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发表于 2011-11-2 09:05:43 | 显示全部楼层 |阅读模式
Pes Anserine Bursitis Treatment & Management 鹅足滑囊炎的处理和管理
  • Author: Robert F LaPrade, MD, PhD; Chief Editor: Sherwin SW Ho, MD
Acute Phase急性期Rehabilitation Program 康复计划Physical Therapy 物理治疗
Patients with pes anserine bursitis need to work on both a hamstring stretching program and a concurrent closed-chain quadriceps strengthening program. This type of program can usually be taught to the patient by an athletic trainer or physical therapist. Patients should understand that, to gain the maximum benefit from this program, they need to stretch their hamstrings frequently during the day, sometimes hourly. The quadriceps strengthening program is recommended in most patients because of other concurrent pathology in the knee.
鹅足滑囊炎患者应该拉伸腘绳肌同时做强化股四头肌的闭链练习。这个方案通常由athletic trainer 和物理治疗师来教授完成,如果病人想或得最大的益处应该一天拉伸腘绳肌多次,经常每隔一小时进行拉伸。由于大多数患者可能会伴发膝盖相应的并发症,股四头肌的强化练习也经常被推荐到康复项目当中。
A regular program of hamstring stretching and quadriceps strengthening usually results in alleviation of the pain from pes anserine bursitis in approximately 6-8 weeks. Addition of a nonsteroidal anti-inflammatory drug (NSAID) may help to alleviate some of the pain at this time, and an ice massage may help to reduce inflammation. Cutting back or eliminating the offending activities is also important.
一个规律6-8周的腘绳肌的伸展和股四头肌的强化计划会减缓由于鹅足滑囊炎所导致的疼痛。甾体抗炎药(NSAID) 也可以对这段时间的疼痛起到减缓的作用,冰敷按摩可以减少发炎。这段时间内排除一些影响或加重患者病情的活动也很重要。
Recreational Therapy  娱乐疗法
In patients with generalized anterior knee pain, activity modification may be necessary to allow the joint to quiet down and to allow the hamstring tightness to resolve. In most patients, this modification involves minimizing the use of stairs, climbing, or other activities that cause irritation of the joint.

Surgical Intervention  手术介入
The need for surgery is very rare in cases of pes anserine bursitis. Surgery is usually indicated in cases in which an immunocompromised patient has a localized infection that does not resolve with standard antibiotic treatment. Surgical decompression of the bursa may be indicated in such cases.
Consultations 协商
Recalcitrant cases that do not respond to a program of activity modification and exercise may need a referral to a specialty-trained, sports medicine physician, primary care physician, or orthopedic surgeon for evaluation.

Other Treatment  其他治疗手段
Local anesthetic (typically lidocaine) and corticosteroid (Celestone) injection directly into the bursa is another treatment option. This should be considered only for refractory cases that have not responded to physical therapy, rest, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs). No more than 3 injections should be used over a 1-year period, with at least 1 month between injections; however, patients who do not respond to the initial injection rarely respond to repeat treatments.[2] When injecting the bursa, make certain to avoid injecting any of the 3 tendons converging at the pes anserinus because this can intensify the patient’s pain and weaken the tendons.

Recovery Phase  回复阶段

Rehabilitation Program   康复计划Physical Therapy  物理治疗
During the rehabilitation program, the patient should incorporate the following measures:
  • Continue with activity modification as necessary.
  • 必要时继续活动的修正计划。
  • Begin a gradual resumption of activities.
  • 开始逐渐的重新恢复活动。
  • Continue alternative training for cardiovascular fitness.
  • 继续代替的性血管适能地锻炼。
  • After regaining full, pain-free motion with good isometric strength, work on improving strength and endurance.
  • 配合适合的等长收缩后,在恢复全关节没有疼痛的的情况下,继续提高力量和耐力。

Medical Issues/Complications 理疗问题/并发症
Pes anserine bursitis is primarily a self-limiting condition, which responds well to an exercise/stretching program.[9] Recalcitrant cases should be referred to a specialist to confirm the diagnosis and to rule out other causes of the patient's pain (eg, proximal tibial plateau fracture).
鹅足滑囊炎是一种主要表现在自我活动受限的症状,对运动及伸展计划都有很好的反应。难应付的情况下应该找相应的专家来诊断和排除其他导致患者疼痛的可能性(eg例如, proximal tibial plateau fracture).
Surgical Intervention 手术治疗
See Treatment, Acute Phase, Surgical Intervention. 参见急性期的手术治疗

Maintenance Phase   保持阶段

Rehabilitation Program  康复计划Physical Therapy 物理治疗
Continue to work on a hamstring stretching program and a concurrent closed-chain quadriceps strengthening program.

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