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中华关节外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (06) : 785 -789. doi: 10.3877/ cma.j.issn.1674-134X.2024.06.013

综述

膝骨关节炎与神经调控
杨美平1, 侯宇2, 曾小龙2, 廖少君2, 林定坤2,()   
  1. 1.510405 广州中医药大学第二临床医学院
    2.520105 广州中医药大学附属广东省中医院骨科
  • 收稿日期:2024-07-22 出版日期:2024-12-01
  • 通信作者: 林定坤
  • 基金资助:
    岐黄学者工作室(国中医药人教司[2022]6号)林定坤广东省名中医传承工作室(0103030912)广东省中医院科学技术专项“岭南骨伤科流派传承工作室” (中医二院 [2013]233号)广东省中医院院内专项(YN2023QN17)

Knee osteoarthritis and regularization

Meiping Yang1, Yu Hou2, Xiaolong Zeng2, Shaojun Liao2, Dingkun Lin2,()   

  1. 1.The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
    2.Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 520105, China
  • Received:2024-07-22 Published:2024-12-01
  • Corresponding author: Dingkun Lin
引用本文:

杨美平, 侯宇, 曾小龙, 廖少君, 林定坤. 膝骨关节炎与神经调控[J/OL]. 中华关节外科杂志(电子版), 2024, 18(06): 785-789.

Meiping Yang, Yu Hou, Xiaolong Zeng, Shaojun Liao, Dingkun Lin. Knee osteoarthritis and regularization[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(06): 785-789.

膝骨关节炎(KOA)伴随的膝关节功能障碍表现为膝关节疼痛,膝关节僵硬,肌肉质量和膝关节屈伸力量减少。KOA的疼痛包括外周损害性疼痛机制引起的疼痛还有神经性疼痛机制或中枢性疼痛机制产生的痛觉敏化,与大脑躯体感觉皮层及情绪调控等区域的活动变化相关。KOA患者进行膝关节运动时涉及的运动控制的变化包括步态和肌肉激活模式的改变、股四头肌肌无力、本体感觉受损及关节活动受限等,与中枢神经调控密切相关。

Knee dysfunction associated with Knee Osteoarthritis(KOA) is characterized by knee pain, knee stiffness, reduced muscle mass and knee flexion and extension strength. The causes of pain in KOA includes peripheral damaging pain mechanisms as well as pain by osteopathic regulation or central sensitization mechanisms, which is associated with changes in activity in the somatosensory cortex and emotion regulation regions of the brain. Changes in knee motor control in KOA patients include changes in gait and muscle activation patterns, quadriceps muscle weakness, proprioceptive impairment, and limited joint movement, which are closely related to central neuroregulation.

