膝骨关节炎的流行病学调查分析论文

合集下载

膝骨性关节炎病理、流行病学、疼痛机制、症状、辅助检查、诊断分期及治疗措施

膝骨性关节炎病理、流行病学、疼痛机制、症状、辅助检查、诊断分期及治疗措施概述膝骨关节炎是临床中常见的一种慢性、退行性疾病，其发生发展与急、慢性关节损伤、年龄、肥胖及代谢性骨病等多种因素有关，临床上以膝关节疼痛、活动受限、功能障碍、关节畸形甚至肢体障碍为常见症状，其中膝关节疼痛严重影响病人的生活质量和心理健康，是病人就医的主要因素。

流行病学中老年人是KOA发病的高危群体，其中65岁及以上的人群接近1/3患有K0A。

我国中老年人群中症状性KOA的患病率为8.1%,随着老龄化趋势逐年加剧，KOA的患病率有不断升高的趋势。

从区域特征来看，农村地区膝关节症状性骨关节炎患病率高于城市地区。

KOA严重影响患者生活质量并有一定的致残率，对社会经济造成极大的负担。

疼痛机制1、诱发KOA疼痛发生的病变组织诱发KOA疼痛的病变组织有关节软骨、软骨下骨、滑膜、骸骨下脂肪垫、半月板和前交叉韧带，病变组织诱发疼痛的作用机制主要集中在炎症反应、血管和神经生成、力学负荷增加和骨重塑等方面。

关节软骨的退化与损伤关节软骨是KOA最早发生病变的部位之一，正常关节软骨结构上是无血管和神经的，故正常情况下不会产生疼痛，但血管的生成和相关的感觉神经生长是诱导疼痛出现的主要原因。

目前存在生物学与生物力学两种机制使关节软骨损伤：①软骨细胞外基质合成与降解过程之间的持续失衡引起软骨被侵蚀；②生物力学因素：关节软骨作为一种高度分化的负重组织，能够承受密集的机械应力，但胫股关节承重接触面移动到不频繁承重的关节软骨区域时，异常的生力学负荷导致局部软骨缺损，随之增加膝关节在该区域的应力，进一步导致关节软骨的丢失。

软骨下骨的损伤软骨下骨损伤是诱发KOA疼痛的重要因素之一，其主要包括软骨下骨骨重塑、骨髓水肿和骨赘生成等。

关节软骨与软骨下骨之间有着密切的关系，关节软骨损伤导致局部软骨缺损，整个关节在软骨缺损部位的应力不断增加，导致周围软骨下骨的骨小梁断裂，软骨下骨和骨髓内的痛觉感受器受到刺激而诱发疼痛。

最新：灸法治疗膝骨关节炎的Meta分析

最新：灸法治疗膝骨关节炎的Meta分析膝骨性关节炎(Knee osteoarthritis, KOA)是一种常见的慢性退行性关节病，每年在65岁以上的人群中发病率约为85％，到2020年，这将是世界上第四大的疾病。

中国传统医学认为KOA属于“膝痹病”等范畴，患者年老体衰，肝肾渐损，气血阴阳虚衰不能濡养骨节，发为膝痹病，最常见的证型为阳虚证。

一般而言，西医治疗KOA主张以口服非甾体抗炎药减轻疼痛、缓解炎症，或用透明质酸钠关节腔灌注治疗以润滑关节、进行膝关节软骨修复，以上疗效欠佳可行膝关节镜下清理术，以缓解疼痛，改善功能，虽然膝关节镜下清理术缓解膝关节疼痛的短期疗效满意，但其有创且长期疗效不确切。

而KOA患者长期口服药物治疗可能存在长期药物不良反应，如胃肠不适等，这也会增加病人肝脏和肾脏负担。

对于KOA的治疗，学界认为药物治疗和非药物治疗是同等重要的。

随着中国人口的老龄化，KOA往往伴随着患者功能受限和生活质量下降，社会健康的人数持续降低，将造成严重的社会健康问题，故而积极探索更为有效、持久、安全且无创的疗法显得尤其必要。

灸法具有温经散寒、通络除痹、防病治病的作用，广泛用于KOA 的临床治疗，其优点有舒适、有效、安全、副作用少，高质量的Meta分析评估灸法治疗KOA的治疗效果有其必要性，可为KOA的治疗提供准确、科学、直观的循证医学依据，本次Meta分析基于PRISMA声明原则书写。

1 资料与方法1.1 纳入标准1.1.1研究类型：RCT。

1.1.2评价指标：VAS评分、WOMAC评分、总有效率。

1.1.3 干预措施：治疗组以灸法为主；对照组方法不限（但不包括灸法）。

1.2 排除标准1.2.1关于动物实验研究、经验教训、案例报告、理论研究、参考资料、系统评估等的文献;1.2.2在治疗组中，排除针灸、温针灸、小针刀等操作干扰治疗。

1.3 文献检索以下数据库被限定检索时间为2014年1月1日—2020年1月31日:检索CNKI、WF和VIP及PubMed数据库，检索词包括灸法、膝骨关节炎、临床随机对照试验及其同义词，Pubmed数据库英文检索词为：Osteoarthritis，Knee，Moxibustion，Randomized Controlled Trial，结果显示CNKI纳入81篇、VIP纳入9篇、WF纳入30篇、PubMed数据库纳入46篇，共计166篇文献。

中老年人膝骨关节炎患病趋势十年前后对照分析

随机抽样，共抽取年龄为５０～７０岁的在住居民６００人，
其中５０２人接受了膝骨关节炎的流行病学调查，并进行了体格检查和ｘ线摄片。于２０１２年３月对同一样本对象进行回访，其中外迁８７人，死亡１７人，拒绝３３人，
膝骨关节炎（ｏｓｔｅｏａｒｔｈｒｉｔｉｓ，ＯＡ）是临床上常见的疾病，是一种慢性进行性骨关节病，多发生于中老年人。随着人口老龄化程度不断提高，膝骨关节炎的患病率在
１１８名，女２４７名；平均年龄（６９．３０ ±６．５６）岁。对３６５名回访对象按２００２年的诊断方法，进行体格检查、ｘ线
Ｃｏｍｐａｒａｔｉｖｅａｎａｌｙｓｉｓｏｆｔｈｅｔｒｅｎｄｏｆｔｈｅｋｎｅｅｏｓｔｅｏａｒｔｈｒｉｔｉｓｐｒｅｖａｌｅｎｃｅｏｆｔｈｅｃｏｍｍｕｎｉｔｙｍｉｄｄｌｅ — ａｇｅｄｐｅｏｐｌｅｂｅｆｏｒｅａｎｄａｆｔｅｒｔｅｎｙｅａｒｓ
・
疾病预防控制
・
中老年人膝骨关节炎患病趋势十年前后对照分析
顾明士张申岳王萍严丹洪２０１１０５）（上海市闵行区龙柏社区卫生服务中心上海
摘
要目的：通过对本社区同一样本中老年人膝骨关节炎十年前后对照分析，为临床预防提供依据。方法：将

膝骨关节炎流行病学研究(英文)

