基于国内外指南的适用于我国全科医疗的膝骨关节炎诊治流程

Diagnosis and Treatment Process of Knee Osteoarthritis Applicable in the General Practice of China Based on Domestic and Abroad Guidelines

我国膝骨关节炎发病率高,为社会带来沉重负担。基层全科医疗全人照顾、健康守门人的特点十分适合用于膝骨关节炎管理。但我国现有的膝骨关节炎指南主要以专科为中心,而国外指南均根据各国国情做出不同的推荐,意见不一。为进一步落实国家分级诊疗的精神,大力提高基层卫生服务能力,有必要制定一套用于指导基层全科医生的膝骨关节炎诊治流程。本文通过概括国内外膝骨关节炎的指南推荐、建议,与我国基层全科医疗实际国情结合,总结出适合我国基层全科医生使用的膝骨关节炎管理方案。总体来讲,膝骨关节炎的处理要以全面评估和各项健康教育等核心治疗为基础,根据不同程度的疼痛采取相应的止痛治疗,并辅以关节腔注射、按摩、支具等其他辅助治疗措施。

The prevalence of knee osteoarthritis is high, which brings heavy burden to the society. Primary care doctors being gatekeepers of our health care system should take the responsibility of managing patients with knee osteoarthritis holistieally. Current guidelines in our country are specialist centered, and different recommendations are made in different countries due to their own situations, it is therefore necessary to establish a primary care centered guideline in China in order to improve our community health service, which is an important part of our nationwide triage system. This article summarized the management of knee osteoarthritis in primary care from the latest international guidelines as below： a comprehensive assessment and core treatment including lifestyle change and exercise should form the basis of knee osteoarthritis management. Braces, insoles, massage and other non - pharmacological treatment are recommended. A step - wise pain management plan starting with paracetamol, NSAID, and finally opioids should be adopted. Intra - articular injection is also recommended.