN-US"><o:p></o:p></span></span></b></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo2; mso-para-margin-left: 0gd; text-align: justify; text-indent: -24.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><a href="https://www.blogger.com/blogger.g?blogID=4716141441447390168" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=4716141441447390168" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><span style="font-size: large;"><span lang="EN-US" style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: BiauKai; mso-font-kerning: 0pt; mso-hansi-font-family: Times;"><span style="mso-list: Ignore;">1.<span style="font-family: 'times new roman'; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">通常並不需要做影像學檢查來確定診斷。<span lang="EN-US"><o:p></o:p></span></span></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo2; mso-para-margin-left: 0gd; text-align: justify; text-indent: -24.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: BiauKai; mso-font-kerning: 0pt; mso-hansi-font-family: Times;"><span style="mso-list: Ignore;">2.<span style="font-family: 'times new roman'; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">站立的足部<span lang="EN-US">X</span>光檢查,可用來排除退化及骨頭結構上的異常,有時會發現跟骨有骨刺或足底筋膜鈣化,但只有約<span lang="EN-US">5%</span>的病患與跟骨骨刺有相關性,因為常在沒有症狀的病人上發現,而且解剖研究也証實這些跟骨骨刺並不是位在足底筋膜上。<span lang="EN-US"><o:p></o:p></span></span></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo2; mso-para-margin-left: 0gd; text-align: justify; text-indent: -24.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: BiauKai; mso-font-kerning: 0pt; mso-hansi-font-family: Times;"><span style="mso-list: Ignore;">3.<span style="font-family: 'times new roman'; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">核磁共振檢查也很少需要用來診斷足底筋膜炎,但可用來排除跟骨的疲勞性骨折。<span lang="EN-US"><o:p></o:p></span></span></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<b style="mso-bidi-font-weight: normal;"><span style="color: #1a1a1a; font-family: "biaukai"; font-size: large; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">治療:<span lang="EN-US"><o:p></o:p></span></span></b></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-align: justify; text-indent: -24.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: BiauKai; mso-font-kerning: 0pt; mso-hansi-font-family: Times;"><span style="mso-list: Ignore;">1.<span style="font-family: 'times new roman'; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">保守治療如休息</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">物理治療</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">居家拉筋運動</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">冰敷(<span lang="EN-US">20</span>分鐘<span lang="EN-US">/</span>每天<span lang="EN-US">3-4</span>次)</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">減重</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">調整鞋類穿著</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">使用鞋跟墊或穿矯正鞋墊</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">非類固醇類止痛藥都可成功的來治療足底筋膜炎,另外也需減少打赤腳或穿著支稱性不足的鞋類走動。<span lang="EN-US"><o:p></o:p></span></span></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-align: justify; text-indent: -24.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: BiauKai; mso-font-kerning: 0pt; mso-hansi-font-family: Times;"><span style="mso-list: Ignore;">2.<span style="font-family: 'times new roman'; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">約有<span lang="EN-US">90%</span>的病患在經過十個月簡單的復健治療可以改善症狀。<span lang="EN-US"><o:p></o:p></span></span></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-align: justify; text-indent: -24.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: BiauKai; mso-font-kerning: 0pt; mso-hansi-font-family: Times;"><span style="mso-list: Ignore;">3.<span style="font-family: 'times new roman'; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">經治療,若上述症狀無法改善,其他如使用夜間型夾板輔具用來緩解腓腸肌腱及足底筋膜的過度緊繃及攣縮</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">定製鞋墊或ㄧ段時間的固定治療也可用來緩解症狀。<span lang="EN-US"><o:p></o:p></span></span></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-align: justify; text-indent: -24.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: BiauKai; mso-font-kerning: 0pt; mso-hansi-font-family: Times;"><span style="mso-list: Ignore;">4.<span style="font-family: 'times new roman'; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;">對於症狀嚴重無法緩解的病患可以給予類固醇或血小板<span lang="EN-US">(PRP)</span>的注射或震波<span lang="EN-US">(ESWT)</span>治療。<span lang="EN-US"><o:p></o:p></span></span></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-align: justify; text-indent: -24.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: BiauKai; mso-font-kerning: 0pt; mso-hansi-font-family: Times;"><span style="mso-list: Ignore;">5.<span style="font-family: 'times new roman'; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span style="color: #1a1a1a; font-family: "biaukai"; mso-bidi-font-family: Times; mso-font-kerning: 0pt; mso-hansi-font-family: Times;"><span style="font-size: large;">若經上述保守治療<span lang="EN-US">12</span>個月後仍無明顯改善,則考慮作手術治療。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "biaukai";"><u>若有任何相關問題 請洽台北醫學大學附設醫院骨科部 吳家麟 醫師<span lang="EN-US"><o:p></o:p></span></u></span></div>
