本体感觉治疗在膝骨关节炎康复中的研究进展

doi:10.3877/cma.j.issn.1674-0785.2026.03.009

良好的本体感觉是人体实现运动控制与姿势稳定的关键。膝骨关节炎（KOA）作为一种多因素诱发的慢性退行性骨关节疾病，常伴随本体感觉减退、关节疼痛、平衡能力下降和步态异常等症状。长期以来，KOA康复训练中肌力强化与关节活动度的治疗方案明确，功能改善明显。然而针对本体感觉训练手段虽多样，但均需进一步探索其有效性。本文现从外周、中枢以及中枢-外周联合康复治疗三个方面入手，综述目前KOA本体感觉康复方法，分析各类治疗的优势及机制原理，并挖掘未来提升KOA患者本体感觉的新技术及研究方向。

关键词: 膝骨关节炎, 本体感觉, 康复治疗

Proprioception is a key factor for human motor control and postural stability. Knee osteoarthritis (KOA), a chronic degenerative osteoarthropathy induced by multiple factors, is often accompanied by impaired proprioception, joint pain, decreased balance ability, abnormal gait, and other symptoms. Muscle strengthening and joint range of motion training have long been cornerstones of KOA rehabilitation, consistently demonstrating significant functional benefits. However, despite the diversity of proprioceptive training modalities currently available, their clinical efficacy warrants further investigation. This review examines existing proprioceptive rehabilitation strategies for KOA from three distinct perspectives— peripheral, central, and combined central-peripheral rehabilitation. It provides an analysis of the advantages and mechanisms of each therapeutic approach and discusses novel technologies as well as future research directions aimed at enhancing proprioceptive function in KOA patients.

Key words: Knee osteoarthritis, Proprioception, Rehabilitation therapy

表1 KOA本体感觉的外周康复治疗常见手段

干预方法	作用	优势	不足
肌内效贴^[18]	改善股四头肌肌力、本体感觉及膝关节活动，消肿止疼。	操作简便、起效迅速、无创无不良反应等。	对皮肤要求较高，皮肤破溃，过敏者禁用。
认知运动疗法^[19]	改善患者的膝关节活动度，增加本体感觉。	激惹性较低、不易引起疼痛，方法简单，增强大脑的感知记忆能力。	需要患者主动配合，大脑参与度高。
PNF^[20]	增强下肢肌肉力量及柔韧性，增大关节活动范围，改善本体感觉	通过独特的对角螺旋运动模式激活和募集最大数量的肌纤维参与活动，从而促进相关肌肉反应，增强肌肉的收缩能力。	操作较为复杂，对治疗师技术及患者的配合度要求较高。
平衡训练^[21]	改善全身的运动、缓解膝关节疼痛和僵硬，增加本体感觉。	增强核心与整体力量，优化运动表现与协调。	训练时有跌倒风险。
传统功法^[22]	提高本体感觉和平衡能力，增强膝关节稳定性，改善躯体功能。	锻炼不受场地和时间的限制，提高运动控制能力和姿势稳定性，降低跌倒风险。	动作复杂，初期学习有难度。
全身振动训练^[23]	减轻疼痛，增加下肢肌力，改善关节功能，改善平衡和本体感觉。	简便易行、安全有效。	对于重度KOA患者，患有急性疼痛、关节严重不稳或骨质疏松的患者，振动刺激可能会加重不适。
肌力训练^[24]	增加膝关节周围肌肉力量，本体感觉及步行功能，减轻疼痛。	增强肌力。	训练枯燥，患者易产生疲劳，动作不规范会有受伤的风险。
矫形鞋垫^[25]	改变足底受力情况，纠正下肢生物力线，降低关节的负荷与关节软骨的磨损，改善本体感觉，增强步行能力和平衡能力。	鞋垫根据个人情况进行定制，针对性较强。	费用相对高昂，制作耗时长，不能及时获取。

表1 KOA本体感觉的外周康复治疗常见手段

干预方法	作用	优势	不足
肌内效贴^[18]	改善股四头肌肌力、本体感觉及膝关节活动，消肿止疼。	操作简便、起效迅速、无创无不良反应等。	对皮肤要求较高，皮肤破溃，过敏者禁用。
认知运动疗法^[19]	改善患者的膝关节活动度，增加本体感觉。	激惹性较低、不易引起疼痛，方法简单，增强大脑的感知记忆能力。	需要患者主动配合，大脑参与度高。
PNF^[20]	增强下肢肌肉力量及柔韧性，增大关节活动范围，改善本体感觉	通过独特的对角螺旋运动模式激活和募集最大数量的肌纤维参与活动，从而促进相关肌肉反应，增强肌肉的收缩能力。	操作较为复杂，对治疗师技术及患者的配合度要求较高。
平衡训练^[21]	改善全身的运动、缓解膝关节疼痛和僵硬，增加本体感觉。	增强核心与整体力量，优化运动表现与协调。	训练时有跌倒风险。
传统功法^[22]	提高本体感觉和平衡能力，增强膝关节稳定性，改善躯体功能。	锻炼不受场地和时间的限制，提高运动控制能力和姿势稳定性，降低跌倒风险。	动作复杂，初期学习有难度。
全身振动训练^[23]	减轻疼痛，增加下肢肌力，改善关节功能，改善平衡和本体感觉。	简便易行、安全有效。	对于重度KOA患者，患有急性疼痛、关节严重不稳或骨质疏松的患者，振动刺激可能会加重不适。
肌力训练^[24]	增加膝关节周围肌肉力量，本体感觉及步行功能，减轻疼痛。	增强肌力。	训练枯燥，患者易产生疲劳，动作不规范会有受伤的风险。
矫形鞋垫^[25]	改变足底受力情况，纠正下肢生物力线，降低关节的负荷与关节软骨的磨损，改善本体感觉，增强步行能力和平衡能力。	鞋垫根据个人情况进行定制，针对性较强。	费用相对高昂，制作耗时长，不能及时获取。

图1 KOA患者本体感觉损伤恶性循环及康复治疗机制。红色箭头示“感觉输入-中枢整合-外周输出”的恶性循环；蓝色箭头示本体感觉康复治疗路径，通过外周强化感觉输入、中枢优化信息处理的双重机制打破恶性循环，改善KOA患者本体感觉功能注：KOA为膝骨关节炎

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Proprioceptive training in knee osteoarthritis rehabilitation: a review

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Proprioceptive training in knee osteoarthritis rehabilitation: a review