[fusion_builder_container admin_label=”Article Intro” hundred_percent=”no” hundred_percent_height=”no” hundred_percent_height_scroll=”no” hundred_percent_height_center_content=”yes” equal_height_columns=”no” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” status=”published” background_color=”#ffffff” background_position=”center center” background_repeat=”no-repeat” fade=”no” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ video_aspect_ratio=”16:9″ video_loop=”yes” video_mute=”yes” border_style=”solid” margin_top=”-90px” padding_right=”0px” padding_bottom=”0px” padding_left=”0px” admin_toggled=”yes” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px” type=”flex”][fusion_builder_row][fusion_builder_column type=”1_1″ layout=”1_1″ spacing=”yes” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_image_id=”” background_color=”rgba(255,255,255,0)” background_image=”” background_position=”left top” undefined=”” background_repeat=”no-repeat” hover_type=”none” border_color=”#3bc863″ border_style=”solid” border_position=”top” border_radius_top_left=”” border_radius_top_right=”” border_radius_bottom_left=”” border_radius_bottom_right=”” box_shadow=”yes” box_shadow_vertical=”-5″ box_shadow_horizontal=”0″ box_shadow_blur=”15″ box_shadow_spread=”0″ box_shadow_color=”rgba(0,0,0,0.03)” box_shadow_style=”” padding_top=”40px” padding_right=”4%” padding_bottom=”20px” padding_left=”4%” margin_top=”0px” margin_bottom=”0px” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”true” first=”true” border_sizes_top=”0px”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” content_alignment_medium=”” content_alignment_small=”” content_alignment=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” font_size=”” fusion_font_family_text_font=”” fusion_font_variant_text_font=”” line_height=”” letter_spacing=”” text_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””] 退化性關節炎是極常見的問題，根據衛生福利部統計，在台灣膝蓋退化性關節炎的盛行率約15%，女性多於男性，隨著年紀越大，盛行率越高。 [/fusion_text][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container][fusion_builder_container admin_label=”Featured Image” hundred_percent=”no” hundred_percent_height=”no” hundred_percent_height_scroll=”no” hundred_percent_height_center_content=”yes” equal_height_columns=”no” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” status=”published” background_color=”#ffffff” background_position=”center center” background_repeat=”no-repeat” fade=”no” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ video_aspect_ratio=”16:9″ video_loop=”yes” video_mute=”yes” border_style=”solid” padding_right=”0px” padding_left=”0px” admin_toggled=”yes” type=”flex”][fusion_builder_row][fusion_builder_column type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” border_radius=”” box_shadow=”no” dimension_box_shadow=”” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”0px” margin_bottom=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”true” first=”true” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px”][fusion_imageframe image_id=”20915|full” max_width=”” sticky_max_width=”” skip_lazy_load=”” style_type=”” blur=”10″ stylecolor=”#fffcf9″ hover_type=”zoomin” bordersize=”0″ bordercolor=”#fffcf9″ borderradius=”” align_medium=”none” align_small=”none” align=”center” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” lightbox=”no” gallery_id=”” lightbox_image=”” lightbox_image_id=”” alt=”Morbi vitae purus dictum, ultrices tellus in, gravida lectus. ” link=”” linktarget=”_self” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ 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劉育志醫師

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劉育志醫師

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安醫院骨科楊志鴻醫師指出，我們的股骨與脛骨間具有軟骨及關節液，讓膝蓋能夠活動自如，但在長期受力、創傷後，可能導致軟骨磨損、病變。

「退化性膝關節炎初期，患者在蹲下去、站起來的過程中，膝蓋會發生聲響，或彎曲到某些角度時感到疼痛。患者會覺得走路變得較吃力，可能走20幾分鐘就會感到膝蓋不舒服，且會漸漸縮短到走10分鐘、5分鐘就會感到疼痛。另一種常見的症狀是在久坐之後，突然要站起來的瞬間覺得疼痛，」楊志鴻醫師說，「到最後連上下樓梯都很困難，日常活動很不方便，嚴重影響生活品質。」

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臨床上會將退化性關節炎分成幾級：

第零級：健康的關節，軟骨完整。 第一級：有輕微骨刺形成，軟骨完整，患者通常沒有明顯疼痛或不適。 第二級：骨刺較明顯，軟骨仍完整。患者在長時間行走後會感到疼痛，或在一段時間不活動後會感到僵硬。 第三級：軟骨明顯受損，關節間距開始變窄。患者在走路、彎曲膝蓋時會感到疼痛。 第四級：軟骨嚴重耗損，關節間距狹窄，患者會感到劇烈疼痛。

「從患者走進診間的步態，膝蓋變形的狀況，大概可以推測退化性關節炎的嚴重程度。」楊志鴻醫師說，「醫師會根據退化性關節炎的分級，選擇不同的治療方式。」 .