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哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-4157044647921968912013-12-09T03:36:00.002-08:002016-04-22T09:20:25.358-07:00認識退化性膝關節炎<div align="center" class="MsoListParagraph" style="margin-left: 24.0pt; mso-para-margin-left: 0gd; text-align: center;">
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<span style="font-size: x-large;">認識退化性膝關節炎</span></h2>
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吳家麟醫師</div>
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<span lang="EN-US" style="font-family: "wingdings"; font-size: 14.0pt;"><span style="mso-list: Ignore;"><br /></span></span>
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; font-size: 14.0pt;"><span style="mso-list: Ignore;"><img alt="*" height="12" src="file://localhost/Users/wujia-lin/Library/Caches/TemporaryItems/msoclip/0/clip_image001.png" width="12" /><span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "biaukai"; font-size: large;">前言:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "biaukai"; font-size: large;">退化性膝關節炎是是相當常見的疾病,年齡是其發展的主要風險因素,在<span lang="EN-US">60</span>歲以上的老人,女性有<span lang="EN-US">25%</span>,男性有<span lang="EN-US">15%</span>,加上亞洲人勤勞的特質,比例更是居高不下。退化性膝關節炎的臨床表現包括關節疼痛,僵硬,喪失關節活動度等。現在醫學已有ㄧ套完整的治療計畫,幫助這類病患對抗退化性關節炎。<span lang="EN-US"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings";"><span style="mso-list: Ignore;"><img alt="*" height="12" src="file://localhost/Users/wujia-lin/Library/Caches/TemporaryItems/msoclip/0/clip_image001.png" width="12" /><span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "biaukai";">膝關節及關節軟骨功能<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-size: large;"><span style="font-family: "biaukai";">膝關節的功能主要在承受身體的重量,可以作下肢彎曲</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="font-family: "biaukai";">伸展</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="font-family: "biaukai";">旋轉等動作</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">;</span><span style="font-family: "biaukai";">並作為日常活動的重要功能。而關節軟骨可以保護關節,減緩骨頭承受身體重量時的壓力及行走時的震動。其中軟骨會隨著磨損持續更新或修補,維持其保護關節的功能。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings";"><span style="mso-list: Ignore;"><img alt="*" height="12" src="file://localhost/Users/wujia-lin/Library/Caches/TemporaryItems/msoclip/0/clip_image001.png" width="12" /><span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "biaukai";">什麼是退化性關節炎<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-size: large;"><span style="font-family: "biaukai";">主要是因為老化或創傷造成的關節軟骨病變</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">軟骨逐漸磨損退化並引起發炎</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">使原本關節因磨損致承受壓力的功能變差</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">病患在活動時有關節疼痛或因關節積水致關節活動受限的</span><span style="font-family: "biaukai"; mso-bidi-font-family: "Heiti TC Light"; mso-hansi-font-family: "Heiti TC Light";">症狀產生</span><span style="font-family: "biaukai"; mso-bidi-font-family: "Heiti TC Light"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai"; mso-bidi-font-family: "Heiti TC Light"; mso-hansi-font-family: "Heiti TC Light";"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings";"><span style="mso-list: Ignore;"><img alt="*" height="12" src="file://localhost/Users/wujia-lin/Library/Caches/TemporaryItems/msoclip/0/clip_image001.png" width="12" /><span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "biaukai";">疾病症狀<span lang="EN-US"><o:p></o:p></span></span></span></div>
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</span></span></span><!--[endif]--><span style="font-family: "biaukai";">早期</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">:</span><span style="font-family: "biaukai";"> 病人並不覺得疼痛<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;">
</span></span></span><!--[endif]--><span style="font-family: "biaukai";">中期</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">:</span><span style="font-family: "biaukai";"> 深及關節的酸痛</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">在使用膝關節時</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">如爬樓梯</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="font-family: "biaukai";">蹲下等</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">疼痛會加劇</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">而休息時酸痛則緩解</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;">
</span></span></span><!--[endif]--><span style="font-family: "biaukai";">晚期</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">:</span><span style="font-family: "biaukai";"> 關節疼痛加劇</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">且可能會關節變形</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">致關節所能活動的角度變小</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l7 level1 lfo1; mso-para-margin-left: 0gd; text-align: justify; text-indent: -24.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings";"><span style="mso-list: Ignore;"><img alt="*" height="12" src="file://localhost/Users/wujia-lin/Library/Caches/TemporaryItems/msoclip/0/clip_image001.png" width="12" /><span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "biaukai";">退化性關節炎的治療</span><span style="font-family: "biaukai";">—</span><span style="font-family: "biaukai";">根據病程的發展給予不同的治療<span lang="EN-US"><o:p></o:p></span></span></span></div>
