踏腳石 - 退化性膝關節炎患者的棲息地

1997夏，日本福岡大學研修兩個月後，帶回一批辛苦得來的數據，【見：憶東瀛：福岡大學病院二三事（其三）】
開始構思這篇論文的架構及內容
不過，重新回到繁重的臨床工作，1998~2000 對我來說，是異常忙碌而關鍵的，三件事同時進行：

因此，這篇論文整整花了兩年的時間才被 CORR 接受，也成為我日後申請醫學博士的主論文：

Lyu SR, Ogata K, and Hoshiko I
"Effects of a cane on floor reaction force and center of force during gait."
Clin Orthop Relat Res(375): 313-9, 2000 June

Abstract In comparative studies of various gait patterns of 20 healthy subjects who used a cane, the vertical reaction forces and the center of force on the foot were measured and recorded by a force recording and analyzing device. The results indicated that when a cane was used in the ipsilateral hand, the center of force did not shift significantly compared with normal gait. When a cane was used in the contralateral hand, the center of force shifted medially compared with normal gait. In analysis of the vertical floor reaction force acting on the foot, the most efficient way to use a cane was to control the pacing so that the tip of the cane and the foot touched the ground simultaneously. By doing so, the cane could share as much as 34.3% of force at heel strike, 25.3% at midstance, and 29.7% at toeoff of the stance phase of the gait cycle. When prescribing use of a cane for a patient with varus gonarthritis, the patient should be instructed to use the cane in the ipsilateral hand so as not to shift the center of force medially; for a patient with valgus gonarthritis, the cane should be used in the contralateral hand to shift the center of force medially. Patients should be taught to control pacing so that the tip of the cane and the foot touch the ground simultaneously.

對於退化性膝關節炎的治療，我時常自我提醒，絕不能因為自己是骨科醫師，就偏好動刀，而忽略了最基本的保守治療，
經常砥礪自己的是：要以全方位的思考治療這個重要而常見的疾病！

這篇論文的題目，相信是不太能吸引一般骨科醫師注意的，
我卻慶幸自己有這機會以截然不同的角度深入探討退化性膝關節炎的保守治療方式，
在日本，包括契型鞋墊（wedge insole）、特製護膝（brace）、手杖（cane）等，是很受重視的治療選項。

當膝關節退化進行至第三期時，開始有顯著變形，此時，負重將會加速軟骨的破壞，
也就是說，任何減少關節負荷的方法都是有益的，其中，手杖的使用是很好的選擇。

我們的研究結果顯示，若能適當的使用手杖，可有效減輕行走時膝關節承受的應力：

1. 對 O 型變形的退化性膝關節炎患者而言，手杖拿在與患肢同側較能減輕患部負荷
2. 對 X 型變形的退化性膝關節炎患者而言，手杖拿在與患肢對側較能減輕患部負荷
3. 若能控制節奏，讓手杖與腳同時著地，可讓手杖分擔最多體重
  （平均減少 34.3% 腳跟著地時的應力， 25.3% 腳底踩平時的應力， 29.7% 腳趾離地時的應力）

這篇論文雖然爭議性不大，卻是意義深遠，
算是在專一領域的研究踏出了艱辛的第一步，

豈料，緒方教授在這篇論文被接受前竟因肺癌辭世，令人無勝唏噓，慨嘆人生之無常！