膝骨关节炎阶梯治疗专家共识(2018年版)
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摘要
<正>一、共识背景骨关节炎(osteoarthritis,OA)是一种严重影响患者生活质量的关节退行性疾病,而膝骨关节炎(knee osteoarthritis,KOA)在临床最常见,主要表现为膝关节疼痛和活动受限。中华医学会骨科学分会关节外科学组和《中华骨科杂志》编辑部2018年6月发布《骨关节炎诊疗指南(2018版)》,该指南结合OA疾病特点提出了金字塔型的阶梯化分级治疗策略,将KOA的治疗分为基础治疗、药物治疗、修复性治疗和重建治疗4个层次,指导医生根据患者骨关节炎的不同程度进行相应治疗。
引文
[1] Tang X, Wang SF, Zhan SY, et al. The prevalence of symptomatic knee osteoarthritis in China results from the China health and retirement longitudinal study[J]. Arthritis Rheumatol,2016,68(3):648-653.
[2] Altman R,Asch E,Bloch D,et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association[J]. Arthritis Rheum,1986,29(8):1039-1049.
[3] Altman R,Alarcón G,Appelrouth D,et al. The American college of rheumatology criteria for the classification and reporting of osteoarthritis of the hip[J]. Arthritis Rheum,1991,34(5):505-514.
[4] Zhang W,Doherty M,Leeb BF,et al. EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis:report of a task force of ESCISIT[J]. Ann Rheum Dis,2009,68(1):8-17.
[5]中华医学会骨科学分会.骨关节炎诊治指南(2018年版)[J].中华骨科杂志,2007,27(10):793-796.
[6] Osteoporosis Group of Chinese Orthopaedic Association. Guideline for diagnosis and treatment of osteoarthritis[J]. Chin J Orthop,2007,27(10):793-796.
[7] Altman R,Alarcón G, Appelrouth D,et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand[J]. Arthritis Rheum,1990,33(11):1601-1610.
[8] Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis[J]. Ann Rheum Dis,1957,16(4):494-502.
[9] RechtMP,Resnick D. Mr imaging of articular cartilage:current status and future directions[J]. AJR Am J Roentgenol,1994,163(2):283-290.
[10] Nelson AE,Allen KD,Golightly YM,et al. A systematic review of recommendations and guidelines for the management of osteoarthritis:The Chronic Osteoarthritis Management Initiative of the US Bone and Joint Initiative[J]. Semin Arthritis Rheum,2014,43(6):701-712.
[11] Thorstensson CA,Garellick G,Rystedt H,et al. Better management of patients with osteoarthritis:development and nationwide implementation of an evidence-based supported osteoarthritis selfManagement Programme[J/OL]. Musculoskeletal Care,2015,13(2):67-75. doi:10. 1002/msc. 1085.
[12] Brand E,Nyland J,Henzman C,et al. Arthritis self-efficacy scale scores in knee osteoarthritis:a systematic review and meta-analysis comparing arthritis self-management education with or without exercise[J/OL]. J Orthop Sports Phys Ther,2013,43(12):895-910. doi:10. 2519/jospt. 2013. 4471.
[13] Fernandes L, Hagen KB, Bijlsma JW, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis[J]. Ann Rheum Dis,2013,72(7):1125-1135.
[14] Christensen R,Bartels EM,Astrup A,et al. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis:a systematic review and meta-analysis[J]. Ann Rheum Dis,2007,66(4):433-439.
[15] Beumer L,Wong J,Warden SJ,et al. Effects of exercise and manual therapy on pain associated with hip osteoarthritis:a systematic review and meta-analysis[J]. Br J Sports Med,2016,50(8):U29-458.
[16] Lauche R,Langhorst J,Dobos G,et al. A systematic review and meta-analysis of Tai Chi for osteoarthritis of the knee[J].Complement Ther Med,2013,21(4):396-406.
[17] De Mattos F,Leite N,Pitta A,et al. Effects of aquatic exercise on muscle strength and functional performance of individuals with osteoarthritis:a systematic review[J]. Rev Bras Reumatol,2016,56(6):530-542.
[18]周谋望,岳寿伟,何成奇,等.《骨关节炎的康复治疗》专家共识[J].中华物理医学与康复杂志,2012,34(12):951-953.
[19] Waller B,Ogonowska-Slodownik A,Vitor MA,et al. Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis:systematic review with MetaAnalysis[J]. Phys Ther,2014,94(10):1383-1395.
[20] Corbett MS,Rice SJ,Madurasinghe V,et al. Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee:network meta-analysis[J]. Osteoarthritis Cartilage,2013,21(9):1290-1298.
[21] Forestier R,Forestier FB,Francon A. Spa therapy and knee osteoarthritis:A systematic review[J]. Ann Phys Rehabil Med,2016,59(3):216-226.
