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膝关节骨关节炎的评估与管理。

Evaluation and management of knee osteoarthritis.

机构信息

Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.

Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.

出版信息

J Evid Based Med. 2024 Sep;17(3):675-687. doi: 10.1111/jebm.12627. Epub 2024 Jul 4.


DOI:10.1111/jebm.12627
PMID:38963824
Abstract

Knee osteoarthritis (KOA) significantly contributes to the global disability burden, with its incidence expected to escalate by 74.9% by 2050. The urgency to comprehend and tackle this condition is critical, necessitating an updated and thorough review of KOA. A systematic review up to February 26, 2024, has elucidated the principal aspects of KOA's pathogenesis, risk factors, clinical manifestations, and contemporary management paradigms. The origins of KOA are intricately linked to mechanical, inflammatory, and metabolic disturbances that impair joint function. Notable risk factors include age, obesity, and previous knee injuries. Diagnosis predominantly relies on clinical assessment, with radiographic evaluation reserved conditionally. The significance of rehabilitation assessments, informed by the International Classification of Functioning, Disability, and Health framework, is highlighted. Treatment strategies are diverse, prioritizing nonpharmacological measures such as patient education, exercise, and weight management, with pharmacological interventions considered adjuncts. Intra-articular injections and surgical options are contemplated for instances where conventional management is inadequate. KOA stands as a predominant disability cause globally, characterized by a complex etiology and profound effects on individuals' quality of life. Early, proactive management focusing on nonpharmacological interventions forms the cornerstone of treatment, aiming to alleviate symptoms and enhance joint function. This comprehensive review underscores the need for early diagnosis, individualized treatment plans, and the integration of rehabilitation assessments to optimize patient outcomes. Further research is needed to refine prevention strategies and improve management outcomes for KOA patients.

摘要

膝骨关节炎(KOA)显著增加了全球残疾负担,预计到 2050 年其发病率将上升 74.9%。理解和应对这种疾病的紧迫性至关重要,需要对 KOA 进行更新和全面的审查。截至 2024 年 2 月 26 日的一项系统综述阐明了 KOA 发病机制、危险因素、临床表现和当代管理模式的主要方面。KOA 的起源与机械、炎症和代谢紊乱密切相关,这些紊乱会损害关节功能。显著的危险因素包括年龄、肥胖和既往膝关节损伤。诊断主要依赖于临床评估,有条件时才进行影像学评估。强调了基于国际功能、残疾和健康分类框架的康复评估的重要性。治疗策略多种多样,优先考虑非药物措施,如患者教育、运动和体重管理,药物干预被视为辅助手段。对于常规管理无效的情况,可以考虑关节内注射和手术选择。KOA 是全球主要的残疾原因之一,其特点是病因复杂,对个人生活质量有深远影响。早期、以非药物干预为重点的积极管理是治疗的基石,旨在缓解症状和增强关节功能。这项全面综述强调了早期诊断、个体化治疗计划和康复评估的整合,以优化患者的治疗效果。需要进一步研究来完善 KOA 患者的预防策略和改善管理结果。

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[1]
Evaluation and management of knee osteoarthritis.

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[2]
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[3]
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[4]
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[7]
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[1]
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[2]
Comparative Effectiveness of Nutritional Supplements in the Treatment of Knee Osteoarthritis: A Network Meta-Analysis.

Nutrients. 2025-8-3

[3]
Swimming exercise reduces H-type vessels by down-regulating the Hif-1α/VEGFa pathway in mice with osteoarthritis of the knee.

BMC Musculoskelet Disord. 2025-7-5

[4]
Burden of knee osteoarthritis in China and globally: 1990-2045.

BMC Musculoskelet Disord. 2025-7-1

[5]
Enhancing knee osteoarthritis detection with AI, image denoising, and optimized classification methods and the importance of physical therapy methods.

PeerJ Comput Sci. 2025-3-25

[6]
Hidden blood loss and its risk factors between high tibial osteotomy and unicompartmental knee arthroplasty for knee osteoarthritis: a retrospective study.

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[7]
Efficacy of arthroscopic cartilage transplantation combined with platelet-rich plasma in the treatment of early knee osteoarthritis: a retrospective cohort study.

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[8]
Comparative efficacy of different doses of platelet-rich plasma injection in the treatment of knee osteoarthritis: a systematic review and network meta-analysis.

J Orthop Surg Res. 2025-3-1

[9]
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