Increasing Prevalence of Knee Pain and Symptomatic Knee Osteoarthritis:Survey and Cohort DataUyen-Sa D.T.Nguyen,DSc;Yuqing Zhang,DSc;Yanyan Zhu,PhD;Jingbo Niu,MD,DSc;Bin Zhang,ScD;and David T.Felson,MD,MPHBackground:A recent surge in knee replacements is assumed to be due to aging and increased obesity of the U.S.population.Objective:To assess whether age,obesity,and change in radio-graphic knee osteoarthritis explain the trend in knee pain and osteoarthritis.Design:Cross-sectional,using data from6NHANES(National Health and Nutrition Examination Survey)surveys between1971 and2004and from3examination periods in the FOA(Framing-ham Osteoarthritis)Study between1983through2005. Setting:U.S.population.Participants:NHANES participants(white or African American; aged60to74years)and FOA Study participants(mostly white; agedՆ70years)were included.Measurements:NHANES participants were asked about pain in or around the knee on most days.In the FOA Study,participants were asked about knee pain and had bilateral weight-bearing anteropos-terior knee radiography to define radiographic knee osteoarthritis. Radiographic evidence and self-reported pain were used to define symptomatic knee osteoarthritis.The age-and age-and body mass index(BMI)–adjusted prevalences of knee pain and osteoarthritis at later examinations were compared with that of earlier examinations by using the ratio of the prevalence estimates.Results:Age-and BMI-adjusted prevalence of knee pain increased by about65%in NHANES from1974to1994among non-Hispanic white and Mexican American men and women and among African American women.In the FOA Study,the age-and BMI-adjusted prevalence of knee pain and symptomatic knee os-teoarthritis approximately doubled in women and tripled in men over20years.No such trend was observed in the prevalence of radiographic knee osteoarthritis in FOA Study participants.After age adjustment,additional adjustment for BMI resulted in a10%to 25%decrease in the prevalence ratios for knee pain and symp-tomatic knee osteoarthritis.Limitations:Differences in sampling of FOA Study participants over time or birth cohort effects cannot be ruled out as possible explanations of the increased reporting of knee pain.Increases in prevalence at the last interval in the FOA Study might be due to differences in cohort membership by interval.Conclusion:Results suggest that the prevalence of knee pain has increased substantially over20years,independent of age and BMI. Obesity accounted for only part of this increase.Symptomatic knee osteoarthritis increased but radiographic knee osteoarthritis did not. Primary Funding Source:American College of Rheumatology Re-search and Education Foundation and National Institutes of Health. The FOA Study was funded by the National Heart,Lung,and Blood Institute(for the parent Framingham Heart Study),National Institute on Aging,and National Institute of Arthritis and Muscu-loskeletal and Skin Diseases(FOA Study),National Institutes of Health.Ann Intern Med.2011;155: For author affiliations,see end of text.F requent knee pain affects approximately25%of adults,limits function and mobility,and impairs quality of life (1–4);osteoarthritis is the most common cause of knee pain in people aged50years or older(5).Among people with knee osteoarthritis,knee pain is a major reason for knee replacements.The rate of knee replacements has surged in recent years. From1991to2006,the age-standardized rates of total knee replacement in the United Kingdom more than tripled in women(from42.5to138.7per100000person-years)and men(from28.7to99.4per100000person-years)(6).In the United States,the rate of knee replacements among persons aged65years or older increased about8-fold from1979(10 per10000persons)to2002(80per10000persons)(7).By 2006,the rate increased further in this age group to87per 10000persons(8).Although this increase may be due to an increase in the prevalence of knee pain or symptomatic knee osteoarthritis,the secular trend of knee pain and symptomatic knee osteoarthritis has not been assessed.Obesity is a strong risk factor for knee pain,and both aging and obesity increase the risk for symptomatic knee osteoarthritis(4,9).Given the increase in the prevalence of obesity and the aging of the U.S.population,one would expect the prevalence of knee pain and symptomatic knee osteoarthritis to also increase.We describe the prevalence of knee pain and symptomatic knee osteoarthritis over the past20years by using data from NHANES(National Health and Nutrition Examination Survey)and the FOA (Framingham Osteoarthritis)Study.We examined whether a change in the prevalence of knee pain and symptomatic knee osteoarthritis could be attributed to age,body mass index(BMI),or radiographic knee osteoarthritis.See also:PrintEditors’Notes (726)Editorial comment (786)Summary for Patients.......................I-46 Web-OnlyAppendix TablesConversion of graphics into slidesAnnals of Internal Medicine Original Research©2011American College of Physicians725M ETHODSStudy PopulationNHANESCross-sectional surveys of nationally representative samples of the noninstitutionalized U.S.population were conducted by the National Center for Health Statistics. Surveys have been conducted in waves from1971to1975 (NHANES I[10]),1976to1980(NHANES II[11]),and 1988to1994(NHANES III[12]),as well as the contin-uous NHANES from1999to2000(13),2001to2002 (14),and2003to2004(15,16).In a supplemental survey for NHANES I(1974to 1975)(17)and NHANES II,participants aged60to74 years were asked about knee pain.The age range was greater in NHANES III and later surveys,but to be con-sistent,we restricted all NHANES data analysis to people aged60to74years.Moreover,in theﬁrst2NHANES, white and Mexican American participants were classiﬁed as 1racial group;thus,our“white”group included Mexican American participants across all time points.We also ex-plored knee pain among African American participants. FOA StudyParticipants included members of the Framingham Heart Study(Original Cohort),the Framingham Off-spring Study(Offspring Cohort),and a newly recruited cohort from Framingham,Massachusetts(Community Cohort).The FOA Study(18–21)was an ancillary study of the Framingham Heart Study,a population-based study of risk factors for cardiovascular disease with biennial ex-aminations beginning in1948.At the18th biennial exam-ination(1983to1985),1805participants from the Orig-inal Cohort were evaluated for knee osteoarthritis.They were similar in age,sex,and knee symptoms to those from the parent Framingham Heart Study.At the22nd exami-nation(1992to1993),the osteoarthritis assessment was repeated for this group.The Framingham Offspring Study began in1971to1975and included surviving descendants of Original Cohort participants and spouses of those de-scendants.As part of a callback visit between1992and 1995,investigators evaluated1779Offspring Cohort members for knee osteoarthritis.This assessment was re-peated between2002and2005for the Offspring Cohort.The Community Cohort consisted of1039members randomly selected from the Framingham,Massachusetts, population but excluded members of the Framingham Heart Study.The Community Cohort(agedՆ50years) was evaluated for osteoarthritis between2002and2005. Although a history of bilateral total knee replacement or rheumatoid arthritis precluded participation,selection was not based on the presence or absence of knee pain or osteoarthritis.The institutional review board of Boston University Medical Center approved the study.Most participants in the FOA Study were white.OutcomesKnee Pain AssessmentData on knee pain were collected in6NHANES (NHANES I,II,and III and the3later surveys[“contin-uous NHANES”]).For theﬁrst3surveys,participants were asked about pain in or around the knee on most days for at least1month or6weeks.In theﬁrst2NHANES, participants who answered“no”to a screening question on pain or aching in any joints on most days,and therefore did not provide a response for the subsequent knee pain question(375and623persons,respectively),were coded as“no”for knee pain.For NHANES III,no recoding was necessary.Starting in1999,the question on knee and joint pain in general was changed from pain ever experienced to pain in the past12months,in addition to symptoms pres-ent for at least1month(Table1).Knee pain was assessed in the FOA Study at3ex-aminations approximately10years apart.Questions were asked about pain in or around the knee for at least 1month over the previous12months for members of the Original Cohort at the1983to1985(time1)and 1992to1993(time2)examinations.The Offspring Cohort was studied in1992to1995,and the Offspring and Community cohorts were assessed in2002to2005 (time3).The only age group consistently studied across 3periods with regard to current knee pain was persons aged70years or older,so we restricted comparisons to this group.Participants were considered to have knee pain if they responded positively to the question that knee pain occurred in the past12months,as deter-mined by an additional response to a question about the last time that pain occurred.