[22] Manyanga T,Froese M,Zarychanski R,et al. Pain management with acupuncture in osteoarthritis:a systematic review and metaanalysis[J/OL]. BMC Complement Altern Med,2014,14:312.doi:10. 1186/1472-6882-14-312.
[23] Zeng C,Li H,Yang T,et al. Electrical stimulation for pain relief in knee osteoarthritis:systematic review and network meta-analysis[J/OL]. Osteoarthritis Cartilage,2015,23(2):189-202. doi:10. 1016/j. joca. 2014. 11. 014.
[24]叶华,左晓霞,古洁若,等.氟比洛芬巴布膏治疗膝骨关节炎疼痛的全国多中心随机开放阳性药对照临床研究[J].中华风湿病学杂志,2012,16(9):606-610.
[25] Risser RC,Hochberg MC,Gaynor PJ,et al. Responsiveness of the intermittent and constant osteoarthritis pain(ICOAP)scale in a trial of duloxetine for treatment of osteoarthritis knee pain[J/OL]. Osteoarthritis Cartilage,2013,21(5):691-694. doi:10. 1016/j. jo-ca. 2013. 02. 007.
[26] Hochberg MC,Wohlreich M,Gaynor P,et al. Clinically relevant outcomes based on analysis of pooled data from 2 trials of duloxetine in patients with knee osteoarthritis[J/OL]. J Rheumatol,2012,39(2):352-358. doi:10. 3899/jrheum.110307.
[27] Chen B,Zhan HS,Marszalek J,et al. Traditional Chinese medications for knee osteoarthritis pain:a Meta-Analysis of randomized controlled trials[J/OL]. Am J Chin Med,2016,44(4):677-703. doi:10. 1142/s0192415x16500373.
[28]中国医疗保健国际交流促进会骨科分会.富血小板血浆在骨关节外科临床应用专家共识(2018年版)[J/CD].中华关节外科杂志(电子版),2018,12(5):1-5.
[29] Moseley JB,O’malley K,Petersen NJ,et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee[J]. N Engl J Med,2002,347(2):81-88.
[30]王庆,黄华扬,张涛,等.基质诱导自体软骨细胞移植修复膝关节软骨损伤的早期疗效[J].中华骨科杂志,2016,36(1):28-34.
[31]戴雪松,宓云峰,熊炎,等.活动与固定平台的单髁假体置换治疗膝关节内侧间室骨关节炎[J].中华骨科杂志,2015,35(7):691-698.
[32] Niinim@ki T, Eskelinen A, M@kel@K, et al.Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship:a 27-year Finnish registry study[J]. Clin OrthopRelat Res,2014,472(5):1496-1501.
[33] Kim YM,Joo YB. Patellofemoral osteoarthritis[J]. Knee Surg Relat Res,2012,24(4):193-200.
[34] Cotic M,Forkel P,Imhoff AB. Patellofemoral arthroplasty. Oper Orthop Traumatol,2017,29(1):40-50.
[2] Altman R,Asch E,Bloch D,et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association[J]. Arthritis Rheum,1986,29(8):1039-1049.
[3] Altman R,Alarcón G,Appelrouth D,et al. The American college of rheumatology criteria for the classification and reporting of osteoarthritis of the hip[J]. Arthritis Rheum,1991,34(5):505-514.
[4] Zhang W,Doherty M,Leeb BF,et al. EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis:report of a task force of ESCISIT[J]. Ann Rheum Dis,2009,68(1):8-17.
[5]中华医学会骨科学分会.骨关节炎诊治指南(2018年版)[J].中华骨科杂志,2007,27(10):793-796.
[6] Osteoporosis Group of Chinese Orthopaedic Association. Guideline for diagnosis and treatment of osteoarthritis[J]. Chin J Orthop,2007,27(10):793-796.
[7] Altman R,Alarcón G, Appelrouth D,et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand[J]. Arthritis Rheum,1990,33(11):1601-1610.
[8] Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis[J]. Ann Rheum Dis,1957,16(4):494-502.
[9] RechtMP,Resnick D. Mr imaging of articular cartilage:current status and future directions[J]. AJR Am J Roentgenol,1994,163(2):283-290.
[10] Nelson AE,Allen KD,Golightly YM,et al. A systematic review of recommendations and guidelines for the management of osteoarthritis:The Chronic Osteoarthritis Management Initiative of the US Bone and Joint Initiative[J]. Semin Arthritis Rheum,2014,43(6):701-712.
[11] Thorstensson CA,Garellick G,Rystedt H,et al. Better management of patients with osteoarthritis:development and nationwide implementation of an evidence-based supported osteoarthritis selfManagement Programme[J/OL]. Musculoskeletal Care,2015,13(2):67-75. doi:10. 1002/msc. 1085.
