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早期 OA 的临床管理。

Clinical Management in Early OA.

机构信息

Orthopaedic Surgery at Centro Hospitalar de Vila Nova de Gaia/Espinho E.P.E, Vila Nova de Gaia, Portugal.

Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.

出版信息

Adv Exp Med Biol. 2018;1059:111-135. doi: 10.1007/978-3-319-76735-2_5.

Abstract

Knee osteoarthritis affects an important percentage of the population throughout their life. Several factors seem to be related to the development of knee osteoarthritis including genetic predisposition, gender, age, meniscal deficiency, lower limb malalignments, joint instability, cartilage defects, and increasing sports participation. The latter has contributed to a higher prevalence of early onset of knee osteoarthritis at younger ages with this active population demanding more consistent and durable outcomes. The diagnosis is complex and the common signs and symptoms are often cloaked at these early stages. Classification systems have been developed and are based on the presence of knee pain and radiographic findings coupled with magnetic resonance or arthroscopic evidence of early joint degeneration. Nonsurgical treatment is often the first-line option and is mainly based on daily life adaptations, weight loss, and exercise, with pharmacological agents having only a symptomatic role. Surgical treatment shows positive results in relieving the joint symptomatology, increasing the knee function and delaying the development to further degenerative stages. Biologic therapies are an emerging field showing early promising results; however, further high-level research is required.

摘要

膝关节骨关节炎在人群一生中的重要阶段都有较高的发病率。许多因素似乎与膝关节骨关节炎的发生有关,包括遗传易感性、性别、年龄、半月板缺失、下肢对线不良、关节不稳定、软骨缺陷和运动参与度增加。后者导致了膝关节骨关节炎在年轻人群中早发的发病率更高,这些活跃的人群需要更一致和持久的治疗效果。诊断较为复杂,常见的体征和症状在这些早期阶段往往不明显。分类系统已经发展起来,基于膝关节疼痛和放射学发现,结合磁共振或关节镜检查早期关节退变的证据。非手术治疗通常是一线选择,主要基于日常生活的适应、减肥和锻炼,药物治疗仅具有对症作用。手术治疗在缓解关节症状、增加膝关节功能和延缓进一步退行性阶段的发展方面显示出积极的结果。生物治疗是一个新兴的领域,早期显示出有前景的结果,但仍需要进一步的高水平研究。

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