原发性膝骨性关节炎的非手术治疗

背景：膝骨性关节炎是中老年人的常见病和多发病,绝经女性发病率明显高于其他人群,临床以膝关节的疼痛及功能障碍为主。目前膝骨性关节炎可供选择的治疗方法有很多种,其中非手术治疗是主要治疗和基础治疗的方法。 目的：总结各种膝骨性关节炎的非手术治疗各种方法的优势及局限性。 方法：以“骨性关节炎,膝骨性关节炎,流行病学,病因,发病机制,治疗”为中文捡索词,以“osteoarthritis/knee osteoarthritis/pathogenesis,therapy”为英文检索词,检索维普、万方和中国知网(CNKI)期刊全文数据库、Medline和PubMed数据库2000年1月至2013年5月有关膝骨性关节炎的流行病学,相关因素、发病机制及非手术治疗的临床报道和综述。排除重复性研究和不典型报道。 结果与结论：膝骨性关节炎的病因不明,发病机制可能与年龄、性激素、负荷传导紊乱、遗传等多种因素相关。膝骨性关节炎的临床表现多种多样,可选用的临床治疗方法很多,但每一种治疗方法的临床适应征不完全相同,临床疗效也各有千秋。药物是治疗膝骨性关节炎的最常用手段,其他如中药、针灸、按摩等也能明显缓解患者的疼痛症状,改善膝关节的功能。而肌力训练与机械振动是一种新兴的治疗方法,虽然未广泛应用到临床,但疗效已渐渐得到了肯定,仍需大量的临床摸索和经验的积累。此外,大量的临床资料还显示采用口服药物的同时配合生活方式的改变、运动或肌力训练等综合疗法,其临床疗效往往优于单一疗法。

Non-operation treatment of primary knee osteoarthritis

BACKGROUND:Knee osteoarthritis is a common and frequently-occurring disease in the elderly, the incidence in the postmenopausal women is significantly higher than that in other groups. The clinical manifestation is various, mainly pain and dysfunction of the knee joint. There are many methods for the treatment of the knee osteoarthritis, and the non-operation treatment is the main and basic treatment method. OBJECTIVE:To summary the advantages and limitations of various non-operation treatment methods of knee osteoarthritis. METHODS:The VIP database, Wanfang database, CNKI database, Medline database and PubMed database were retrieved for the clinical reports and reviews on epidemiology, related factors, pathogenesis and non-operation treatment of knee osteoarthritis from January 2000 to May 2013 with the key words of “osteoarthritis, knee osteoarthritis, epidemiology, etiology, pathogenesis, treatment” in Chinese and “osteoarthritis, knee osteoarthritis, pathogenesis, therapy” in English. The reproductive researches and atypical reports were excluded. RESULTS AND CONCLUSlON:The etiology of knee osteoarthritis is unknown, and the pathogenesis may be related to various, of factors such as age, sex hormone, load conduction disturbance and genetic correlation. The clinical manifestations of knee osteoarthritis are varied, and many clinical treatment methods can be selected, but different treatment methods have different indications and the effects are not identical, and each has its own merits. Drugs are the most commonly used means for the treatment of knee osteoarthritis, such as traditional Chinese medicine, acupuncture and massage, which can significantly relieve the pain and improve the function of knee joint. Strength training and mechanical vibration are new methods of treatment, although not widely used in clinic, the effect has been gradually confirmed, but still need clinical exploration and experience accumulation. In addition, a large number of clinical data also showed that the oral drug in combination with life changing, exercise or muscle training therapy, its clinical effect is often better than single therapy.