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</span></span></span><!--[endif]--><span style="font-family: "biaukai";">保守療法:以物理治療減輕腫脹及疼痛的症狀</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">針對早期病症有較佳效果</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;">
</span></span></span><!--[endif]--><span style="font-family: "biaukai";">藥物:減少痛楚或減輕發炎程度</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">但不能根治已退化的關節</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span style="font-family: "biaukai";">止痛藥包括有消炎和止痛作用的(非類固醇)消炎止痛藥</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">必須按醫生的指示下使用</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,長期使用須注意腸胃道或腎臟副作用。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 84.0pt; mso-list: l10 level3 lfo12; mso-para-margin-left: 0gd; text-align: justify; text-indent: -24.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "biaukai";">輕度膝關節炎可適度服用<span lang="EN-US">Glucosamine (</span>維骨力<span lang="EN-US">)</span></span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">每日不超過<span lang="EN-US">1500</span>毫克</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "biaukai";">注射類固醇</span><span style="font-family: "biaukai";">:在關節內注射此藥物</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">能止痛併減緩關節積水情況</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">但過度使用會令其退化惡化</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">雖屬標準療法</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">但須謹慎使用</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 84.0pt; mso-list: l10 level3 lfo12; mso-para-margin-left: 0gd; text-align: justify; text-indent: -24.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "biaukai";">玻尿酸關節內注射</span><span style="font-family: "biaukai";">:利用補充關節內原有的玻尿酸回復膝關節功能</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,具有抗</span><span style="font-family: "biaukai";">發炎及潤滑關節功能</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">能減緩關節病變對膝關節的傷害</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。每個療程為期五週,每週施以關節內注射ㄧ次,效果約可持續半年。</span><span style="font-family: "biaukai";"> <span lang="EN-US"><o:p></o:p></span></span></span></div>
<div class="MsoListParagraph" style="margin-left: 84.0pt; mso-list: l10 level3 lfo12; mso-para-margin-left: 0gd; text-align: justify; text-indent: -24.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="color: black; font-family: "biaukai"; mso-bidi-font-family: Arial; mso-hansi-font-family: 標楷體;">血小板血漿治療(稱為<span lang="EN-US">PRP</span>)</span><span style="font-family: "biaukai";">:</span><span style="color: black; font-family: "biaukai"; mso-bidi-font-family: Arial; mso-hansi-font-family: 標楷體;">是利用自己的血液分離出血液中的血小板,再把血小板所含的生長因子萃取出來,注射至關節內,可以減緩或是終止軟骨細胞壞死磨損,緩解關節的退化,減輕膝關節的疼痛</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;">
</span></span></span><!--[endif]--><span style="font-family: "biaukai";">關節鏡手術:可對損傷軟骨進行清創或移除碎骨片</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span lang="EN-US" style="font-family: "biaukai";">50%</span><span style="font-family: "biaukai";">至<span lang="EN-US">70%</span>有效</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">效果隨著年紀及活動性而有所不同</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;">
</span></span></span><!--[endif]--><span style="font-family: "biaukai";">人工關節置換術</span><span style="font-family: "biaukai";">:若軟骨傷害到嚴重程度</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">甚至磨耗消失</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">就必須接受人工膝關節置換手術</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">是最後的治療方式</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><br /></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings";"><span style="mso-list: Ignore;"><img alt="*" height="12" src="file://localhost/Users/wujia-lin/Library/Caches/TemporaryItems/msoclip/0/clip_image001.png" width="12" /><span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "biaukai";">退化性膝關節炎的保養</span><span style="font-family: "biaukai";">—</span><span style="font-family: "biaukai";">主要的目的可以減少痛楚</span><span style="font-family: "biaukai";">、</span><span style="font-family: "biaukai";">防止退化加劇或復發的機會<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;">
</span></span></span><!--[endif]--><span style="font-family: "biaukai";">飲食方面:<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;">