—The EditorsOriginal Research Trends in Knee Pain and Knee Osteoarthritis7266December2011Annals of Internal Medicine Volume155•Radiographic AssessmentThe FOA Study participants had bilateral weight-bearing anteroposterior knee radiography.Weight-bearing posteroanterior radiography was performed for the Com-munity Cohort,and both posteroanterior and anteroposte-rior radiography were performed for the Offspring Cohort.Radiographic features of the knee were assessed by a mus-culoskeletal radiologist using the Kellgren–Lawrence scale of 0to 4,based on the presence of osteophytes,joint space narrowing,sclerosis,attrition,and cysts.A knee was con-sidered to have radiographic knee osteoarthritis if the Kellgren–Lawrence score was 2or greater.In addition,we classiﬁed a knee as having severe radiographic knee osteo-arthritis if the score was 3or greater.For participants with posteroanterior and anteroposterior radiography,we found that the method of acquisition did not affect prevalence,and for this study,we used the anteroposterior radiograph to be consistent with earlier radiographs.Because it was important to use the same deﬁnition over time,we evaluated agreement in deﬁning radiographic knee osteoarthritis (Kellgren–Lawrence score Ն2)between the musculoskeletal radiologist who read ﬁlms from the Original Cohort (reader 1)and the radiologist who read ﬁlms from the Offspring and Community cohorts (reader 2).The interreader ␬was 0.83(95%CI,0.63to 1.00).Symptomatic Osteoarthritis of the KneeSymptomatic osteoarthritis of the knee was deﬁned in the FOA Study if the participant reported knee pain as previously deﬁned and showed radiographic osteoarthritis in the painful knee.CovariatesBody mass index was calculated from measured height and weight.In the FOA Study,height was measured with-out shoes by using a stadiometer and weight was measured by using a balance-beam scale without heavy clothing or shoes.Similarly,we used the measured height and weight from NHANES to calculate BMI.Statistical AnalysisUsing marginal standardization with logistic regres-sion,we estimated the standardized prevalence of knee pain from NHANES and the FOA Study,and that of radiographic and symptomatic knee osteoarthritis from the FOA Study,and adjusted for age (years)and BMI (25to 29kg/m 2,30to 34kg/m 2,35to 39kg/m 2,and Ն40kg/m 2,compared with Ͻ25kg/m 2as the reference)(22).We also compared the prevalence of knee pain and symptom-atic knee osteoarthritis from later examinations with those from earlier examinations by using the ratio of the prevalence estimates,adjusting for age and BMI.Bootstrapping methods were applied to estimate 95%CIs around the estimates ofStudyKnee Pain Query,by Examination PeriodFOA ϭFramingham Osteoarthritis;NHANES ϭNational Health and Nutrition Examination Survey.Original ResearchTrends in Knee Pain and Knee Osteoarthritis6December 2011Annals of Internal Medicine Volume 155•Number 11727prevalence and prevalence ratios(22).We tested for trends in the age-and BMI-adjusted prevalence estimates over time.For the3later NHANES,we used the prevalence of knee pain from1999to2000as the reference for compar-isons with2001to2002and2003to2004.Appropriate sampling weights were used to account for NHANES clus-ter design and multistage sampling.Because approximately 10%of participants in some NHANES surveys had miss-ing BMI,we used IVEware within SAS,version9.2(SAS Institute,Cary,North Carolina),which is a sequential re-gression approach(23),to create5data sets assuming that BMI was missing at random.To impute missing BMI,we used age,sex,race,education,marital status,poverty index, self-reported height and weight,and self-reported medical conditions(such as heart attacks and diabetes).We then combined estimates from the5imputed data sets(24).In addition,we performed several sensitivity analyses in the FOA Study.We excluded data from the Offspring Cohort to see whether results would change.We also ana-lyzed the trend in knee pain by using a different question. At the1992to1995and2002to2005examinations,we asked all FOA Study participants the following question about knee pain:“On most days,do you have pain,aching, or stiffness in either of your knees?”We also performed an analysis of the trend in radiographic knee osteoarthritis among participants aged60years or older.Two-tailed tests of statistical signiﬁcance were based on an␣level of0.05.Analyses were performed by using STATA,version11(StataCorp,College Station,Texas), and SAS,version9.2.Role of the Funding SourceThe American College of Rheumatology Research and Education Foundation and the National Institutes of Health provided funding for this study.The FOA Study was funded by the National Heart,Lung,and Blood Insti-tute(for the parent Framingham Heart Study),National Institute on Aging,and National Institute of Arthritis and Musculoskeletal and Skin Diseases(the FOA Study),Na-tional Institutes of Health.The study sponsors played no role in the design and conduct of the study,including data management,analysis,or interpretation or in the prepara-tion,review,or approval of the manuscript.Theﬁrst,sec-ond,and last authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.R ESULTSFor the analysis of theﬁrst3NHANES,we included 1382,4342,and3682participants,respectively.In the subsequent3NHANES,1066,1011,and1054partici-pants were from1999to2000,2001to2002,and2003to 2004,respectively.Also included were902,1132,and671 participants of the FOA Study over the3intervals,respec-tively.Appendix Tables1and2(available at www.annals .org)show additional descriptive data.As shown in Table2,the prevalence of knee pain increased over time in NHANES and the FOA Study in-dependent of age,and the prevalence of symptomatic knee osteoarthritis increased in the FOA Study,as indicated byStudy and Outcome Men WomenTime2vs.Time1: PR(95%CI)Time3vs.Time1:PR(95%CI)Time2vs.Time1:PR(95%CI)Time3vs.Time1:PR(95%CI)NHANES,knee pain(1971–1994*)Crude 1.39(1.01–1.91) 1.86(1.30–2.49) 1.21(0.95–1.56) 1.79(1.40–2.33) Adjusted for age 1.40(1.06–1.92) 1.85(1.33–2.54) 1.21(0.92–1.57) 1.79(1.35–2.35) Adjusted for age and BMI 1.36(1.03–1.89) 1.66(1.22–2.31) 1.22(0.95–1.62) 1.66(1.29–2.21) NHANES,knee pain(1999–2004†)Crude 1.13(0.78–1.69) 1.31(0.96–2.00) 1.42(1.03–1.95) 1.29(0.96–1.85) Adjusted for age 1.14(0.75–1.65) 1.32(0.91–1.65) 1.42(1.02–1.96) 1.30(0.91–1.77) Adjusted for age and BMI 1.13(0.80–1.64) 1.24(0.89–1.80) 1.37(1.00–1.90) 1.34(0.97–1.85) FOA Study,knee pain(1983–2005‡)Crude 1.39(0.87–2.14) 3.87(2.70–5.77) 1.26(0.96–1.66) 2.39(1.87–3.08) Adjusted for age 1.49(0.89–2.42) 3.89(2.74–5.78) 1.22(0.93–1.60) 2.38(1.88–3.04) Adjusted for age and BMI 1.31(0.79–2.14) 3.18(2.14–4.93) 1.16(0.90–1.54) 2.09(1.60–2.75) FOA Study,symptomatic knee OA(1983–2005‡)Crude 1.33(0.76–2.53) 3.52(2.17–5.76) 1.31(0.95–1.95) 2.04(1.47–2.97) Adjusted for age 1.49(0.80–2.75) 3.54(2.24–6.46) 1.20(0.85–1.73) 2.04(1.46–2.92) Adjusted for age and BMI 1.36(0.75–2.52) 2.81(1.72–5.00) 1.13(0.82–1.62) 1.60(1.15–2.32) BMIϭbody mass index;FOAϭFramingham Osteoarthritis;NHANESϭNational Health and Nutrition Examination Survey;OAϭosteoarthritis;PRϭprevalence ratio.