Jones Brandon Q, Covey Carlton J, Sineath Marvin H
Nellis Family Medicine Residency, Nellis Air Force Base, NV, USA.
Am Fam Physician. 2015 Nov 15;92(10):875-83.
The role of the family physician in managing knee pain is expanding as recent literature supports nonsurgical management for many patients. Effective treatment depends on the etiology of knee pain. Oral analgesics-most commonly nonsteroidal anti-inflammatory drugs and acetaminophen-are used initially in combination with physical therapy to manage the most typical causes of chronic knee pain. The American Academy of Orthopaedic Surgeons recommends against glucosamine/chondroitin supplementation for osteoarthritis. In patients who are not candidates for surgery, opioid analgesics should be used only if conservative pharmacotherapy is ineffective. Exercise-based therapy is the foundation for treating knee osteoarthritis and patellofemoral pain syndrome. Weight loss should be encouraged for all patients with osteoarthritis and a body mass index greater than 25 kg per m2. Aside from stabilizing traumatic knee ligament and tendon tears, the effectiveness of knee braces for chronic knee pain is uncertain, and the use of braces should not replace physical therapy. Foot orthoses can be helpful for anterior knee pain. Corticosteroid injections are effective for short-term pain relief in patients with osteoarthritis. The benefit of hyaluronic acid injections is controversial, and recommendations vary; recent systematic reviews do not support a clinically significant benefit. Small studies suggest that regenerative injections can improve pain and function in patients with chronic knee tendinopathies and osteoarthritis.
随着近期文献支持对许多患者进行非手术治疗，家庭医生在处理膝关节疼痛方面的作用正在扩大。有效的治疗取决于膝关节疼痛的病因。口服镇痛药——最常用的是非甾体抗炎药和对乙酰氨基酚——最初与物理治疗联合使用，以处理慢性膝关节疼痛的最常见原因。美国矫形外科医师学会不建议使用氨基葡萄糖/软骨素补充剂治疗骨关节炎。对于不适合手术的患者，仅在保守药物治疗无效时才应使用阿片类镇痛药。基于运动的疗法是治疗膝关节骨关节炎和髌股疼痛综合征的基础。对于所有骨关节炎且体重指数大于每平方米25千克的患者，都应鼓励其减肥。除了稳定创伤性膝关节韧带和肌腱撕裂外，膝关节支具对慢性膝关节疼痛的有效性尚不确定，并且支具的使用不应替代物理治疗。足部矫形器对膝关节前部疼痛可能有帮助。皮质类固醇注射对骨关节炎患者的短期疼痛缓解有效。透明质酸注射的益处存在争议，建议也各不相同；最近的系统评价不支持其具有临床显著益处。小型研究表明，再生注射可改善慢性膝关节肌腱病和骨关节炎患者的疼痛和功能。