</span></span></span><!--[endif]--><span style="font-family: "biaukai";">多吃富含膠質 軟骨素等食物 有利於關節軟骨修復<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "biaukai"; font-size: large;">補充物質<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "biaukai"; font-size: large;">食品種類<span lang="EN-US"><o:p></o:p></span></span></div>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="85"><div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "biaukai"; font-size: large;">膠質<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "biaukai";">豬耳</span><span style="font-family: "biaukai";">、</span><span style="font-family: "biaukai";">蹄筋</span><span style="font-family: "biaukai";">、</span><span style="font-family: "biaukai";">木耳<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="85"><div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "biaukai"; font-size: large;">鈣質<span lang="EN-US"><o:p></o:p></span></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" valign="top" width="142"><div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: large;"><span style="font-family: "biaukai";">貝類</span><span style="font-family: "biaukai";">、</span><span style="font-family: "biaukai";">小魚乾<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="85"><div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "biaukai"; font-size: large;">抗氧化劑<span lang="EN-US"><o:p></o:p></span></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" valign="top" width="142"><div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: large;"><span style="font-family: "biaukai";">青菜</span><span style="font-family: "biaukai";">、</span><span style="font-family: "biaukai";">水果<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<tr style="mso-yfti-irow: 4; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="85"><div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "biaukai"; font-size: large;">維他命<span lang="EN-US">C<o:p></o:p></span></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" valign="top" width="142"><div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: large;"><span style="font-family: "biaukai";">柳橙</span><span style="font-family: "biaukai";">、</span><span style="font-family: "biaukai";">奇異果等<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><br /></span></span>
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;">
</span></span></span><!--[endif]--><span style="font-family: "biaukai";">運動方面<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;">
</span></span></span><!--[endif]--><span style="font-family: "biaukai";">加強大腿部分肌肉</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">,</span><span style="font-family: "biaukai";">幫助關節的穩定</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;">
</span></span></span><!--[endif]--><span style="font-family: "biaukai";">行走</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="font-family: "biaukai";">游泳等緩和運動</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 72.0pt; mso-list: l1 level1 lfo5; mso-para-margin-left: 0gd; text-align: justify; text-indent: -24.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;">
</span></span></span><!--[endif]--><span style="font-family: "biaukai";">康復治療:配合物理治療師設計適當的運動</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-size: large;"><br /></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;">
</span></span></span><!--[endif]--><span style="font-family: "biaukai";">日常生活方面<span lang="EN-US"><o:p></o:p></span></span></span></div>
<div class="MsoListParagraph" style="margin-left: 72.0pt; mso-list: l9 level1 lfo6; mso-para-margin-left: 0gd; text-align: justify; text-indent: -24.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font-family: "times new roman"; font-style: normal; font-variant: normal; line-height: normal;">
</span></span></span><!--[endif]--><span style="font-family: "biaukai";">減輕體重:減少膝關節的負擔</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 72.0pt; mso-list: l9 level1 lfo6; mso-para-margin-left: 0gd; text-align: justify; text-indent: -24.0pt; text-justify: inter-ideograph;">
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</span></span></span><!--[endif]--><span style="font-family: "biaukai";">避免提帶過重物品</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
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</span></span></span><!--[endif]--><span style="font-family: "biaukai";">避免長期站立</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="font-family: "biaukai";">步行過久</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">、</span><span style="font-family: "biaukai";">或上下樓梯</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
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</span></span></span><!--[endif]--><span style="font-family: "biaukai";">避免膝關節長時間保持同一個姿勢等</span><span style="font-family: "biaukai"; mso-hansi-font-family: 新細明體;">。</span><span lang="EN-US" style="font-family: "biaukai";"><o:p></o:p></span></span></div>
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哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-44785412983227088122013-12-09T03:26:00.000-08:002016-04-22T09:21:47.284-07:00十字韌帶損傷的治療<div class="MsoNormal" style="mso-char-indent-count: 1.16; text-indent: 25.15pt;">
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<span style="font-weight: normal;"><span style="font-family: "biaukai"; font-size: x-large;">十字韌帶損傷的治療</span></span></h2>
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<span style="font-weight: normal;"><span style="font-family: "biaukai";">吳家麟醫師</span></span></div>
