骨关节炎发病机制和治疗的最新进展

摘要

BACKGROUND: The etiology of osteoarthritis is not yet clear. There are a large number of studies on the pathogenesis of osteoarthritis, such as cartilage degeneration, subchondral bone degeneration, joint mechanical changes, and nerve conduction abnormality. OBJECTIVE: To explore the latest advances in the pathogenesis and treatment methods of osteoarthritis at home and abroad.METHODS: The literatures concerning osteoarthritis at home and abroad were searched using the keywords of "osteoarthritis, mechanism, therapy" in English and Chinese, respectively. Finally, 46 eligible literatures were enrolled for overview.RESULTS AND CONCLUSION: The incidence of osteoarthritis is closely related to the degeneration of articular cartilage and subchondral bone, changes in joint mechanics and arthralgia. Superficial zone tissues of articular cartilage vary with age increasing, which is easy to cause osteoarthritis. The treatment should lay emphasis on prevention so as to reduce the risk of osteoarthritis and delay its progression, but not on the combination of non-drug and drug-based treatment. Notably, obesity is the most important risk factor for osteoarthritis. Non-steroid anti-inflammatory drug is the first choice for the treatment of knee osteoarthritis according to Guidelines for the Prevention and Treatment of Osteoarthritis. Fish oil cannot alleviate the progression of osteoarthritis. Surgical treatment is not recommended in the early osteoarthritis, osteoarthritis will not be cured completely through arthroscopic operation, and arthroplasty is recommended for those severe patients.%背景:关于骨关节炎的病因目前尚不完全明确,目前有大量关于软骨退变、软骨下骨退化、关节力学改变、神经传导异常等多种发病机制的研究,近年来对骨关节炎的各种致病因素有大量的研究.目的:探讨骨关节发病机制和治疗方法的最新国内外进展.方法:检索国内外关于骨关节炎的相关文献.中文检索词为"骨关节炎、机理、治疗和进展"等;英文检索词为"osteoarthritis、mechanism、therapy"等.对纳入的46条相关文献进行归纳总结.结果与结论:①骨关节炎的发病和关节软骨及软骨下骨的退变、关节力学的改变及关节的疼痛均密切相关;②研究发现软骨浅表区组织会随着年龄发生巨大的变化,软骨浅表区的损伤容易导致骨关节炎;③骨关节炎的治疗应该基于以非药物和药物联合治疗为主转向预防为主,以降低患病风险和减缓疾病进展为目标;④肥胖是可以干预的最重要的危险因素;⑤骨关节炎防治指南推荐非类固醇类抗炎药作为一线治疗膝骨性关节炎的药,深海鱼油也并不能缓解膝骨关节炎的进展;⑥手术干预应避免用在骨关节炎的早期阶段,关节镜手术并不能治愈骨关节炎,严重骨关节炎应考虑关节置换治疗.