图1 膝关节疼痛敏化的神经调控示意图
Figure 1 The nerve regulation of knee pain sensitization
图2 膝关节功能障碍的神经调控示意图
Figure 2 The nerve regulation of knee joint dysfunction
[1]
Hunter DJ, Bierma-Zeinstra S. Osteoarthritis[J]. Lancet, 2019, 393( 10182 ): 1745-1759.
[2]
Piasecki J, Inns TB, Bass JJ, et al. Influence of sex on the agerelated adaptations of neuromuscular function and motor unit properties in elite Masters athletes[J]. J Physiol, 2021, 599( 1 ):193-205.
[3]
Borzuola R, Giombini A, Torre G, et al. Central and peripheral neuromuscular adaptations to ageing[J/OL]. J Clin Med, 2020, 9( 3 ):741. DOI: 10.3390/jcm9030741.
[4]
Birkbeck MG, Blamire AM, Whittaker RG, et al. The role of novel motor unit magnetic resonance imaging to investigate motor unit activity in ageing skeletal muscle[J]. J Cachexia Sarcopenia Muscle, 2021, 12( 1 ): 17-29.
[5]
Monteiro TS, King BR, Seer C, et al. Network-specific differences in transient brain activity at rest are associated with age-related reductions in motor performance[J/OL]. Neuroimage, 2022, 252:119025. DOI: 10.1016/j.neuroimage.2022.119025.
[6]
Yao Q, Wu X, Tao C, et al. Osteoarthritis: pathogenic signaling pathways and therapeutic targets[J/OL]. Signal Transduct Target Ther, 2023, 8( 1 ): 56. DOI: 10.1038/s41392-023-01330-w.
[7]
Sofat N, Lambarth A. Can we achieve pain stratification in musculoskeletal conditions? Implications for clinical practice[J/OL]. Front Pain Res, 2024, 5: 1362757. DOI: 10.3389/fpain.2024. 1362757.
[8]
Rankin J, Rudy-Froese B, Hoyt C, et al. Quantitative sensory testing protocols to evaluate central and peripheral sensitization in knee OA: a scoping review[J]. Pain Med, 2022, 23( 3 ): 526-557.
[9]
李健雄, 张程, 辛鹏飞, 等. 膝骨关节炎疼痛机制研究进展[J/CD]. 中华关节外科杂志( 电子版 ), 2021, 15( 5 ): 596-600.
[10]
Robinson WH, Lepus CM, Wang Q, et al. Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis[J]. Nat Rev Rheumatol, 2016, 12( 10 ): 580-592.
[11]
Culemann S, Grüneboom A, Nicolás-Ávila JÁ, et al. Locally renewing resident synovial macrophages provide a protective barrier for the joint[J]. Nature, 2019, 572( 7771 ): 670-675.
[12]
Mantyh PW. Mechanisms that drive bone pain across the lifespan[J]. Br J Clin Pharmacol, 2019, 85( 6 ): 1103-1113.
[13]
Jiang BC, Liu T, Gao YJ. Chemokines in chronic pain: cellular and molecular mechanisms and therapeutic potential[J/OL]. Pharmacol Ther, 2020, 212: 107581. DOI: 10.1016/j.pharmthera.2020.107581.
[14]
郑义, 康凯, 王智杰, 等. 中枢敏化及其对膝关节骨关节炎临床治疗的影响[J]. 中华老年骨科与康复电子杂志, 2020, 6( 4 ):243-247.
[15]
Iuamoto LR, Ito FLK, Tomé TA, et al. Effects of neuroplasticity in people with knee osteoarthritis: a systematic review of the literature[J/OL]. Medicine, 2022, 101( 3 ): e28616. DOI:10.1097/MD.0000000000028616.
[16]
Conaghan PG, Cook AD, Hamilton JA, et al. Therapeutic options for targeting inflammatory osteoarthritis pain[J]. Nat Rev Rheumatol,2019, 15( 6 ): 355-363.
[17]
Lin G, Lan F, Wu D, et al. Resting-state functional connectivity alteration in elderly patients with knee osteoarthritis and declined cognition: an observational study[J/OL]. Front Aging Neurosci,2022, 14: 1002642. DOI: 10.3389/fnagi.2022.1002642.
[18]
Cottam WJ, Condon L, Alshuft H, et al. Associations of limbicaffective brain activity and severity of ongoing chronic arthritis pain are explained by trait anxiety[J]. Neuroimage Clin, 2016, 12:269-276.
[19]
Kang BX, Ma J, Shen J, et al. Altered brain activity in end-stage knee osteoarthritis revealed by resting-state functional magnetic resonance imaging[J/OL]. Brain Behav, 2022, 12( 1 ): e2479.DOI: 10. 1002/brb3. 2479.
[20]
谢洪武. 基于功能磁共振技术研究膝骨性关节炎患者慢性疼痛及热敏点艾灸镇痛的中枢机制[D]. 北京: 北京大学医学部,2022.
[21]
Chai Y, Chen J, Hou M, et al. Gait strategies for individuals with knee osteoarthritis when transitioning between floor and stair walking[J/OL]. Front Physiol, 2023, 14: 1026299. DOI: 10.3389/fphys.2023.1026299.
[22]
马淑敏, 高谦, 徐峰, 等. 膝骨关节炎患者股四头肌功能水平及髋关节步态运动学特征分析[J]. 中国康复, 2023, 38( 6 ): 345-349.
[23]
Tieland M, Trouwborst I, Clark BC. Skeletal muscle performance and ageing[J]. J Cachexia Sarcopenia Muscle, 2018, 9( 1 ): 3-19.