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<span style="font-weight: normal;"><span style="font-family: "biaukai";"><span lang="EN-US"><o:p></o:p></span></span><span style="font-family: "biaukai";"> <span style="font-size: large;"> 一</span></span></span><span style="font-family: "biaukai"; font-weight: normal; text-indent: 17.6pt;"><span style="font-size: large;">、十字韌帶損傷</span></span><br />
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<span style="font-family: "biaukai"; font-weight: normal; text-indent: 17.6pt;"><span style="font-size: large;">前十字韌帶斷裂常見於運動傷害的青少年及中年人,尤其是籃球,而後十字韌帶斷裂則多是車禍直接撞擊所造成。以解剖來看,後十字韌帶源自股骨間的內後側,斜斜走向脛骨近端的後央處偏外側,其走向位於前十字韌帶後方正好成為十字形因而得名。十字韌帶在膝關節扮演著一個很重要的穩定的角色,後十字韌帶是人體裡面最強的一條韌帶,它主要的作用是防止膝關節的脛骨在活動的時候向後滑動,前十字韌帶則是可以防止脛骨向前過度滑動。</span></span></h4>
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<span style="font-size: large;"><span lang="ZH-CN" style="font-family: "biaukai"; font-weight: normal; text-indent: 17.6pt;">二</span><span style="font-family: "biaukai"; font-weight: normal; text-indent: 17.6pt;">、</span><span lang="ZH-CN" style="font-family: "biaukai"; font-weight: normal; text-indent: 17.6pt;">常見症狀</span><span lang="EN-US" style="font-family: "biaukai"; font-weight: normal; text-indent: 17.6pt;"><span style="mso-spacerun: yes;"> </span></span></span></h4>
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<span style="font-family: "biaukai"; font-size: large; font-weight: normal; text-indent: 17.6pt;">受傷當下,病人常會描述聽到斷裂聲<span lang="EN-US">(</span><i style="mso-bidi-font-style: normal;">“<span lang="EN-US">pop sound</span>”</i><span lang="EN-US">)</span>,然後就感覺到膝關節腫痛與跛行,嚴重時甚至無法行走。之後關節會越來越痛,這是由於關節內出血腫脹的緣故,於二十四小時內會達到最高點。若是受傷較嚴重的病人,可能會同時合併有骨折、半月板破裂、關節軟骨損傷、內側副韌帶斷裂或後外側軟組織損傷等傷害。當腫脹逐漸消除時,病患於行走時不會感覺有困難,但是有時會有軟腳現象。可是,如果此種狀況不予以積極治療,再去從事劇烈運動就可能造成因反復膝關節不穩定,造成關節軟骨及半月軟骨的進一步磨損,最後造成關節的提早退化,形成創傷性關節炎。</span></h4>
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<span style="font-size: large; font-weight: normal;"><span style="font-family: "biaukai";">三</span><span style="font-family: "biaukai";">、檢查方式</span></span></h4>
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<span style="font-size: large;"><span style="font-weight: normal;"><span style="font-family: "biaukai";"><br /><span lang="EN-US"><o:p></o:p></span></span><span lang="EN-US" style="font-family: "biaukai";"> 1. </span><span style="font-family: "biaukai";">醫師會請病患平躺,為膝關節做完整理學檢查,可檢查出患膝內血腫及韌帶鬆動造成的</span></span><span style="font-family: "biaukai"; font-weight: normal; text-indent: 17.6pt;">不穩定。</span></span></h4>
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<span style="font-size: large; font-weight: normal;"><span style="font-family: "biaukai";"><span lang="EN-US"><o:p></o:p></span></span><span lang="EN-US" style="font-family: "biaukai";">2. </span><span style="font-family: "biaukai";">受傷後膝關節會因疼痛併不穩定而減少活動,患肢可能產生股四頭肌肉萎縮現象,與對側正常腿比較可看到大腿圍明顯變小的情形。</span></span></h4>
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<span style="font-size: large;"><span style="font-family: "biaukai"; font-weight: normal; text-indent: 17.6pt;">3. 安排<span lang="EN-US">X</span>光的檢查,少數</span><span style="font-family: "biaukai"; font-weight: normal; text-indent: 17.6pt;"></span><span style="font-family: "biaukai"; font-weight: normal; text-indent: 17.6pt;">病人因韌帶的撕裂性骨折所致,可由</span><span lang="EN-US" style="font-family: "biaukai"; font-weight: normal; text-indent: 17.6pt;">X</span><span style="font-family: "biaukai"; font-weight: normal; text-indent: 17.6pt;">光見到韌帶從骨頭附著處拉扯開來,另外<span lang="EN-US">X</span>光檢查亦可排除一些骨性病變。</span></span></h4>
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<span style="font-size: large; font-weight: normal;"><span style="font-family: "biaukai";"><span lang="EN-US"><o:p></o:p></span></span><span lang="EN-US" style="font-family: "biaukai";">4. </span><span style="font-family: "biaukai";">核磁共振檢查<span lang="EN-US">(MRI)</span>對於確定診斷很有幫助,同時可以看出半月板或其他的韌帶及關節軟骨的損傷程度。</span></span></h4>
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<span style="font-size: large; font-weight: normal;"><span style="font-family: "biaukai";"><br /><span lang="EN-US"><o:p></o:p></span></span><span lang="EN-US" style="font-family: "biaukai";"> 5. </span><span style="font-family: "biaukai";">利用關節鏡檢查(微創)直接見到韌帶斷裂處,是最精確直接的檢查。</span></span></h4>
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<span style="font-size: large; font-weight: normal;"><span style="font-family: "biaukai";"><span lang="EN-US"><o:p></o:p></span></span><br /><span style="font-family: "biaukai";">四</span><span style="font-family: "biaukai";">、十字韌帶損傷的治療</span></span></h4>
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<span style="font-size: large; font-weight: normal;"><span style="font-family: "biaukai";"><span lang="EN-US"><o:p></o:p></span></span><span lang="EN-US" style="font-family: "biaukai";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "biaukai";">最初的治療包括休息、患肢抬高、冰敷與使用拐杖助行直到不會跛行為止。如果關節內血腫嚴重則可以行關節液抽出,以減輕疼痛,經由關節液的初步判斷分析亦同時可排除關節內骨折的可能性。有些則可以考慮使用膝關節支架固定,直到疼痛消失。急性期過後可開始做膝關節的活動,避免關節僵硬與腿部肌肉的萎縮。接著就是要做復建治療以增強肌肉的力量,訓練動作包括:爬樓梯、騎腳踏車、蹲下與站立等,另外,用儀器輔助,則可加強伸展活動、被動關節活動及等速肌力運動。</span></span></h4>
