2022-07-20
人體猶如機器,由不同零件組成。俗語有云「年紀大,機器壞」,隨著歲月流逝,不少「零件」難免折舊又退化,以致周身骨痛不足為奇,而退化性膝關節炎亦是長者常見痛症之一(1)。若然膝關節疼痛,以致寸步難行,日常生活受到影響,就適宜考慮進行膝關節置換手術。有骨科醫生表示,現今膝關節置換手術技術純熟,人工關節耐用度十分高(2, 15),手術前還可選擇注射透明質酸,以紓緩痛症(3, 14)。
年齡與體重致退化性關節炎(1, 16)
膝關節的退化性關節炎是不少長者的夢魘,骨科專科醫生鍾廣賢解釋,膝關節以半月板與軟骨作為吸收與緩衝膝關節的壓力(4)。由於軟骨修復的能力非常有限(17),隨著年齡增長,軟骨逐漸磨蝕,造成膝關節發炎(1)。最嚴重的情況下,軟骨會完全磨蝕,露出硬骨,導致硬骨碰硬骨的情況(5)。部分患者亦因肥胖,以致關節受壓增加,膝關節需承受額外負擔,容易令軟骨磨蝕而出現炎症(6, 18)。
退化性膝關節炎患者最常見的症狀為膝關節痛(1),部分患者膝關節活動時甚至出現「咔咔」聲。骨科專科醫生鍾廣賢表示,一般患者的關節初期出現腫脹及疼痛的感覺(1, 7)。如退化持續,嚴重者會出現膝關節僵硬,甚至變形,難以伸直,影響日常活動能力,甚至痛到無法行走(1)。
X 光檢查退化性膝關節炎
不少人感到膝痛時便會聯想到膝關節炎,甚至擔心要接受膝關節置換手術。但骨科專科醫生鍾廣賢表示,膝痛原因眾多,部分患者的病因甚至源自腰椎或髖關節(6),才引致膝痛。故需要透過臨床診症,了解患者疼痛的特徵及程度,配合 X 光檢查膝關節受損的程度,從而達到退化性膝關節炎的診斷(8, 19, 20)。
一旦確診退化性膝關節炎,不少長者都擔心關節置換手術及風險,甚至會問「要切咗個膝頭?」、「換咩代替原本膝蓋?」、「我那麼大年紀,承受到手術嗎?」。骨科專科醫生鍾廣賢解釋,並不是診斷為退化性膝關節炎,便需要進行膝關節置換手術。相反,醫生會因應每名患者膝關節退化的嚴重程度,痛楚的程度,以及對日常生活及工作的影響,以制定適合患者的治療方案。
膝關節置換手術
若果屬於輕症的退化性膝關節炎的患者,建議先從體重入手,減磅以降低膝蓋負重的壓力(7, 20),同時持續以物理治療,強化大腿四頭肌(9, 20),部分人亦可以配合服用一些止痛藥物,以減輕膝痛的情況(10, 20)。不過一旦軟骨磨蝕程度嚴重,既無法正常運動,連步行亦受影響時,便需要考慮接受膝關節置換手術(11, 21),以長遠有效地解決退化性膝關節炎的問題。
膝關節置換手術分為全膝關節及部分膝關節置換(12),前者將整個膝關節換成人工關節(12);後者則只置換受損的部分,創傷性較少,康復過程較快(12, 21)。骨科專科醫生鍾廣賢表示,現今科技先進,近年更引入嶄新機械臂輔助進行膝關節置換手術(13),提高手術精確度及安全性。一般患者於手術後翌日甚至當天已可下牀嘗試活動(22),同步接受物理治療,大概四至八星期已經可以重投日常生活,更可以逐漸重拾一般運動的習慣。
近年部分患者在確診退化性膝關節炎後,會接受透明質酸注射。骨科專科醫生鍾廣賢表示,透明質酸在膝關節內,具有潤滑和避震效能(14),減低膝關節的耗損,抑制發炎反應及疼痛感(14)。鍾醫生曾治療退化性膝關節炎的患者,因退化嚴重,已計劃進行膝關節置換手術。但由於其他健康問題,需要延遲進行手術,故先接受透明質酸治療,顯著減低等候期間膝關節痛(14)。
*本文內容僅供參考,並不能取代臨床醫學意見,詳情請向專業醫護人員查詢。 (資料及相片由客戶提供)
MAT-HK-2200471-1.0-08/2022
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