*Time1was1974–1975,time2was1976–1980,and time3was1988–1994,among non-Hispanic white and Mexican American participants aged60to74y.†Time1was1999–2000,time2was2001–2002,and time3was2003–2004,among non-Hispanic white and Mexican American participants aged60to74y.‡Time1was1983–1985,time2was1992–1995,and time3was2002–2005,using the query on knee pain in the past month over the previous12mo for participants agedՆ70y.Original Research Trends in Knee Pain and Knee Osteoarthritis7286December2011Annals of Internal Medicine Volume155•increasing age-adjusted prevalence ratios.For example,the age-adjusted prevalence ratio for knee pain in the FOA Study was3.89for time3versus time1and1.49for time 2versus time1in men,and2.38for time3versus time1 and1.22for time2versus time1in women.Additional adjustment for BMI among men resulted in a10%de-crease in the prevalence ratio for knee pain from1971to 1994in NHANES(from1.85to1.66time3vs.time1), an18%decrease in the prevalence ratio for knee pain in the FOA Study from1983to2005(from3.89to3.18), and a21%decrease in the prevalence ratio for symptom-atic knee osteoarthritis in the FOA Study(from3.54to 2.81).Among women,the corresponding decreases after additionally controlling for BMI were7%,12%,and22%, respectively.The age-and BMI-adjusted prevalence of knee pain increased by66%in NHANES from1974to1994(Fig-ure1),with statistically signiﬁcant trends for white men(P for trendϭ0.003)and women(P for trendϭ0.002).In the subsequent3NHANES,the prevalence increased fur-ther from1999to2004in white women(P for trendϭ0.012),whereas the increase was borderline statistically sig-niﬁcant for white men(P for trendϭ0.090).For African American participants,a trend was found toward an in-crease in knee pain,although it was statistically signiﬁcant only in women.As shown in Figure2,even after adjustment for age and BMI,the prevalence of knee pain from the FOA Study doubled over20years in women and tripled in men(P for trendϽ0.001).Moreover,among participants without ra-diographic knee osteoarthritis,the prevalence of knee pain tripled in women and more than quadrupled in men over 20years.The age-and BMI-adjusted prevalence over the corresponding3intervals was8.0%,10.0%,and24.7%in women and3.9%,4.8%,and16.5%in men.Among par-ticipants with radiographic knee osteoarthritis,the preva-lence estimates over the corresponding3intervals were 26.3%,31.1%,and48.5%in women and19.0%,21.7%, and49.4%in men(P for trendϽ0.001).After adjustment for age and BMI,the prevalence of symptomatic knee osteoarthritis in the FOA Study(Figure 3)approximately tripled in men(P for trendϽ0.001)and almost doubled in women over20years(P for trendϭ0.006).However,the age-and BMI-adjusted prevalence of radiographic knee osteoarthritis did not substantially change over this same period for men(P for trendϭ0.82) and actually may have decreased for women(P for trendϭ0.036).Similarly,no increase was observed in the age-and BMI-adjusted prevalence of radiographic knee osteoarthri-tis among participants aged60years or older or in that of severe radiographic knee osteoarthritis for both men and women.Sensitivity analysis that excluded members of the Off-spring Cohort showed similar trends to those in Figures2 and3.In addition,a similar trend was observed when we used the query on knee pain on most days in FOA Study participants aged60years or older at examinations in1992 to1995and2002to2005.The age-and BMI-adjusted prevalence of knee pain among participants aged60years or older increased from19.7%to26.8%among men and from27.0%to33.5%among women.When this knee pain question was used to deﬁne symptomatic knee osteo-arthritis,the corresponding age-and BMI-adjusted preva-lence of symptomatic knee osteoarthritis increased from 9.0%to15.0%in men and from13.9%to18.0%in women.D ISCUSSIONUsing data from2community-based studies,we found that the age-and BMI-adjusted prevalence of knee pain over20years has increased for non-Hispanic white and Mexican American men and women and African American women.In the FOA Study,the prevalence of symptomatic but not radiographic knee osteoarthritis in-creased.Adjustment for age did not substantially alter the prevalence estimate for knee pain or symptomatic knee osteoarthritis over time,whereas additional adjustment forWeighted,Age-andBMI-AdjustedPrevalenceofKneePain,%Examination Period1974–19751976–1981988–19941999–221–2223–24 010203040Test for trend from1974to1994:Pϭ0.003(men)and Pϭ0.002 (women).Test for trend from1999to2004:Pϭ0.090(men)and Pϭ0.012(women).The prevalences in African American participants over theﬁrst3NHANES were12.6%,10.7%,and15.6%(Pϭ0.35),re-spectively,for men and16.7%,22.0%,and28.7%(Pϭ0.037),respec-tively,for women.For the subsequent3continuous NHANES,the cor-responding prevalences were7.9%,16.6%,and18.6%(Pϭ0.22)for men and13.8%,22.2%,and29.9%(Pϭ0.003)for women.BMIϭbody mass index;NHANESϭNational Health and Nutrition Exami-nation Survey.Original ResearchTrends in Knee Pain and Knee Osteoarthritis6December2011Annals of Internal Medicine Volume155•Number11729BMI resulted in a 10%to 25%decrease in prevalence ratios.In the FOA Study,the prevalence of knee pain increased over time for participants with and without ra-diographic knee osteoarthritis in both men and women.Although our study is,to our knowledge,the ﬁrst to evaluate a secular trend in knee pain,others have examined the prevalence of arthritis in general over time.Leveille and coworkers (25)did not ﬁnd any difference in the preva-lence of self-reported,physician-diagnosed arthritis across 4birth cohorts of baby boomers and their predecessors.Kopec and colleagues (26),using administrative data,re-ported a 13.6%increase in age-adjusted incidence of clin-ical osteoarthritis between 1996and 2004among Cana-dian women with at least 1medical visit or hospitalization for osteoarthritis (14.7vs.16.7per 1000persons);there was no increase in men (11.3vs.11.6per 1000persons).These studies did not examine knee osteoarthritis speciﬁcally.The prevalence of musculoskeletal pain in sites outside the knee may also be increasing.The prevalence of low back pain increased by 31%over 16years (1990to 2006)in Great Britain (27).In the United States,Freburger and colleagues (28),using data collected in a North Carolina household survey,reported that the prevalence of chronic,impairing lower back pain increased dramatically from 3.9%in 1992to 10.2%in 2006,although no such trend was seen in National Health Interview Surveys (29).Re-searchers attributed the increase in prevalence to a height-ened awareness and perception of pain (27).This may also explain the increase in reporting of knee pain.Moreover,people from younger generations may be more willing toreport pain without fear of being judged than are people from older generations.The increase in knee pain in the United States that we report may underlie the dramatic recent increase in total knee replacements in Great Britain and the United States.It is evidently not explained by the increasing availability of orthopedic surgeons trained to do replacements (30).Total knee replacement and knee pain are different,and al-though it seems reasonable to assert that the increase in prevalence of knee pain translates into higher demand for knee replacement,we did not follow our participants to the point of knee replacement.Further investigation of the causes of the increased rate of knee replacement is needed.We also acknowledge that in the FOA Study,the in-crease in knee pain without a commensurate increase in radiographic knee osteoarthritis (Kellgren–Lawrence score Ն2)or severe radiographic knee osteoarthritis (Kellgren–Lawrence score Ն3)cannot be easily d forms of osteoarthritis that were not visualized on radiography,or disease in the patellofemoral compartment not seen on the anteroposterior ﬁlm,may have increased in prevalence over time.Nonosteoarthritic knee pain could also be increasing as a result of the rise in obesity.Our study has limitations.It would have been ideal to have the exact question about knee pain in each survey of NHANES (Table 1).However,all questions from NHANES I,II,and III were similar and should not have produced marked differences in prevalence.Unlike NHANES I,II,and III,the FOA Study used identicalA g e - a n dB M I -A d j u s t e dP r e v a l e n c e o f K n e e P a i n , %Examination PeriodOriginalOriginalOffspring and CommunityTest for trend:P Ͻ0.001(men and women).BMI ϭbody mass index.A g e - a n dB M I -A d j u s t e d P r e v a l e n c e o fR a d i o g r a p h i c a n d S y m p t o m a t i c K n e e O A , %Examination PeriodOriginalOriginalOffspring and Community1020305040For radiographic knee OA (Kellgren–Lawrence score Ն2),test for trend from 1983to 2005:P ϭ0.82(men)and P ϭ0.036(women).For symptomatic knee OA (knee pain in the knee with radiographic OA),test for trend from 1983to 2005:P Ͻ0.001(men)and P ϭ0.006(women).BMI ϭbody mass index;OA ϭosteoarthritis.Original ResearchTrends in Knee Pain and Knee Osteoarthritis7306December 2011Annals of Internal Medicine Volume 155•Number 11questions about current knee pain;the later continuous NHANES examinations used the same questions as well. Also,whereas the Original Cohort of the FOA Study was representative of the population-based Framingham Heart Study and the Community Cohort was representative of the population of Framingham,Massachusetts,some members of the Offspring Cohort were related to members of the Original Cohort.Sensitivity analyses excluding the Offspring Cohort showed similar trends.The Community Cohort was recruited by using random-digit dialing,and participants were not selected on the basis of having knee or other joint problems(20).We cannot rule out birth cohort or generational effects as a possible explanation for the increasing prevalence in the reporting of knee pain over time.If this were the case,knee pain would be dependent on factors common to birth cohorts and would not neces-sarily change in a secular manner.Finally,participants from the different Framingham cohorts may be biased rep-resentatives of knee pain prevalence from their parent co-horts and this bias may have changed with time,with par-ticipants in later examinations more likely to be those with knee pain.Our study also has several strengths.We assessed knee pain similarly over3intervals in a population-based study of knee osteoarthritis in older adults.Moreover,we radio-graphically deﬁned knee osteoarthritis and corroborated ourﬁndings regarding the prevalence of knee pain in the FOA Study with that from nationally representative sam-ples.Furthermore,data from the FOA Study permitted us to extend information on knee pain prevalence from the NHANES age range of60to74years to a slightly older group,aged70years or older.In conclusion,ourﬁndings suggest a marked recent increase in the prevalence of knee pain and,in the Fra-mingham Study,an increase in symptomatic knee osteoar-thritis.These increases may explain the surge in knee re-placement surgeries and suggest a bigger burden of knee pain in our society than previously thought.Although our ﬁndings were consistent across2studies,additional repli-cation in other populations is needed.From Clinical Epidemiology Research&Training Unit,Boston Univer-sity School of Medicine,and Brigham and Women’s Hospital,Boston, Massachusetts.Acknowledgment:The authors thank the FOA Study research team and study participants for the contribution of their time,effort,and dedica-tion.They also thank the National Center for Health Statistics for access to NHANES data.Finally,they thank Piran Aliabadi,MD,for expertise and assistance in reading Framingham Study radiographs.Grant Support:By the National Institutes of Health(NIH AR47785 and AG18393)and an American College of Rheumatology Research and Education Foundation Rheumatology Scientist Development Award (Dr.Nguyen).The Framingham Heart Study was funded by the Na-tional Heart,Lung,and Blood Institute,National Institutes of Health (NHLBI/NIH contract N01-HC-25195),and the FOA Study was funded by the National Institute on Aging and National Institute of Arthritis and Musculoskeletal and Skin Diseases,National Institutes of Health.Potential Conflicts of Interest:Disclosures can be viewed at www.acponline .org/authors/icmje/ConﬂictOfInterestForms.do?msNumϭM11-1776.Reproducible Research Statement:Study protocol and statistical code: Not available.Data set:NHANES data are available at /nchs/nhanes.htm;data from the Framingham Heart Study and the FOA Study are available after approval from Boston University(see www ).Requests for Single Reprints:David T.Felson,MD,MPH,Boston University School of Medicine,Clinical Epidemiology Research and Training Unit,650Albany Street,Suite X200,Boston,MA02118. Current author addresses and author contributions are available at www .References1.Jinks C,Jordan K,Croft P.Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoarthri-tis Index(WOMAC).Pain.2002;100:55-64.[PMID:12435459]2.Grotle M,Hagen KB,Natvig B,Dahl FA,Kvien TK.Prevalence and burden of osteoarthritis:results from a population survey in Norway.J Rheumatol.2008; 35:677-84.[PMID:18278832]3.Peat G,McCarney R,Croft P.Knee pain and osteoarthritis in older adults:a review of community burden and current use of primary health care.Ann Rheum Dis.2001;60:91-7.[PMID:11156538]4.Felson DT,Zhang Y.An update on the epidemiology of knee and hip osteo-arthritis with a view to prevention.Arthritis Rheum.1998;41:1343-55.[PMID: 9704632]5.Zeni JA Jr,Axe MJ,Snyder-Mackler L.Clinical predictors of elective total joint replacement in persons with end-stage knee osteoarthritis.BMC Musculo-skelet Disord.2010;11:86.[PMID:20459622]6.Culliford DJ,Maskell J,Beard DJ,Murray DW,Price AJ,Arden NK. Temporal trends in hip and knee replacement in the United Kingdom:1991to 2006.J Bone Joint Surg Br.2010;92:130-5.[PMID:20044691]7.Centers for Disease Control and Prevention,National Center for Health Statistics.QuickStats:rate of total knee replacement for persons agedՆ65years, by sex—United States,1979–2002.MMWR Morb Mortal Wkly Rep.2005;54: 179.8.Centers for Disease Control and Prevention(CDC).Racial disparities in total knee replacement among Medicare enrollees—United States,2000-2006. MMWR Morb Mortal Wkly Rep.2009;58:133-8.[PMID:19229164]9.Marks R.Obesity proﬁles with knee osteoarthritis:correlation with pain,dis-ability,disease progression.Obesity(Silver Spring).2007;15:1867-74.[PMID: 17636106]10.National Health and Nutrition Examination Survey Questionnaire: NHANES I.Accessed at /nchs/nhanes/nhanesi.htm on22Septem-ber2011.11.National Health and Nutrition Examination Survey Questionnaire: NHANES II.Accessed at /nchs/nhanes/nhanesii.htm on22Sep-tember2011.12.National Health and Nutrition Examination Survey Questionnaire: NHANES III.Accessed at /nchs/nhanes/nh3data.htm on22Sep-tember2011.13.National Health and Nutrition Examination Survey Questionnaire: NHANES1999-2000.Accessed at http://cdcgov/nchs/nhanes/nhanes1999-2000 /nhanes99_00htm on22September2011.14.National Health and Nutrition Examination Survey Questionnaire: NHANES2001-2002.Accessed at http://cdcgov/nchs/nhanes/nhanes2001-2002 /nhanes01_02htm on22September2011.15.National Health and Nutrition Examination Survey Questionnaire: NHANES2003-2004.Accessed at http://cdcgov/nchs/nhanes/nhanes2003-2004 /nhanes03_04htm on22September2011.Original ResearchTrends in Knee Pain and Knee Osteoarthritis6December2011Annals of Internal Medicine Volume155•Number11731。