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<span style="font-size: large; font-weight: normal;"><span style="font-family: "biaukai";"><br /><span lang="EN-US"><o:p></o:p></span></span><span lang="EN-US" style="font-family: "biaukai";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "biaukai";">手術治療主要是要依患者的年齡、需求與合併相關的傷害而定,年輕人或是有運動需求的成年人而言,韌帶重建可提供膝關節穩定度幫助病患再恢復從事劇烈運動及避免進一步相關軟骨的傷害。對年齡大的人或是活動量較少的病患,可建議接受復健治療即可。目前韌帶重建手術大多使用自體肌腱移植,例如<span lang="EN-US">: </span>髕骨韌帶或腿後肌腱等,早期十字韌帶重建傷口大且恢復期長,近年來由於關節鏡器械及手術技術的進步,現在於關節鏡下做十字韌帶重建,除了傷口小疼痛減輕外,恢復期也縮短,再加上積極的復健療程,病人大多可在<span lang="EN-US">6</span>至<span lang="EN-US">12</span>個月左右恢復正常的運動。</span></span></h4>
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<span style="font-size: large; font-weight: normal;"><br /><span style="font-family: "biaukai";">五</span><span style="font-family: "biaukai";">、手術治療後的注意事項及復健方法</span></span></h4>
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<span style="font-size: large; font-weight: normal;"><span style="font-family: "biaukai";"><br /><span lang="EN-US"><o:p></o:p></span></span><span lang="EN-US" style="font-family: "biaukai";"> 1. </span><span style="font-family: "biaukai";">手術後建議冰敷及患肢抬高,戴上可調整角度的護膝支架幫助固定。</span></span></h4>
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<span style="font-size: large; font-weight: normal;"><span style="font-family: "biaukai";"><br /><span lang="EN-US"><o:p></o:p></span></span><span lang="EN-US" style="font-family: "biaukai";"> 2. </span><span style="font-family: "biaukai";">手術後<span lang="EN-US">3</span>天可利用拐杖支撐下床行走,患肢僅能支撐身體部分重量。</span></span></h4>
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<span style="font-size: large; font-weight: normal;"><span style="font-family: "biaukai";"><br /><span lang="EN-US"><o:p></o:p></span></span><span lang="EN-US" style="font-family: "biaukai";"> 3. </span><span style="font-family: "biaukai";">當術後發炎期過後時,則可穿戴膝支架以健康的腳支托患肢的膝部做被動及主動性的運</span></span><span style="font-family: "biaukai"; font-size: large; font-weight: normal; text-indent: 17.6pt;">動。</span></h4>
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<span style="font-size: large;"><span lang="EN-US" style="font-family: "biaukai"; font-weight: normal; text-indent: 17.6pt;">4. </span><span style="font-family: "biaukai"; font-weight: normal; text-indent: 17.6pt;">術後即可開始接受復健治療,視使用移植韌帶之不同,約<span lang="EN-US">6</span>至<span lang="EN-US">12</span>個月後始可開始運動。</span></span></h4>
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<span style="font-size: large; font-weight: normal;"><span style="font-family: "biaukai";"><span lang="EN-US"><o:p></o:p></span></span><br /><span lang="ZH-CN" style="font-family: "biaukai";">六</span><span style="font-family: "biaukai";">、</span><span lang="ZH-CN" style="font-family: "biaukai";">結語</span><span lang="EN-US" style="font-family: "biaukai";"><span style="mso-spacerun: yes;"> </span></span></span></h4>
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<span style="font-weight: normal;"><span style="font-family: "biaukai"; font-size: large; text-indent: 17.6pt;">膝關節是人體活動承受重量非常重要的部位,而十字韌帶則是穩定膝關節非常重要的組織。一旦發現膝關節有任何不適時,一定要儘早尋求骨科專科醫師檢查,及早診斷及時治療,可以避免產生不必要的後遺症,並且及早恢復日常的活動。</span></span></h4>
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<span style="font-weight: normal;"><span style="font-family: "biaukai"; font-size: large; text-indent: 17.6pt;"><span style="background-color: white; color: #333333; font-family: "arial" , "helvetica" , sans-serif; font-size: 11pt; line-height: 20px; text-align: justify; text-indent: 0px;"><b><u>若有任何相關問題 請洽台北醫學大學附設醫院骨科部 吳家麟 醫</u></b></span><span style="background-color: white; color: #333333; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: 11pt; line-height: 20px; text-align: justify; text-indent: 0px;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b><u>師</u></b></span></span></span></span></div>
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哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-32901721524095296792012-08-31T07:34:00.000-07:002016-04-22T09:28:38.767-07:00退化性膝關節炎治療的新觀念<div style="text-align: center;">
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">除了因年紀退化造成的原發性關節炎, 尚有其他因素造成的次發性原因:</span></span></div>
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<tr><td class="tr-caption" style="text-align: center;"><b><br /><span class="Apple-style-span" style="font-size: large;">治療原則</span></b></td></tr>
