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中老年广场舞对着月亮唱情歌 老年人膝盖痛有什么好的办法?

字号+作者:ag体育娱乐官网网址 | 弹条 鱼尾板 铁路配件 弹条铁路配件来源:临沂市2021-10-30 04:07:32我要评论(0)

六旬大爷用手机玩陌陌和探探,被街坊邻居背后议论,你怎么看?\r\n老年人的膝关节使用了很多年,不出现问题的有,但是很少,所以我们国家有句“人老先老腿”的老话儿,我个人认为老话儿一般都错不了。在临床上,

六旬大爷用手机玩陌陌和探探,被街坊邻居背后议论,你怎么看?\r\n老年人的膝关节使用了很多年,不出现问题的有,但是很少,所以我们国家有句“人老先老腿”的老话儿,我个人认为老话儿一般都错不了。在临床上,常见的导致老年人膝盖疼痛的原因,多数都是骨关节炎就如同我们常年骑的自行车一样,轴承就会出现磨损,自行车的轴承会由光滑的表面转变成比较粗糙的形态。这种情况放在我们人类的关节当中也是可以适用的,只不过这种光滑的表面不是金属,而是我们的关节软骨。当我们的关节软骨在体重增加、长时间的过度使用、不正确的运动、外伤以及寒凉等因素的刺激下。关节内的软骨就会发生磨损,由于关节内的软骨会有一定的厚度,在磨损的早期只会发生类似于天鹅绒样的改变,患者并不会有特殊的症状,只有在特殊的查体或者是特殊的体位,与动作的时候,会诱发轻度的疼痛。比如很多老年患者会在上下楼梯和蹲起的时候感觉到膝关节前方的疼痛,走平路反而没有症状,这就是骨关节炎早期的一种特殊表现。但是如果磨损进一步的加重,那么就会出现软骨的剥脱碎裂,患者的疼痛可能就会越来越严重,在此阶段的患者通常会走平路的时候,也会有明显的疼痛,做x线检查,基本会发现关节间隙已经开始出现了狭窄,而且会有骨赘也就是骨刺的形成。当病程进行到了晚期,患者关节间隙会越来越严重,关节也会随之出现明显的变形,有的老年人会出现明显的o型腿,或者是x型腿的改变,基本都是源自于关节内软骨的磨损,导致的关节畸形。而患者呢,也会出现明显的关节疼痛,严重影响患者的生活质量,有一些患者会出现明显的夜间痛以及休息痛。针对骨关节炎的治疗,要有阶梯早期骨关节炎的治疗:早期骨关节炎的患者症状相对来讲比较轻,那么此时我们需要做的是建议老年患者减轻体重,减少长时间行走的量,一般建议老年人每天控制在行走6000步到8000步左右即可,最好是在游泳池中行走或者是游泳,这种对于关节没有负担的动作是非常好的运动方式。也建议老年人进行关节肌肉的康复锻炼,促进肌肉的强化,保更好的保护关节。在这个阶段一般不建议患者采取药物治疗的办法,如果疼痛比较明显,但是检查反而表现的不是很严重的话,建议可以采取外用非甾体镇痛药的办法来控制疼痛。中期骨关节炎的治疗:患者到了中期,关节疼痛会有明显的加重,在坚持早期骨关节治疗的基础上,可以建议患者口服一些非甾体镇痛药,通常我们建议口服西乐葆这一类比较对胃黏膜伤害较轻的药物来控制疼痛。也可以采取一些物理治疗的办法,比如微波治疗,超声波治疗,帮助控制关节炎症的进展。由于中期骨关节炎患者的关节软骨已经有了明显的退变,部分患者的关节软骨会出现明显的皲裂与脱落,破碎。那么此时,建议给关节内进行关节腔注射玻璃酸钠的办法来增加关节软骨的弹性,减轻关节软骨的摩擦。最近这几年,对于富血小板血浆因子也就是PRP的使用越来越广泛。这是一种新的技术,可以采取患者自身的血液,经过专业的无菌技术给予离心出PRP,由于这种因子具有比较好的促进损伤修复的作用,最近也被开始用于关节腔注射。在中期的患者如果关节内的半月板出现了明显的破裂,导致患者出现了疼痛,经过核磁诊断能够明确患者的症状与半月板之间是互为因果关系的话,可以进行关节腔的手术治疗,在处理半月板的同时,将关节腔的滑膜或者是积液进行相应的处理,帮助患者控制病情,减轻症状。晚期骨关节炎:晚期骨关节炎由于患者已经出现了明显的关节畸形,很多患者已经谈不上生活质量,被折磨的痛不欲生,那么此时可能进行手术治疗的办法是最好的措施。过去主要采取的办法是比较单一的,我们称之为全膝关节表面置换术,也就是像膝关节软骨已经磨损殆尽的表面替换成金属表面,关节内的骨骼就不会发生直接的摩擦,疼痛也就会消失。但是在常年的手术经验积累当中,很多医生也发现,部分患者仅仅是内侧的膝关节或者是外侧的膝关节问题比较严重,而针对某一侧的关节问题将整个关节的表面全都置换掉,确实有些可惜。所以目前也开展了单髁置换手术以及模块化的置换手术,我们统称为部分关节置换术。以上是针对骨关节炎患者的老年人一些治疗的建议。目前对于骨关节炎的阶梯治疗,每年都有新的认识,最新的骨关节炎治疗专家共识也刚刚发颁布,期待将来随着医学的进展,将会有更多更好的办法帮助老年人来缓解关节的疼痛问题。导致老年人关节疼痛的问题还有很多,比如风湿性关节炎、骨质疏松、类风湿性关节炎。但是都没有骨关节炎患者这样的常见。以上就是对您问题的一部分解答,如果您还有其他的疑惑,可以在下方留言,大家共同探讨。关于骨质疏松等引起关节疼痛,患者的问题如何解决?谢医生在以前的问答和文章中也有了详细的描述,就不在这里一一赘述了,大家如果有想了解的可以在头条关注谢医生,在既往的文章当中找到一些建议。(治疗骨关节炎的办法绝对不是只有这么少,比如我们祖国医学的针灸以及艾灸,外用的中成药等办法都可以帮助患者来解决问题,但是谢医生是西医,就不在鲁班门前弄大斧了)我是坚持用简单语言解释复杂疾病知识的谢新辉,码字不易,如果能赞同我的观点,请帮忙点个关注或点个赞吧,如果您或者是您身边的家人朋友正在经历着膝痛,尤其是由骨关节炎导致的膝痛的折磨,请把这篇文章转发给需要的他们吧,谢谢了!

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