从流行病学浅析膝关节骨性关节炎的危险因素

从流行病学浅析膝关节骨性关节炎的危险因素姚兴璋;李兴勇【摘要】Current states of epidemiology on knee osteoarthritis were elucidated and analyzed from the following aspects: age, gender, obesity, occupation and injury, inheritance, life styles, environment and others, aiming at guide clinical treatment and study.%通过分析相关文献,从年龄、性别、肥胖、职业与损伤、遗传、生活方式及居住环境等方面就膝关节骨性关节炎的流行病学研究现状进行阐述、分析,旨在指导临床治疗及研究.【期刊名称】《西部中医药》【年(卷),期】2012(025)009【总页数】4页(P132-135)【关键词】关节炎;膝关节;流行病学;综述【作者】姚兴璋;李兴勇【作者单位】甘肃中医学院,甘肃,兰州,730000;甘肃省中医院【正文语种】中文【中图分类】R684.3膝关节骨性关节炎(knee osteoarthritis，KOA)是世界上最常见的一类关节疾病，是最常见的关节炎形式和引起慢性残疾的首要因素，又称退行性关节炎、退行性骨关节病、肥大或增生性关节炎。

以关节软骨的变性、破坏及骨质增生为特征，临床特点主要是关节疼痛、变形和功能受限。

K O A对人类的威胁正在迅速增加，有效的治疗和预防骨关节炎已成为重大的公共卫生学问题。

1.1 年龄 K O A的发病率随年龄的增高而增高。

汤敏生等［1］调查发现骨关节炎(O A)在＜20岁年龄组中，男女均未发现O A患者，随年龄上升，40岁以后明显增高，在60～70岁及＞70岁年龄组段达高峰。

陈维等［2］的一项调查结果显示：高龄人群患O A的风险是低龄人群的2.225倍。

玻璃酸钠论文膝关节骨性关节炎论文：玻璃酸钠结合高乌甲素关节腔注射治疗膝骨性关节炎32例疗效观察

玻璃酸钠论文膝关节骨性关节炎论文：玻璃酸钠结合高乌甲素关节腔注射治疗膝骨性关节炎32例疗效观察【摘要】目的：观察玻璃酸钠结合高乌甲素膝关节腔内注射治疗膝骨性关节炎(oa)的临床效果。

方法：对32例膝骨性关节炎患者关节腔内注射玻璃酸钠及高乌甲素，每周注射1次，连续5次为1个疗程。

结果全部病例至少随访6个月，其中优12例(占37.5％)，良16例(占50％)，差2例(占6.25％)，无效2例(占6.25％) 。

结论玻璃酸钠结合高乌甲素关节腔内注射能有效缓解疼痛等症状，改善关节功能。

【关键词】玻璃酸钠；高乌甲素；膝关节骨性关节炎；临床效果膝关节骨性关节炎(oa)又称退行性膝关节炎，主要临床症状为膝关节疼痛、肿胀、畸形、功能障碍。

治疗目的是减轻或消除疼痛，改善或恢复膝关节功能，改善生活质量。

玻璃酸钠为关节滑液的主要成分，是软骨基质的成分之一。

在关节腔内起润滑作用，具有保护滑膜，促进关节软骨的愈合与再生，消炎镇痛等作用[1]。

高乌甲素是为非成瘾镇痛新药，并且有显著抗炎消肿降温解热和局部麻醉作用[2]。

我们应用玻璃酸钠结合高乌甲素关节腔内注射治疗32例膝oa 患者，疗效满意。

报告如下：1 资料与方法1.1 一般资料:32例均为膝oa患者符合美国风湿学会膝oa诊断标准[3]。

男9例，女23例，其中8例为双膝关节，皆为女性。

年龄50～78岁，平均64岁。

全部病例均有活动性膝关节疼痛，有劳累、受凉加重、休息后减轻的特点。

临床检查压痛点多分布在膝关节两侧及髌骨周围。

膝关节x线显示均有骨质增生，13例有不同程度关节间隙狭窄，5例伴有关节积液。

实验室检查：抗链“o”及血沉均正常。

1.2 治疗方法：患者仰卧位，膝下垫枕，取膝内外侧副韧带及关节周缘软组织压痛最明显处为穿刺点。

严格无菌操作下，行关节穿刺，有落空感后回抽无血，推注无阻力，如有关节积液，应抽尽并保留针头位置，先注入高乌甲素8mg （如为双侧，则一边注入4 mg），再注入玻璃酸钠注射液2 ml （施沛特），拔针后在穿刺部位无菌敷料覆盖保护针孔，然后缓慢被动活动膝关节数次，使玻璃酸钠均匀分布在关节软骨和滑膜表面，每周注射1次，连续5次为1个疗程。