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哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-14044460616191344222012-04-03T20:48:00.003-07:002013-12-09T04:26:16.180-08:00慎用止痛劑 不讓藥物副作用成負擔<!--[if gte mso 9]><xml> <o:documentproperties> <o:template>Normal.dotm</o:Template> <o:revision>0</o:Revision> <o:totaltime>0</o:TotalTime> <o:pages>1</o:Pages> <o:words>100</o:Words> <o:characters>574</o:Characters> <o:company>TSGH</o:Company> <o:lines>4</o:Lines> <o:paragraphs>1</o:Paragraphs> <o:characterswithspaces>704</o:CharactersWithSpaces> <o:version>12.0</o:Version> </o:DocumentProperties> <o:officedocumentsettings> <o:allowpng/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:worddocument> <w:zoom>0</w:Zoom> <w:trackmoves>false</w:TrackMoves> <w:trackformatting/> <w:punctuationkerning/> <w:drawinggridhorizontalspacing>18 pt</w:DrawingGridHorizontalSpacing> <w:drawinggridverticalspacing>18 pt</w:DrawingGridVerticalSpacing> <w:displayhorizontaldrawinggridevery>0</w:DisplayHorizontalDrawingGridEvery> <w:displayverticaldrawinggridevery>0</w:DisplayVerticalDrawingGridEvery> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:dontgrowautofit/> <w:dontautofitconstrainedtables/> <w:dontvertalignintxbx/> <w:usefelayout/> </w:Compatibility> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="276"> </w:LatentStyles> </xml><![endif]--> <!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} </style> <![endif]--> <!--StartFragment--> <p class="MsoNormal" align="center" style="text-align: left;text-indent: 30.3pt; "><span style="font-family: 新細明體; font-family:";">水腫也有可能是止痛劑所引起的!一名</span><span lang="EN-US">60</span><span style="font-family: 新細明體; font-family:";">歲男子,發現下肢嚴重水腫,赴醫就診後才發現,原來是服用的止痛劑影響腎功能,造成體液滯留,引發下肢水腫。三軍總醫院骨科部運動醫學科吳家麟醫師表示,約有一成患者使用止痛劑會有水腫症狀,屬正常反應,民眾切勿恐慌,經醫師處方換藥或停藥就可改善。</span></p> <p class="MsoNormal" style="text-align: left;text-indent: 24pt; "><span style="font-family:新細明體; mso-ascii-font-family:"Times New Roman";mso-hansi-Times New Roman"font-family:";">止痛劑造成的副作用其實不只下肢水腫,不正確用藥也可能引發胃腸道出血及肝臟功能受損。吳家麟指出,民眾常自行到藥局或藥妝店購買含有乙醯氨酚的藥物,是屬於中樞神經止痛劑,能阻斷疼痛傳導,有解熱、止痛效果,對腸胃道副作用小,但若大劑量服用,卻可能傷肝。</span></p> <p class="MsoNormal" style="text-align: left;text-indent: 24pt; "><span style="font-family:新細明體; mso-ascii-font-family:"Times New Roman";mso-hansi-Times New Roman"font-family:";">而另一種常見的非類固醇消炎止痛劑,止痛效果好,可緩解像是下背痛、退化性關節炎等因發炎而造成的疼痛。此類止痛劑是藉由抑制環氧化酶(</span><span lang="EN-US">COX</span><span style="font-family:新細明體;mso-ascii-font-family:"Times New Roman"; mso-hansi-Times New Roman"font-family:";">)做用,來達到消炎、止痛的效果。吳家麟解釋,環氧化酶又分為</span><span lang="EN-US">COX-1</span><span style="font-family:新細明體;mso-ascii-font-family: "Times New Roman";mso-hansi-Times New Roman"font-family:";">和</span><span lang="EN-US">COX-2</span><span style="font-family:新細明體;mso-ascii-font-family: "Times New Roman";mso-hansi-Times New Roman"font-family:";">,是合成發炎物質的重要酵素,若能抑制這些酵素,就能減少疼痛感。</span></p> <p class="MsoNormal" style="text-align: left;text-indent: 24pt; "><span style="font-family:新細明體; mso-ascii-font-family:"Times New Roman";mso-hansi-Times New Roman"font-family:";">傳統型的非類固醇消炎止痛劑,如阿斯匹靈,同時抑制</span><span lang="EN-US">COX-1</span><span style="font-family:新細明體;mso-ascii-font-family: "Times New Roman";mso-hansi-Times New Roman"font-family:";">及</span><span lang="EN-US">COX-2</span><span style="font-family:新細明體;mso-ascii-font-family: "Times New Roman";mso-hansi-Times New Roman"font-family:";">,但</span><span lang="EN-US">COX-1</span><span style="font-family:新細明體;mso-ascii-font-family: "Times New Roman";mso-hansi-Times New Roman"font-family:";">具有維持胃腸道黏膜完整性及調節血小板凝結的功能,所以當</span><span lang="EN-US">COX-1</span><span style="font-family:新細明體;mso-ascii-font-family: "Times New Roman";mso-hansi-Times New Roman"font-family:";">被抑制時,會引發胃痛或出血等副作用;為了避免上述的問題,新型的非類固醇消炎止痛劑,選擇性的只抑制</span><span lang="EN-US">COX-2</span><span style="font-family:新細明體;mso-ascii-font-family: "Times New Roman";mso-hansi-Times New Roman"font-family:";">,能達到消炎、止痛效果,較不會有胃腸道損傷的風險。</span> </p> <p class="MsoNormal" style="text-align: left;text-indent: 24pt; "><span style="font-family:新細明體; mso-ascii-font-family:"Times New Roman";mso-hansi-Times New Roman"font-family:";">每一種藥都會有其不同的副作用,吳家麟強調,醫師在開立處方前,應瞭解患者的病史以及用藥情形,以避免藥物造成腸胃道或心血管疾病的風險。醫師也會針對患者疼痛的深淺,投以藥膏、貼布或止痛劑進行緩解,正確、合適的用藥,才不會讓止痛引發另一種負擔。</span></p> <!--EndFragment-->哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-48308163493816952192010-08-04T08:34:00.001-07:002016-04-22T09:01:42.646-07:00退化性膝關節炎治療的新觀念<div align="justify">
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<span style="font-size: x-large;">退化性膝關節炎治療的新觀念</span></h2>
<div style="text-align: center;">
吳家麟醫師</div>
<div style="text-align: center;">
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<span style="font-size: large;">退化性關節炎在成人為最好發的疾病,其發生率隨著年齡的增加而逐年上升,其中退化性膝關節炎約占6%。其盛行率在70至74歲之間為其發生的高峰期,可上升至約40%;但是若以臨床表徵來統計,則會降低至約10%;若以X光片上典型退化性膝關節炎的表現,則只有約15%的病患會有膝關節疼痛的症狀,且此疾病的發生率在70歲以後約以每年1%的比例逐年增加。在60至64歲男性病患,以右膝關節最常見;在女性,雙側膝關節發生率幾乎一樣。</span></div>
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<span style="font-size: large;">促使退化性膝關節炎發生的危險因子,可分為內源性及外因性。內源性因子有年紀、性別、遺傳、種族或停經後的改變等;外因性因子有創傷、膝關節反覆損傷、體重過重、曾接受過切除性關節手術或不當之生活型態(如抽菸、喝酒)等。若以發生原因來區別可以分為原發性或次發性,但是最主要導致關節炎的原因為膝關節的透明軟骨受破壞所致。</span></div>
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<span style="font-size: large;">治療膝關節炎的方法主要為保守療法及手術治療。理想的保守療法應包括結合藥物及非藥物治療,且應根據關節炎發生的危險因子、疼痛程度、是否有關節積液及關節受到破壞的程度而定。非藥物治療如減重、使用膝關節護具、物理復健治療等;藥物治療有非類固醇類的抗發炎藥物、各類止痛藥物、針對關節炎做症狀治療及緩慢作用的藥物(如玻尿酸、 葡萄糖胺、 軟骨素、 部分阻斷生長素IL-1的藥物等)、關節內類固醇注射及基因治療等。其中有些新藥的研發,尚須要長時間的臨床試驗方能證實其安全性及療效。</span></div>
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<span style="font-size: large;">當前述之保守療法治療無效後,可考慮關節保留手術,如關節鏡清創術及沖洗術(減輕症狀)、關節鑽洞(刺激軟骨生長)、軟骨或骨軟骨移植(保留關節表面軟骨)及近關節之矯形手術(矯正膝關節不當的受力方向),若所有上述之治療皆無法改善症狀、減緩疼痛及影響生活品質時,則考慮接受部分或全人工關節置換手術。</span></div>
