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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 52 -59. doi: 10.3877/cma.j.issn.1674-134X.2023.01.007

综述

全身关节过度活动的研究进展
江钰璇1, 陈颖1, 周钟明1, 温宝泓1, 陈文韬1, 钟国庆2, 张余3, 李丽萍4,†()   
  1. 1. 515041　汕头大学医学院
    2. 515041　汕头大学医学院；510080　广州，广东省人民医院（广东省医学科学院）骨肿瘤科
    3. 510080　广州，广东省人民医院（广东省医学科学院）骨肿瘤科
    4. 515041　汕头大学医学院；515063　汕头大学公共卫生学院
  • 收稿日期:2021-09-23 出版日期:2023-02-01
  • 通信作者: 李丽萍
  • 基金资助:
    汕头大学医学院省级大学生创新训练计划(S202110560129)

Research progress of general joint hypermobility

Yuxuan Jiang1, Ying Chen1, Zhongming Zhou1, Baohong Wen1, Wentao Chen1, Guoqing Zhong2, Yu Zhang3, Liping Li4,†()   

  1. 1. Shantou University Medical College, Shantou 515041, China
    2. Shantou University Medical College, Shantou 515041, China; Bone Tumor Department, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
    3. Bone Tumor Department, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
    4. Shantou University Medical College, Shantou 515041, China; The School of Public Health, Shantou 515041, China
  • Received:2021-09-23 Published:2023-02-01
  • Corresponding author: Liping Li
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江钰璇, 陈颖, 周钟明, 温宝泓, 陈文韬, 钟国庆, 张余, 李丽萍. 全身关节过度活动的研究进展[J/OL]. 中华关节外科杂志(电子版), 2023, 17(01): 52-59.

Yuxuan Jiang, Ying Chen, Zhongming Zhou, Baohong Wen, Wentao Chen, Guoqing Zhong, Yu Zhang, Liping Li. Research progress of general joint hypermobility[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(01): 52-59.

全身关节过度活动(GJH)是一种结缔组织遗传病，主要表现为全身多个关节活动度过大。近年来，临床上日益重视GJH。GJH本身并未对患者的生活质量造成很大影响，但GJH会提高患者并发其他肌肉骨骼病症(如关节疼痛、骨关节炎)的概率，增加发生运动损伤的风险。目前，有关研究已初步探明GJH危险因素及与其他疾病的联系，但是仍缺乏对GJH治疗方法的系统性总结。在此，本文将总结近期全身关节过度活动的相关研究报告，有助于临床上GJH的诊断与个性化治疗方案的选择。

关键词: 关节不稳定性, 活动范围，关节, 创伤和损伤, 物理治疗方法, 外科手术

General joint hypermobility (GJH) is a genetic disorders associated with connective tissue, which is characterised by abnormal excessive motion of multiple joints. In recent years, more and more clinical attentions have been paid to GJH. Although GJH itself does not have a great impact on the quality of life of patients, GJH will pose risks to patients to suffer from other musculoskeletal diseases (such as joint pain and osteoarthritis) and increase the chance of sports injury. At present, relevant studies have preliminarily discovered the risk factors of GJH and its relationship with other diseases, however there is still a lack of systematic review of GJH treatment methods. This review mainly aimed at investigating research progress on the general joint hypermobility, which might be helpful to the diagnosis of GJH and the selection of personalized treatment.

Key words: Joint instability, Range of motion, articular, Wounds and injuries, Physical therapy modalities, Surgical procedures
表1 GJH的危险因素
遗传因素(基因) 关系 其他因素 关系  
SLC39A13[35] Beighton评分与SLC39A1呈显著正相关 年龄[29,30,31] － 随着年龄增长，关节活动度降低，GJH的发生率下降
TNXB[34,35] GJH女性的TNXB表达量比对照组高；Beighton评分与TNXB呈显著正相关   瑜伽 瑜伽通过伸展肌肉使关节更加柔软，更可能发生GJH
B3GALT6[35] Beighton评分与B3GALT6呈显著正相关 体育活动[37,38] 舞蹈 舞蹈运动员的GJH患病率比普通人群高
    性激素水平[39] － 性激素结合球蛋白(sex hormone-binding globulin, SHBG)水平和GJH风险成正相关
    血清中离子浓度[35] Zn GJH女性血清Zn水平比对照组高
      Sr GJH女性血清Sr水平比对照组高
表2 Beighton评分标准[40,44]
测试项目 阳性标准a
拇指对掌 拇指被动活动可触及前臂屈侧
小指背侧屈曲 第5掌指关节被动背屈≥90°
肘关节伸直 肘关节过度伸展≥10°
膝关节伸直 膝关节过度伸展≥10°
躯干和臀部屈曲 保持膝关节伸直位，向前弯腰手掌可触及地面
表3 JHS的治疗方法和疗效
作者 样本量(例) 干预方法 疗效
Kemp等[57] 一般训练(27)
针对性训练(30)		 一般训练：增强肌力和健康；
针对性训练：针对有症状关节的功能稳定性		 两组的疼痛均显著且持续降低(P<0.001)，但两组间差异无统计学意义(P>0.05)
Sahin等[59] 实验组(15)
对照组(25)		 膝关节本体感觉训练 疼痛减轻(P<0.05)
本体感觉增强(P<0.01)
Ferrell等[46] 实验组(18) 闭链运动训练 疼痛减轻(P＝0.03)
本体感觉(P<0.001)、平衡(P<0.001)、股四头肌和腘绳肌肌力(P<0.05)均增强
生活质量明显改善(身体功能P＝0.029，心理健康P＝0.008)
Barton等[79] 实验组(25) 热身/迁移训练、本体感觉训练 减少运动时疼痛(P<0.001)
最大步行距离提高(P<0.006)
减少膝关节活动范围(左膝P＝0.003，右膝P＝0.022)
Pacey等[80] 中间活动范围组(14)
完整活动范围组(12)		 肌力训练、关节抗阻和控制训练 总体的疼痛减轻(P＝0.004)、腿部肌力增强(P＝0.004)
完整活动范围组的生活质量较中间活动范围组高(身体P＝0.037，社会心理P＝0.009)
Bathen等[81] 实验组(12) 体能训练、小组讨论、讲座、个人家庭训练(专注于肌力、核心稳定性、身体意识、姿势、耐力) 肌力和耐力增强、运动恐惧减少(P<0.05)
Rahman等[62] 实验组(87) 认知行为疗法(疼痛管理教育) 自我效能、疼痛灾难化、抑郁、焦虑、挫败感、疼痛和平均疼痛强度的影响均改善(P<0.001)
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