[24]
Hunter SK, Pereira HM, Keenan KG. The aging neuromuscular system and motor performance[J]. J Appl Physiol ( 1985 ), 2016,121( 4 ): 982-995.
[25]
Shanahan CJ, Hodges PW, Wrigley TV, et al. Organisation of the motor cortex differs between people with and without knee osteoarthritis[J/OL]. Arthritis Res Ther, 2015, 17( 1 ): 164. DOI:10.1186/s13075-015-0676-4.
[26]
Marshall RN, Morgan PT, Martinez-Valdes E, et al. Quadriceps muscle electromyography activity during physical activities and resistance exercise modes in younger and older adults[J/OL]. Exp Gerontol, 2020, 136: 110965. DOI: 10.1016/j.exger.2020.110965.
[27]
Sanders O, Hsiao HY, Savin DN, et al. Aging effects of motor prediction on protective balance and startle responses to sudden drop perturbations[J]. J Biomech, 2019, 91: 23-31.
[28]
Iijima H, Eguchi R, Shimoura K, et al. Transcutaneous electrical nerve stimulation improves stair climbing capacity in people with knee osteoarthritis[J/OL]. Sci Rep, 2020, 10( 1 ): 7294. DOI:10.1038/s41598-020-64176-0.
[29]
Stelmach GE, Worringham CJ. Sensorimotor deficits related to postural stability. Implications for falling in the elderly[J]. Clin Geriatr Med, 1985, 1( 3 ): 679-694.
[30]
Jones R, Ratnakumar N, Akbaş K, et al. Delayed center of mass feedback in elderly humans leads to greater muscle co-contraction and altered balance strategy under perturbed balance: a predictive musculoskeletal simulation study[J/OL]. PLoS One, 2024, 19( 5 ):e0296548. DOI: 10.1371/journal.pone.0296548.
[31]
Purohit R, Bhatt T. Mobile brain imaging to examine task-related cortical correlates of reactive balance: a systematic review[J/OL].Brain Sci, 2022, 12( 11 ): 1487. DOI: 10.3390/brainsci12111487.
[32]
姚放鸣, 焦莹莹, 何敏聪, 等. 膝骨关节炎患者的肌少症发病率及发病特点分析[J/CD]. 中华关节外科杂志( 电子版 ), 2024,18( 1 ): 30-38.
[33]
Cole KJ, Rotella DL, Harper JG. Mechanisms for age-related changes of fingertip forces during precision gripping and lifting in adults[J]. J Neurosci, 1999, 19( 8 ): 3238-3247.
[34]
Iskusnykh IY, Zakharova AA, Kryl'skii ED, et al. Aging,neurodegenerative disorders, and cerebellum[J/OL]. Int J Mol Sci,2024, 25( 2 ): 1018. DOI: 10.3390/ijms25021018.
[35]
Bondi D, Robazza C, Lange-Küttner C, et al. Fine motor skills and motor control networking in developmental age[J/OL]. Am J Hum Biol, 2022, 34( 8 ): e23758. DOI: 10.1002/ajhb.23758.
[36]
Gao Z, Pang Z, Chen Y, et al. Restoring after central nervous system injuries: neural mechanisms and translational applications of motor recovery[J]. Neurosci Bull, 2022, 38( 12 ): 1569-1587.
[37]
Nakano H, Tang Y, Morita T, et al. Theoretical proposal for restoration of hand motor function based on plasticity of motorcortical interhemispheric interaction and its developmental rule[J/OL]. Front Neurol, 2024, 15: 1408324. DOI: 10.3389/fneur.2024.1408324.
[38]
Binder E, Leimbach M, Pool EM, et al. Cortical reorganization after motor stroke: a pilot study on differences between the upper and lower limbs[J]. Hum Brain Mapp, 2021, 42( 4 ): 1013-1033.
[39]
Cassady K, Gagnon H, Lalwani P, et al. Sensorimotor network segregation declines with age and is linked to GABA and to sensorimotor performance[J]. Neuroimage, 2019, 186: 234-244.
[40]
Cassady K, Gagnon H, Freiburger E, et al. Network segregation varies with neural distinctiveness in sensorimotor cortex[J/OL].Neuroimage, 2020, 212: 116663. DOI: 10.1016/j.neuroimage.2020. 116663.
[41]
Li SC, Lindenberger U. Cognitive neuroscience of memory. Seattle:Hogrefe & Huber Publishers, 1999: 103-146.
[42]
Srokova S, Aktas ANZ, Koen JD, et al. Dissociative effects of age on neural differentiation at the category and item levels[J/OL].J Neurosci, 2024, 44( 4 ): e0959232023. DOI: 10.1523/JNEUROSCI. 0959-23. 2023.
[43]
Cassady K, Ruitenberg MFL, Reuter-Lorenz PA, et al. Neural dedifferentiation across the lifespan in the motor and somatosensory systems[J]. Cereb Cortex, 2020, 30( 6 ): 3704-3716.
[44]
中国老年保健协会骨关节保护与健康分会, 国家骨科医学中心北京积水潭医院保膝联盟. 膝骨关节炎糖皮质激素注射应用专家共识[J]. 实用骨科杂志, 2024, 30(:1 ) : 865-875.
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