中医治疗膝骨性关节炎研究进展

中医治疗膝骨性关节炎研究进展【摘要】膝骨性关节炎是一种常见的关节疾病，给患者带来较大的痛苦。

近年来，中医药治疗膝骨性关节炎取得了一定的研究进展。

本文通过对中医治疗膝骨性关节炎的理论基础、临床实践、药物研究、针灸疗法、推拿按摩等方面进行探讨，发现中医药在治疗膝骨性关节炎中具有独特优势。

疗效确切、持久且无明显副作用是中医治疗膝骨性关节炎的显著特点。

中医药注重整体调理，改善体内气血循环，缓解疼痛，促进关节功能的恢复，使患者获得更好的生活质量。

中医治疗膝骨性关节炎在临床中有广泛应用的前景，值得进一步的研究和推广。

【关键词】中医药，膝骨性关节炎，研究进展，理论基础，临床实践，药物研究，针灸疗法，推拿按摩，疗效，副作用1. 引言1.1 中医治疗膝骨性关节炎研究进展膝骨性关节炎是一种常见的慢性疾病，主要表现为关节疼痛、僵硬、功能障碍等症状，严重影响患者的生活质量。

中医药作为我国传统医学的重要组成部分，在治疗膝骨性关节炎方面积累了丰富的经验。

近年来，中医治疗膝骨性关节炎取得了一系列研究进展，不断探索和完善治疗方法，提高治疗效果，为患者带来了新的希望。

中医药治疗膝骨性关节炎的理论基础主要包括“肝主筋，肾主骨”、“湿热蕴瘀”等理论。

通过调理肝肾、活血化瘀、祛湿排毒等方法来改善膝骨性关节炎症状，恢复关节功能。

临床实践中，中医医生结合患者的具体病情，运用针灸、推拿按摩等多种方法综合治疗，取得了良好的效果。

中医药研究不断深入，通过药物研究不断创新，开发出更加适合膝骨性关节炎患者的治疗药物。

中医治疗膝骨性关节炎在临床实践中表现出疗效确切、持久而且无明显副作用的特点，为患者带来了新的希望和选择。

随着中医药研究的不断深入，相信中医治疗膝骨性关节炎的疗效将会得到进一步提高，为患者带来更好的治疗体验。

2. 正文2.1 中医药治疗膝骨性关节炎的理论基础1. 中医理论基础：根据中医理论，膝骨性关节炎主要是由于气血不足、肝肾不足、风湿痹阻等因素导致。

探讨分析针刺治疗膝骨性关节炎的临床效果

探讨分析针刺治疗膝骨性关节炎的临床效果摘要：目的：以本院膝骨性关节炎治疗病例为研究数据，调查针刺治疗效果。

方法：纳入在本院骨科、风湿科、脑病科、消化科、普外科治疗的患者400例，入院时间在2022年1月至2022年12月范围内。

按照治疗方法的不同分为参照组（常规口服药物治疗，200例）和针刺组（对患者施以针刺治疗，200例）。

行以膝关节功能评分量表Lysholm、生活质量评分表SF-36、VAS疼痛得分和治疗总有效率的评测。

结果：针刺组Lysholm、SF-36得分、治疗总有效率高于参照组而VAS疼痛得分低于参照组，统计学结果显示：P<0.05。

结论：膝骨性关节炎患者采用针刺治疗，可以帮助患者更好地进行身体恢复，有效改善膝关节功能和提高治疗有效率，提升患者生活质量。

关键词：针刺治疗；膝骨性关节炎；临床研究膝骨性关节炎是一种以关节软骨退行性变为主要特征的关节疾病，长期药物治疗可能产生副作用。

针刺作为一种传统的中医疗法，通过刺激特定的穴位，调节机体的气血运行，达到平衡阴阳、调和气血的作用，且其作为一种安全、无副作用的治疗方式，越来越受到患者的青睐。

已有一些研究表明，针刺治疗膝骨性关节炎具有显著的临床效果，如缓解疼痛、改善关节功能、抑制炎症反应等[1-2]。

然而，目前对针刺治疗膝骨性关节炎的临床效果的研究还相对有限且不够一致。

本文将针刺治疗措施用于膝骨性关节炎中，在长期的观察和随访中获得结果，旨在提供更加科学准确的证据支持，促进针刺治疗在膝骨性关节炎患者中的应用。

1临床资料1.1一般资料纳入在本院骨科、风湿科、脑病科、消化科、普外科治疗的患者400例，入院时间在2022年1月至2022年12月范围内。

临床资料收集均由医院伦理委员会讨论通过，患者及家属知情并签署同意书。

按照治疗方法的不同分为参照组（常规口服药物治疗，200例）和针刺组（对患者施以针刺治疗，200例）。

参照组男：女分别为103:97例，50～75岁、平均（63.34±12.22）岁，病程3个月~12年、平均（3.22±1.02）年；针刺组男：女分别为104:96例，50～75岁、平均（62.98±12.16）岁，病程3个月~12年、平均（3.09±0.99）年；两组上述基线资料具有均衡性：P>0.05，可比。

1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。

摘要目的：通过对武汉市550例膝骨关节炎患者进行流行病学调查，对膝骨关节炎的主要致病因素进行相关性分析，探讨其流行病学特点，从而指导临床对该疾病的治疗及预防。

方法：通过自行制定的膝骨关节流行病学调查表，调查了自2011年1月到2012年3月到湖北省中山医院就诊的及接受患者健康教育的膝骨关节炎患者共550例，年龄从38到80岁。

入选对象均自愿参加调查，调查组人员经统一培训，采用一对一的方式对患者进行问卷调查及相关体格检查。

辅助检查包括X线摄片及骨密度测定均采用湖北省中山医院的同一仪器及标准，整理所收集的患者的临床资料，对流行病学数据进行统计学分析，包括独立样本t 检验，单样本t 检验。

结果：收集资料完整的膝骨关节炎患者550例，其中男性182例，女性368例。

女性约是男性的2倍。

调查的患者中月平均收入在3000元一下者380例占69%，且这部分患者病情较高收入者病情偏重。

职业特点经统计分析无明显统计学差异。

家住电梯房、平房或2层一下的楼房的患者与家住3层以上，每天上下楼不多于2次的患者相比，膝关节患者的HSS评分无统计学差异。

不同出行方式之间未发现统计学差异。

550例膝骨关节炎患者中骨密度正常者19例占3.3%，绝大多数伴有不同程度的骨质疏松，男性轻中度多见，女性则表现为中重度多见。

结论：膝骨关节炎的发病与性别、年龄、体重指数相关，年龄与本病的发病率呈正相关，居住条件与本病的严重程度有关，爬楼次数多的患者比居住电梯房或低层楼爬楼梯少的患者病情严重。

