基于中医大健康理念探讨膝骨关节炎循证分期及阶梯治疗
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摘要
膝骨关节炎(KOA)以疼痛、关节僵硬、功能障碍为主要临床体征,是困扰我国老年人群的重要疾患之一;在中医整体观与大健康理念指引下,亟需不断创新并发掘机体病理变化的早期监测技术,以及健康维持与疾患预防的早期干预方案,以实现对个体健康与不同疾患阶段的最优化处理。文章围绕上述核心问题在大健康思维与内涵阐释、中医整体观与大健康的相关性、KOA中西医防治方案优化等方面展开论述,并就KOA循证分期、KOA阶梯治疗以及KOA决策优化等方面进行相关分析,以期为当前KOA临床诊治提供参考。
Knee osteoarthritis(KOA), with pain, joint stiffness and dysfunction as the main clinical signs, is one of the important diseases that plague the elderly in China; under the guidance of the concept of health, there is an urgent need to continuously innovate and explore early monitoring techniques for pathological changes in the body, as well as early intervention programs for health maintenance and disease prevention to achieve optimal treatment of individual health and different disease stages. The article revolves around the above core issues. In the aspects of big health thinking and connotation interpretation, the relationship between TCM holistic view and great health, KOA Chinese and western medicine prevention and treatment program,etc., and related analysis on KOA evidence-based staging, KOA ladder treatment, and KOA decision-making optimization, with a view to provide reference for the current clinical diagnosis and treatment of KOA.
Knee osteoarthritis(KOA), with pain, joint stiffness and dysfunction as the main clinical signs, is one of the important diseases that plague the elderly in China; under the guidance of the concept of health, there is an urgent need to continuously innovate and explore early monitoring techniques for pathological changes in the body, as well as early intervention programs for health maintenance and disease prevention to achieve optimal treatment of individual health and different disease stages. The article revolves around the above core issues. In the aspects of big health thinking and connotation interpretation, the relationship between TCM holistic view and great health, KOA Chinese and western medicine prevention and treatment program,etc., and related analysis on KOA evidence-based staging, KOA ladder treatment, and KOA decision-making optimization, with a view to provide reference for the current clinical diagnosis and treatment of KOA.
引文
[1]陈淑娇,李灿东.论大健康背景下的中国特色的中医健康管理模式.中华中医药杂志,2017,32(11):4789-4792
[2]杨嘉璐,郭滢,张乐吟,等.习近平总书记大健康理念在浙江中医“治未病”工程中的实践研究.浙江中医药大学学报,2017,41(7):562-568
[3]张伯礼,张俊华,陈士林,等.中药大健康产业发展机遇与战略思考.中国工程科学,2017,19(2):16-20
[4]黄惠勇.谈大健康产业创新发展模式.湖南中医杂志,2017,33(3):1-4
[5]司建平.大健康背景下中医药国际化的策略选择.中医学报,2015,30(5):678-680
[6]王亮,陈祁青,童培建,等.膝关节骨性关节炎早期诊断的临床特征分析.中国骨与关节损伤杂志,2015,30(2):161-163
[7]王亮,陈祁青,童培建,等.膝骨性关节炎早期诊断的研究进展.中国骨伤,2016,29(3):288-291
[8]雷顺群.论大健康理念形成的立论基础和根据.中医杂志,2016,57(15):1261-1265
[9]刘德培.人民共建共享“大健康”.中国卫生,2016,2(10):26-27
[10]蔡青青,蔡芳川.21世纪大健康的理念及其时代特征.体育科学研究,2003,7(3):53-55
[11]戴伟,张霄艳,孙晓伟.大健康理念下的“医养结合”模式.中国社会保障,2015,3(10):82-83
[12]杨志平,刘运芳,樊代明.整合医学实践的本质及要素.医学研究杂志,2017,46(7):6-8
[13]陈致慜.对发展中医药大健康产业的几点建议.中国科技产业,2017,5(2):31
[14]黄建始.最大回报:健康投资.北京:中国协和医科大学出版社,2004
[15]中华中医药学会.骨性关节炎(ZYYXH/T387-2012).风湿病与关节炎,2013,2(2):71-73
[16]中华医学会风湿病学分会.骨关节炎诊断及治疗指南.中华风湿病学杂志,2010,14(6):416-419
[17]McAlindon T E,Bannuru R R,Sullivan M C,et al.OARSI guidelines for the non-surgical management of knee osteoarthritis.Osteoarthritis Cartilage,2014,22(3):363-388
[18]中国中西医结合学会骨伤科专业委员会关节工作委员会.膝骨关节炎中医诊疗专家共识(2015年版).中医正骨,2015(7):4-5
[19]Fransen M,McConnell S,Harmer A R,et al.Exercise for osteoarthritis of the knee.Cochrane Database Syst Rev,2015,1:CD004376.doi:10.1002/14651858.CD004376.pub3
