膝骨关节炎疼痛机制研究进展

Research progress on pain mechanism of knee osteoarthritis

膝骨关节炎是一种慢性、退行性、累及关节内所有结构的疾病。疼痛、活动受限、关节畸形等是膝骨关节炎患者的主要症状。目前膝骨关节炎疼痛的具体机制尚不明确,导致对膝骨关节炎的治疗效果不尽人意,疼痛是患者接受关节置换手术的主要原因之一。本文通过文献回顾,总结出膝关节内关节软骨、软骨下骨、滑膜及髌下脂肪垫等组织病变可能导致炎症介质等分子的产生,使关节内发生炎症反应;病变也可能会使关节内机械应力改变,均可刺激感觉神经产生疼痛。神经功能改变可能存在于膝骨关节炎整个病程,感觉神经长期受到刺激使神经功能发生改变,产生提高疼痛敏感性、放大疼痛区域等协同效应。

Knee osteoarthritis is a chronic,degenerative disease involving all structures in the joint.Pain,limitation of movement and joint deformity are the main symptoms of knee osteoarthritis.At present,the specific mechanism of knee osteoarthritis pain had not been fully elucidated,resulting in the treatment of knee osteoarthritis is not satisfactory.Pain is one of the main reasons for patients to receive joint replacement surgery.Based on the review of the literature,it is concluded that the pathological changes of articular cartilage,subchondral bone,synovium and infrapatellar fat pad of the knee joint may lead to the production of inflammatory mediators and other molecules,which may cause inflammatory reaction in the articulation and stimulate the sensory nerve.The pathological changes may also change the mechanical stress in the joint,which can stimulate the sensory nerve to cause pain.The changes of nerve function may exist in the whole course of knee osteoarthritis.Long-term stimulation of the sensory nerve changes the neurological function,resulting in synergistic effects such as improving pain sensitivity and magnifying the pain area.