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<span style="font-size: large;">退化性膝關節炎到目前為止,仍然是一個未能完全治癒的疾病,而且關於它的致病機轉也尚未完全清楚,所以最好的治療方法就是「預防」,而治療的目的就是改善其臨床症狀。 </span><br />
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<span style="background-color: white; color: #333333; font-family: "arial" , "helvetica" , sans-serif; font-size: 11pt; line-height: 20px;"><b><u>若有任何相關問題 請洽台北醫學大學附設醫院骨科部 吳家麟 醫</u></b></span><span style="background-color: white; color: #333333; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: 11pt; line-height: 20px;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b><u>師</u></b></span></span></div>
哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-55003818185614911702010-05-02T07:49:00.001-07:002010-05-02T07:49:49.776-07:00哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-56298852290404356802010-05-02T07:33:00.000-07:002010-08-04T08:43:03.110-07:00壓力與剪應力分別應用於關節軟骨代謝之研究概況三軍總醫院骨科部 吳家麟<br /><br />人類關節軟骨的破壞是退化性關節炎的主要特徵,這一個與年齡息息相關的疾病,最後終將隨著每個人邁入晚年而不可避免的發生。如果能從了解關節軟骨所承受的機械力學與生物因子之間的相互關係,進而延緩退化性關節炎的發生或減緩它的進程,所有人類將因而受益。<br />股骨的軟骨骨化作用,最早發生於胚胎時期的第五週,隨後其組織的分化與組成即快速的發展;而第一次的隨意肌收縮發生於第七週左右,胎兒的肌肉收縮和其相關的骨骼運動,對於關節的發展扮演了很重要的角色,也引導著周圍軟骨和軟骨內的骨化過程,這些機械力在軟骨發展的基礎上已經創造了隨著時間與空間改變的應力和應變;由此可知這些局部的力學刺激,已經影響了細胞的生物特性,並對隨後組織的發展產生了很大的影響。<br />在過去的研究已經知道許多的基因表現受到局部機械力學環境的影響,擁有這些力學感應的基因群包括有細胞外間質蛋白質(ECM):如collagens, proteoglycans, tenacins, COMP;調節細胞生長週期的生長蛋白(cyclins, Cdks);Cytokines(IL-1, 4, 6);生長因子(TGF-βs, BMPs, Ihh), MMPs﹔血管增生與抗血管增生因子(VEGFs, CTGF, angiopoetin2, METH-1, endostatin)等,而這些因子也將隨著研究的發展而日益增加。因此近來有些研究致力於機械力學與關節軟骨的相關性研究得知,間歇性的靜水壓力刺激(hydrostatic pressure)會增加正常軟骨的aggrecan和Type II collagen的基因表現以及誘使正常關節與退化性關節炎的軟骨細胞相關的蛋白質產生變化;靜水壓力刺激,也在培養出來的軟骨細胞上,產生拮抗bacterial lipopolysaccharide (LPS) 的作用,抑制其作用於間質蛋白質的表現。<br />對於應用剪應力(shear stress)於退化性關節炎的軟骨細胞,會增加發炎前導物質nitric oxide(NO)的表現與減少aggrecan和Type II collagen的表現,它亦會導致與apoptosis有關的細胞產生分子上的改變;然而靜水壓卻會增加間質細胞的表現;這些發現都可說明機械力學上的作用形式會影響到關節軟骨的代謝狀況。<br />目前利用靜水壓和剪應力應用於單獨人類關節軟骨細胞約可獲致下列四種結果:<br />一、 5至10MPa的間歇性靜水壓力可以增加aggrecan和Type II collagen的表現,而且髖關節軟骨於日常生活中所承受的力量亦落於此範圍中。<br />二、 靜水壓對於軟骨細胞的代謝上,具有抑制發炎前導物質如LPS的作用;放置軟骨細胞於LPS中會增加nitrite的量,然而應用靜水壓於LPS活化的軟骨細胞卻可減少nitrite的分泌量;LPS亦可增加iNOS的mRNA信號,但若給予間歇性靜水壓刺激,則可以減少被LPS誘使產生iNOS的mRNA。<br />三、 應用剪應力於退化性的關節軟骨細胞會減少軟骨間質蛋白質的表現,但間歇性的靜水壓卻會增加它們的表現。剪應力亦會增加NO的釋放,而NO會增加軟骨細胞的apoptosis,但NO的釋放卻會因為靜水壓的作用而減少。<br />四、 許多研究對軟骨細胞的基因體表現如轉錄、轉譯及後轉錄作用都很容易受到靜水壓的刺激而改變,但仍須進一步深入研究。<br /><br />機械力學的壓力刺激用於改變軟骨細胞的代謝作用,在分子機轉上仍需進一步的研究,像是如何將力學的刺激訊號從細胞外間質傳送到細胞核中;目前假定軟骨細胞的細胞膜上有認知力學刺激的部位,但是對於該部位是接受靜水壓力或剪應力則尚未知悉;假如這個假設是成立的,則蛋白質產生的化學訊號、生長因子接受器、離子交換管道或細胞結構組成,都會有其相關性。<br />關節軟骨根據給予的力學刺激存在著多樣性的代謝變化,雖然正確的機轉仍然必須建立,但是藉由特定的力學刺激狀況來調節軟骨細胞的蛋白質作用,可行性仍然很高;因此藉由靜水壓力和剪應力的力學作用,來調節軟骨細胞的代謝狀況,對於利用組織工程來達到治療退化性關節炎仍是一個極有潛力的發展方向。哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.comtag:blogger.com,1999:blog-4716141441447390168.post-75336354438743497272008-11-25T19:31:00.000-08:002016-04-22T09:19:42.177-07:00膝關節半月軟骨損傷<h2 style="text-align: center;">
<b><span style="font-size: x-large;">膝關節半月軟骨損傷</span></b></h2>
<div style="text-align: center;">
<span style="font-size: large;">吳家麟醫師</span></div>
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<span style="font-size: large;">半月軟骨位在左右膝關節內,屬於纖維軟骨,在解剖上其與關節囊相連在一起,可分為內側及外側半月軟骨,內側半月軟骨是C型,前窄後寬,有一個橫向半月軟骨間韌帶可以維持它的穩定性。外側半月軟骨為接近O型,它覆蓋該側的關節面積大於內側半月軟骨,它有3.5%至5%的機會形成所謂的”盤狀半月軟骨”;半月軟骨除了提供脛骨、股骨關節之間的緩衝與避震效果之外,並且經由填補關節接觸間隙分散其間的壓力;在關節活動時會略為改變外形及位置,以提供膝關節額外的穩定性;半月軟骨也和膝關節的本體感覺有關。因此,當半月軟骨損傷或切除後,會造成整個膝關節的接觸壓力增加,進而造成膝關節炎的產生。半月軟骨外側有血管系統提供養分,內側2/3是沒有血管供應的,故一旦發生半月軟骨破裂,只有外面1/3的半月軟骨比較有機會經由血管提供養分,而達成修補的功能。</span><br />
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<span style="font-size: large;">半月軟骨損傷,多以男性居多,有1/3的患者會同時合併前十字韌帶損傷,在急性前十字韌帶損傷時,外側半月軟骨破裂會多於內側;而慢性十字韌帶損傷時,則以內側半月軟骨居多,因為它有限制膝關節往前、後移動的作用。目前半月軟骨損傷可以分成五類:輻射狀破裂、皮瓣狀破裂、縱向破裂、水平破裂及複雜性破裂,約有80%的破裂是屬於縱向破裂或皮瓣狀破裂,其中又以輻射狀破裂的預後較差,而退化性關節炎造成的半月軟骨損傷,多屬複雜性破裂。</span><br />
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<span style="font-size: large;">至於何時要接受治療?當膝部疼痛已影響日常生活、工作或運動時、藥物或復健治療無效、盤狀半月板破裂或經核磁共振檢查證實為半月軟骨破裂時,須接受關節鏡檢查及治療。</span><br />
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<span style="font-size: large;">關節鏡治療可分為半月軟骨部分切除、全切除、半月軟骨修補及半月軟骨移植手術。若破裂位於內側2/3時,多選擇部份切除手術,應盡量避免全切除,以免提早發生退化性關節炎;若破裂位於半月軟骨外1/3時,則可考慮修補治療,在年輕人及急性受傷時,修補癒合的機會較高,但在半月軟骨本身品質不佳、合併前十字韌帶損傷、膝內翻或患者不合作時,會產生較差的修補結果。因膝關節外側有腓總神經,內側有隱神經分支,故傳統的修補必須分別於內外側開一個約3公分的傷口,避開上述神經,以達成修補的目的;目前已可經由關節鏡完成所謂“全關節內(All-Inside)”微創半月軟骨修補手術,經由關節鏡傷口直接修補,術後只有二個約一公分的傷口,可以達成早期恢復的目的。</span><br />
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<span style="background-color: white; color: #333333; font-family: "arial" , "helvetica" , sans-serif; font-size: 11pt; text-align: justify;"><b><u>若有任何相關問題 請洽台北醫學大學附設醫院骨科部 吳家麟 醫</u></b></span><span style="background-color: white; color: #333333; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: 11pt; text-align: justify;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b><u>師</u></b></span></span><br />
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哈佛醫學院(HMS)麻州總醫院(MGH)骨科部研究員 台北醫學大學骨科部運動醫學科主任http://www.blogger.com/profile/08923170083129040844noreply@blogger.com