[20]曾令烽,杨伟毅,郭达,等.传统运动疗法干预对膝骨关节炎患者疼痛改善及关节功能影响的系统评价.中华中医药杂志,2018,33(5):2132-2139
[21]元永金,赵耀东,张国晓,等.基于经筋理论探讨毫针刺法治疗膝骨性关节炎.中华中医药杂志,2018,33(3):979-982
[22]李西海,刘献祥.基于筋骨理论探讨膝骨关节炎筋骨失衡的治疗策略.中华中医药杂志,2017,32(8):3344-3346
[23]艾健,房敏,孙武权,等.“筋骨失衡,以筋为先”理论在膝关节病中的应用探讨.中华中医药杂志,2014,29(8):2404-2406
[24]卜婉萍,林栋,庄婉玉,等.肌筋膜链理论与经络系统中阳经的相关性研究.新中医,2016,48(11):196-198
[25]Mc Alinden A,Im G I.MicroRNAs in orthopaedic research:Disease associations,potential therapeutic applications,and perspectives.J Orthop Res,2018,36(1):33-51
[26]Urban H,Little C B.The role of fat and inflammation in the pathogenesis and management of osteoarthritis.Rheumatology(Oxford),2018,57(4):10-21
[27]Wang B,Wu S,Wang T,et al.Bone marrow-derived mesenchymal stem cells-mediated protection against organ dysfunction in disseminated intravascular coagulation is associated with peripheral immune responses.J Cell Biochem,2017,118(10):3184-3192
[28]Lopes E B P,Filiberti A,Husain S A,et al.Immune contributions to osteoarthritis.Curr Osteoporos Rep,2017,15(6):593-600
[29]李宁,李应福,谢兴文,等.中药诱导骨髓间充质干细胞的定向分化:研究与进展.中华细胞与干细胞杂志(电子版),2013,20(4):135-139
[2]杨嘉璐,郭滢,张乐吟,等.习近平总书记大健康理念在浙江中医“治未病”工程中的实践研究.浙江中医药大学学报,2017,41(7):562-568
[3]张伯礼,张俊华,陈士林,等.中药大健康产业发展机遇与战略思考.中国工程科学,2017,19(2):16-20
[4]黄惠勇.谈大健康产业创新发展模式.湖南中医杂志,2017,33(3):1-4
[5]司建平.大健康背景下中医药国际化的策略选择.中医学报,2015,30(5):678-680
[6]王亮,陈祁青,童培建,等.膝关节骨性关节炎早期诊断的临床特征分析.中国骨与关节损伤杂志,2015,30(2):161-163
[7]王亮,陈祁青,童培建,等.膝骨性关节炎早期诊断的研究进展.中国骨伤,2016,29(3):288-291
[8]雷顺群.论大健康理念形成的立论基础和根据.中医杂志,2016,57(15):1261-1265
[9]刘德培.人民共建共享“大健康”.中国卫生,2016,2(10):26-27
[10]蔡青青,蔡芳川.21世纪大健康的理念及其时代特征.体育科学研究,2003,7(3):53-55
[11]戴伟,张霄艳,孙晓伟.大健康理念下的“医养结合”模式.中国社会保障,2015,3(10):82-83
[12]杨志平,刘运芳,樊代明.整合医学实践的本质及要素.医学研究杂志,2017,46(7):6-8
[13]陈致慜.对发展中医药大健康产业的几点建议.中国科技产业,2017,5(2):31
[14]黄建始.最大回报:健康投资.北京:中国协和医科大学出版社,2004
[15]中华中医药学会.骨性关节炎(ZYYXH/T387-2012).风湿病与关节炎,2013,2(2):71-73
[16]中华医学会风湿病学分会.骨关节炎诊断及治疗指南.中华风湿病学杂志,2010,14(6):416-419
[17]McAlindon T E,Bannuru R R,Sullivan M C,et al.OARSI guidelines for the non-surgical management of knee osteoarthritis.Osteoarthritis Cartilage,2014,22(3):363-388
[18]中国中西医结合学会骨伤科专业委员会关节工作委员会.膝骨关节炎中医诊疗专家共识(2015年版).中医正骨,2015(7):4-5
[19]Fransen M,McConnell S,Harmer A R,et al.Exercise for osteoarthritis of the knee.Cochrane Database Syst Rev,2015,1:CD004376.doi:10.1002/14651858.CD004376.pub3
[20]曾令烽,杨伟毅,郭达,等.传统运动疗法干预对膝骨关节炎患者疼痛改善及关节功能影响的系统评价.中华中医药杂志,2018,33(5):2132-2139
[21]元永金,赵耀东,张国晓,等.基于经筋理论探讨毫针刺法治疗膝骨性关节炎.中华中医药杂志,2018,33(3):979-982
[22]李西海,刘献祥.基于筋骨理论探讨膝骨关节炎筋骨失衡的治疗策略.中华中医药杂志,2017,32(8):3344-3346
[23]艾健,房敏,孙武权,等.“筋骨失衡,以筋为先”理论在膝关节病中的应用探讨.中华中医药杂志,2014,29(8):2404-2406
[24]卜婉萍,林栋,庄婉玉,等.肌筋膜链理论与经络系统中阳经的相关性研究.新中医,2016,48(11):196-198
[25]Mc Alinden A,Im G I.MicroRNAs in orthopaedic research:Disease associations,potential therapeutic applications,and perspectives.J Orthop Res,2018,36(1):33-51
[26]Urban H,Little C B.The role of fat and inflammation in the pathogenesis and management of osteoarthritis.Rheumatology(Oxford),2018,57(4):10-21
[27]Wang B,Wu S,Wang T,et al.Bone marrow-derived mesenchymal stem cells-mediated protection against organ dysfunction in disseminated intravascular coagulation is associated with peripheral immune responses.J Cell Biochem,2017,118(10):3184-3192
[28]Lopes E B P,Filiberti A,Husain S A,et al.Immune contributions to osteoarthritis.Curr Osteoporos Rep,2017,15(6):593-600
[29]李宁,李应福,谢兴文,等.中药诱导骨髓间充质干细胞的定向分化:研究与进展.中华细胞与干细胞杂志(电子版),2013,20(4):135-139