[12] Brand E,Nyland J,Henzman C,et al. Arthritis self-efficacy scale scores in knee osteoarthritis:a systematic review and meta-analysis comparing arthritis self-management education with or without exercise[J/OL]. J Orthop Sports Phys Ther,2013,43(12):895-910. doi:10. 2519/jospt. 2013. 4471.
[13] Fernandes L, Hagen KB, Bijlsma JW, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis[J]. Ann Rheum Dis,2013,72(7):1125-1135.
[14] Christensen R,Bartels EM,Astrup A,et al. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis:a systematic review and meta-analysis[J]. Ann Rheum Dis,2007,66(4):433-439.
[15] Beumer L,Wong J,Warden SJ,et al. Effects of exercise and manual therapy on pain associated with hip osteoarthritis:a systematic review and meta-analysis[J]. Br J Sports Med,2016,50(8):U29-458.
[16] Lauche R,Langhorst J,Dobos G,et al. A systematic review and meta-analysis of Tai Chi for osteoarthritis of the knee[J].Complement Ther Med,2013,21(4):396-406.
[17] De Mattos F,Leite N,Pitta A,et al. Effects of aquatic exercise on muscle strength and functional performance of individuals with osteoarthritis:a systematic review[J]. Rev Bras Reumatol,2016,56(6):530-542.
[18]周谋望,岳寿伟,何成奇,等.《骨关节炎的康复治疗》专家共识[J].中华物理医学与康复杂志,2012,34(12):951-953.
[19] Waller B,Ogonowska-Slodownik A,Vitor MA,et al. Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis:systematic review with MetaAnalysis[J]. Phys Ther,2014,94(10):1383-1395.
[20] Corbett MS,Rice SJ,Madurasinghe V,et al. Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee:network meta-analysis[J]. Osteoarthritis Cartilage,2013,21(9):1290-1298.
[21] Forestier R,Forestier FB,Francon A. Spa therapy and knee osteoarthritis:A systematic review[J]. Ann Phys Rehabil Med,2016,59(3):216-226.
[22] Manyanga T,Froese M,Zarychanski R,et al. Pain management with acupuncture in osteoarthritis:a systematic review and metaanalysis[J/OL]. BMC Complement Altern Med,2014,14:312.doi:10. 1186/1472-6882-14-312.
[23] Zeng C,Li H,Yang T,et al. Electrical stimulation for pain relief in knee osteoarthritis:systematic review and network meta-analysis[J/OL]. Osteoarthritis Cartilage,2015,23(2):189-202. doi:10. 1016/j. joca. 2014. 11. 014.
[24]叶华,左晓霞,古洁若,等.氟比洛芬巴布膏治疗膝骨关节炎疼痛的全国多中心随机开放阳性药对照临床研究[J].中华风湿病学杂志,2012,16(9):606-610.
[25] Risser RC,Hochberg MC,Gaynor PJ,et al. Responsiveness of the intermittent and constant osteoarthritis pain(ICOAP)scale in a trial of duloxetine for treatment of osteoarthritis knee pain[J/OL]. Osteoarthritis Cartilage,2013,21(5):691-694. doi:10. 1016/j. jo-ca. 2013. 02. 007.
[26] Hochberg MC,Wohlreich M,Gaynor P,et al. Clinically relevant outcomes based on analysis of pooled data from 2 trials of duloxetine in patients with knee osteoarthritis[J/OL]. J Rheumatol,2012,39(2):352-358. doi:10. 3899/jrheum.110307.
[27] Chen B,Zhan HS,Marszalek J,et al. Traditional Chinese medications for knee osteoarthritis pain:a Meta-Analysis of randomized controlled trials[J/OL]. Am J Chin Med,2016,44(4):677-703. doi:10. 1142/s0192415x16500373.
[28]中国医疗保健国际交流促进会骨科分会.富血小板血浆在骨关节外科临床应用专家共识(2018年版)[J/CD].中华关节外科杂志(电子版),2018,12(5):1-5.
[29] Moseley JB,O’malley K,Petersen NJ,et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee[J]. N Engl J Med,2002,347(2):81-88.
[30]王庆,黄华扬,张涛,等.基质诱导自体软骨细胞移植修复膝关节软骨损伤的早期疗效[J].中华骨科杂志,2016,36(1):28-34.
[31]戴雪松,宓云峰,熊炎,等.活动与固定平台的单髁假体置换治疗膝关节内侧间室骨关节炎[J].中华骨科杂志,2015,35(7):691-698.
[32] Niinim@ki T, Eskelinen A, M@kel@K, et al.Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship:a 27-year Finnish registry study[J]. Clin OrthopRelat Res,2014,472(5):1496-1501.
[33] Kim YM,Joo YB. Patellofemoral osteoarthritis[J]. Knee Surg Relat Res,2012,24(4):193-200.
[34] Cotic M,Forkel P,Imhoff AB. Patellofemoral arthroplasty. Oper Orthop Traumatol,2017,29(1):40-50.