社区膝骨关节炎患者非手术治疗现状:多中心横断面研究

The Current Status of Non-surgical Treatment for Knee Osteoarthritis Patients in the Community:a Multi-center Cross-sectional Study

背景膝骨关节炎(KOA)是临床常见疾病,病程长达数十年,在社区医院开展长期和个性化健康管理是KOA防治的最佳途径,非手术治疗是延缓关节退变和推迟关节置换手术的有效方式。目的了解社区医院KOA就诊人群的人群特征、临床分期和治疗方式特点,为优化基层KOA治疗方案提供依据。方法对北京市市区所有街道采用整群抽样方法,随机抽取北京市东城区和平里街道KOA患者为研究对象,普查该街道辖区内所有社区医院(7家)2022年1—6月就诊的所有患者,采集一般资料、既往史、个人史、临床分期、影像学Kellgren&Lawrence(KL)分级、治疗方式等资料。结果本研究共纳入3615例KOA患者,男1327例(36.71%)、女2288例(63.29%),年龄(71.8±13.3)岁,发作期867例(23.98%)、缓解期2009例(55.57%)、康复期739例(20.45%)。不同临床分期患者的性别、年龄与临床分期无相关性(P>0.05),BMI(K=0.235)、KL分级(K=0.406)与临床分期相关(P<0.001)。发作期多选用4~5种治疗方式联合治疗(48.67%),治疗方式主要为外用中成药598例(68.97%)、口服中成药475例(54.79%)、健康教育396例(45.67%);缓解期多选用2~3种治疗方式联合治疗(48.58%),治疗方式主要为外用中成药1084例(53.96%)、健康教育1047例(52.12%)、拔罐790例(39.32%);康复期多选用2~3种治疗方式联合治疗(47.23%),治疗方式主要为健康教育488例(66.04%)、传统功法286例(38.70%)、外用中成药279例(37.75%)。临床分期与联合治疗方式的种类相关(K=0.356,P<0.05)。结论社区医院KOA就诊患者以缓解期为主,治疗多采用多种方式结合,中成药和传统功法也有广泛的应用。

Background Knee osteoarthritis(KOA)is a common clinical condition with a decades-long course.Long-term and personalised health management in community hospitals is the best way to prevent and treat KOA,and non-surgical treatment is an effective way to slow joint degeneration and postpone joint replacement surgery.Objective To understand the population characteristics,clinical staging and treatment modality characteristics of the population attending community hospitals for knee osteoarthritis,in order to provide a basis for optimising the treatment protocol for knee osteoarthritis at the grassroots level.Method All streets in the urban area of Beijing were randomly selected for the study using the whole cluster sampling method,and Hepingli Street in Dongcheng District,Beijing was censored for all patients who attended all community hospitals(7)belonging to the street from January to June 2022,and general information,medical history,personal history,clinical staging,K-L grading and treatment modalities were collected.Results A total of 3615 KOA patients were included in this study,including 1327 males(36.71%)and 2288 females(63.29%),aged(71.8±13.3)years.There were 867 cases(23.98%)in the onset period,2009 cases(55.57%)in the remission period and 739 cases(20.45%)in the rehabilitation period.Gender and age of patients with different clinical stages were not correlated with clinical stages(P>0.05),while BMI(K=0.235)and KL grading(K=0.406)were correlated with clinical stages(P<0.001).During the attack period,4-5 kinds of treatment methods(48.67%)were combined,and the treatment methods were mainly traditional Chinese patent medicines and simple preparations for external use 598 cases(68.97%),475 cases(54.79%)of traditional Chinese patent medicines and simple preparations for oral use,and 396 cases(45.67%)of health education;in the remission stage,2-3 treatment methods were used in combination(48.58%),mainly including 1084 cases(53.96%)of traditional Chinese patent medicines and simple preparations for external use,1047 cases(52.12%)of health education and 790 cases(39.32%)of cupping;in the rehabilitation stage,2-3 kinds of treatment methods were used in combination(47.23%).The main treatment methods were health education in 488 cases(66.04%),traditional exercises in 286 cases(38.70%),and external use of traditional Chinese patent medicines and simple preparations in 279 cases(37.75%).There was a correlation between clinical stage and type of combination therapy(K=0.356,P<0.05).Conclusion KOA patients in community hospitals are mainly in remission,and treatment is often combined with various methods of traditional Chinese patent medicine and simple preparations,and traditional exercises are also widely used.