改善退化性關節炎，可以這樣做

楊志鴻醫師解釋，退化性關節炎在第二級以前，會建議加強下肢的肌力、維持理想體重，其中股四頭肌是穩定膝關節最主要的肌肉，日常生活中也要避免一些容易讓膝蓋受傷的動作，例如跪姿、久蹲、久站。

「很多人會因為還能走路就不太在意，但是等到疼痛的時候才要去訓練肌力，就得花費更多時間。」楊志鴻醫師說，「我們都會解釋清楚，希望患者好好配合，就不用常常跑醫院。」

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當退化性關節炎進展到第三級，就需要藥物介入，除了股四頭肌的訓練、避免傷害關節的姿勢之外，可能使用口服藥、關節注射等方式來改善患者的不適。

進展到第四級時，治療方法就漸漸偏向手術，可考慮用關節鏡進到關節腔內檢查、清創、沖洗，至於關節磨損嚴重的患者只好做人工關節置換手術。 .

人工關節置換手術的進化

近年來人工膝關節置換手術的發展已相當成熟，楊志鴻醫師說，包括手術觀念、人工關節的設計與材質、手術過程中的輔助工具等，皆有長足進步，讓術後的效果大大改善，例如術後疼痛、傷口大小、對軟組織的保護、膝關節活動角度、復原時間等。

「二十年前，我們替患者換人工膝關節，隔天去查房的時候，病人經常痛到不願意講話，還會抱怨被騙了！」楊志鴻醫師分享，「現在我們可以很有信心地告訴病人，術後疼痛已經減輕到以前的50%以下，不管是換單側，或換雙側膝關節的病人，大部分會說傷口有一點痛，但是還可以忍受，患者一般可以在五天內出院。術後恢復到正常膝蓋活動角度的時間，也大幅縮短。」

人工膝關節置換手術可能出現血栓、感染等併發症，患者要與醫療團隊密切配合，以降低併發症發生的機率。

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人工膝關節有三個主要結構，分別植入在股骨、脛骨、髕骨。「考量到人體工學，現在有的股骨植入物會設計成多曲率，相較於單曲率，膝蓋從彎曲到伸直的過程能夠較為省力。」楊志鴻醫師解釋，「有的髕骨植入物也有助於減少髕骨偏移，走路較不會出現喀喀聲。」

每個人的腳型都有些許不同，為了提升人工膝關節手術的滿意度，手術中的輔助工具會利用多個定位點提升精確度，如果在術中能替患者挑選合適的尺寸與角度，術後病人會覺得跟原來的腳型差不多，走起來很自然，類似原來的步態，能提早恢復他原來的活動。楊志鴻醫師說，「人工膝關節的尺寸越齊全，越有助醫師達到精準手術，提升患者術後的滿意度。」

以前換人工膝關節都會建議病人要減少活動量，避免人工膝關節的墊片太早磨壞，但是現在的墊片皆使用超耐磨材質，所以術後病人可以維持溫和的運動，如走路、游泳，但要避免蹲下、跳躍、賽跑。

「我母親在十幾年前膝蓋的狀況就很差，下樓梯都需要側著身走，否則就會痛到軟腳，讓她很擔心跌倒。直到我幫她換了雙側的全人工膝關節，才改善症狀。」楊志鴻醫師分享，「她現在一天可以走一萬步呢！」 .

人工膝關節術後保養這樣做

經過多年發展，人工膝關節的手術、設計、材質、輔助工具已相當進化，讓治療成果提升許多。楊志鴻醫師提醒，換完人工膝關節後，應避免提重物、不可猛烈撞擊。請避免半蹲、跪姿、久坐、久站、盤腿、翹腳、或頻繁上下樓梯。

居家環境應有充足照明、裝置扶手及防滑設施、地板不要堆放雜物，以減少跌倒意外。如果需要接受牙科處置、內視鏡檢查、心導管等檢查或治療時，請事先告知醫師。膝蓋若出現紅、腫、熱、痛、滲液、異音，務必立刻回診喔！ .

【本文由「照護線上」授權轉載，原文出處：蹲下去，站不起來的退化性關節炎，全人工膝關節醫師圖解。】

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