经济条件与本病的发生及病情的发展有关，经济条件相对差的人群患病率高，且病情易延误而相对较重。

职业。

饮食因素、日常出行方式等因素与本病无显著相关性，不恰当的体育锻炼可以加重本病的发生和进展。

上下楼、下蹲、不恰当的锻炼等使关节负重增加的动作是导致膝关节疼痛加重的主要因素。

压痛部位多在髌骨周围及内侧副韧带附着处。

上下楼次数增多可加重疾病的病情。

膝骨关节炎与骨质疏松有关，膝骨关节炎症状越严重，骨质疏松程度越重。

X线表现以关节面磨损硬化最多见，其次为关节间隙变窄。

患者的就医意识低缺乏专业的医疗保健知识指导是病情延误的主要原因。

关键词：膝关节；骨关节；流行病学调查；武汉市目录中文摘要 (1)一、前言 (1)二、资料与方法 (2)2.1病例来源 (2)2.2研究对象 (2)2.3临床资料的采集 (3)2.4统计学分析 (3)三、结果 (3)3.1社会人口学特征 (3)3.2体重与体重指数 (3)3.3经济状况 (4)3.4生活习惯，方式 (4)3.5病变局部特征 (5)四.讨论 (6)4.1祖国医学对膝骨关节炎的认识 (6)4.2现代医学对膝骨关节炎的认识 (6)4.3国外膝骨关节炎的流行病学的认识 (7)4.4本组调查的流行病学的特点 (8)五、总结 (11)参考文献 (12)附录 (13)致谢 (14)一、前言骨关节炎又称退行性骨关节炎，是骨科常见的一种疾病，目前公认的定义是滑膜关节以伴有关节周围骨质增生为特点的软骨丧失所致疾病。

只有滑膜和关节同时具备产生软骨退变与骨质增生才能称之骨关节炎。

按照美国风湿病协会的分类标准，骨关节炎可分为原发性骨关节炎和继发性骨关节炎。

原发性骨关节炎确切病因不清，可能与年龄、性别、职业、种族、肥胖、遗传和过度运动等因素有关；后者继发于任何关节创伤或疾病，如关节内或关节周围骨折、交叉韧带或侧副韧带损伤、半月板损伤、先天畸形或关节感染等。

好发于骻关节、膝关节及脊柱关节。

在亚洲国家，尤其是我国，膝关节是关节炎的最常见好发关节。

膝关节骨关节炎是40岁以上中老年人中最常见的慢性退行性关节疾病，临床上以进行性的膝关节肿痛、僵硬、功能受限为主要表现，严重时可导致关节畸形，甚至丧失关节功能而致残，它虽不像癌症那样致命，但是由于病变部位在下肢，其功能障碍影响患者日常正常生活和工作可降低老年人的生活质量。

由于现代社会人口老龄化的加剧，膝骨关节炎的患者病率也越来越高，其所致关节不适以致功能障碍对病人生活质量和社会公共卫生事业的影响不可忽视，近年来已经引起了国内及国际社会的广泛关注。

本病的病理改变主要是关节软骨的退变，但由于目前的医疗科学水平有限，尚未发现软骨再生的手段及方法，暂不能通过软骨再生修复来逆转这一过程。

因此，调查膝骨关节炎的流行病学特点，找出本病相关的危险因素，从预防学角度来控制本病的发生及发展显得尤为重要。

目前国内外已有一些学者发表了不同地区或城市关于膝骨关节炎流行病学的调查报告，经过调查和文献检索，到目前为止，未发现任何有关武汉地区的相关调查报告。

有鉴于此，我们对武汉市的膝骨关节炎患者进行了流行病学调查，通过收集和分析相关调查数据，以期发现该地区膝骨关节炎患者的发病特点和流行病学特征，为本病的临床防治提供充分指导依据。

膝骨关节炎是常见于中老年的由于滑膜关节的退变引起的膝关节疼痛、僵硬、功能障碍为主要特征的疾病。

其发病因素多样，尚不确切，未了解武汉市膝关节关骨关节炎的发病特点，对武汉是550例膝骨关节炎患者进行了流行病学调查研究，调查结果如下：二、资料与方法2.1病例来源：本调查组病例均来自湖北省中山医院骨外科、膝关节病专科住院部及门诊的已确诊为膝骨关节炎的患者。

患者分别来自武汉三镇。

2.2研究对象：疾病临床诊断标准：参考美国风湿病学会1995年制定的诊断标准。

1）临床诊断标准：（1）必须有近1个月大多数时间有膝关节痛；（2）同时具备以下有骨摩擦音或关节活动响声；晨僵时间小于等于30min；年龄大于等于40岁；有膝关节骨性膨大。

为探讨该病的临床特点本组病理纳入年龄标准提前到38岁，最大年龄到80岁。

2）膝关节炎放射学检查标准：所调查患者均统一采用系关节负重位使正侧X片及髌骨轴位片，骨关节炎的放射学表现主要为骨赘增生、关节间隙变窄、软骨下骨硬化和囊性变。

骨关节炎的程度按Kellgem等标准分为5度：0度为正常；1度为可疑骨赘；2度为明确骨赘和（或）关节间隙可疑狭窄；3度为重度骨赘和关节间隙明确狭窄；4度为重度骨赘、关节间隙明确狭窄和（或）关节面硬化。

本组研究中膝关节放射学OA 以至少一个系关节分级大于等于2度作为标准。

3）纳入标准：符合膝骨关节炎的诊断标准，年龄在38-80岁之间。

4）排除标准：年龄大于80岁或小于38岁；继发性膝骨关节炎；有严重的糖尿病、心脏病、慢性肾病等基础的器质性病变；又严重双膝关节创伤、感染史或先天性畸形者、精神病等全身重大疾病者；不愿配合调查者；2.3临床资料的采集：参考前期文献研究结果，结合膝骨关节炎临床特征，制定统一的膝骨关节炎流行病学调查表，采用问卷调查形式，调查主要内容包括：A社会人口学资料；经济状况；生活习惯；患者对病情认知程度及就医意识；B膝关节局部症状；膝关节专科检查；辅助检查资料；以上调查内容由本课题组调查人员按调查表对每一例病例进行逐一询问、体检，如实填写调查表。

2.4统计学分析：采用软件进行流行病学数据分析，独立样本t检验，单体样本t 检验为显著检验的判断标准。

三、结果3.1社会人口学特征3.1.1年龄、性别本次调查总人数550人，男182人，女368人。

在年龄构成比中，40岁一下女性患者有3人，无男性患者；随年龄的增长，患者人数逐渐增加，61-70岁年龄段患者最多，70岁以后患病率减少3.1.2退休reny调查人群职业分布特点：本调查中429例占78%的患者为已退休人员，退休后以家务为主，369例占67%的女性患者家务劳动较多，职业特点经统计分析无明显统计学差异，但家庭负担重、家务劳动多的老人患病率更高，这可能有膝关节反复屈伸活动有关。

3.2体重与体重指数体重指数根据2000年国际肥胖特别工作组提出的亚洲成人体重指数的标准；3.3经济状况经本次调查显示，前来就诊膝骨关节炎患者中，中低水平收入这占多数，月平均收入在3000元以下380例占69%，且这部分中低收入水平患者生活负担较重，病情较高收入者病情为重；3.4生活习惯，方式3.4.1饮食习惯：从550例患者的调查结果显示473例占86%的患者饮食较均衡，无明显偏好，超过半数的患者饮食口味偏辣。

这只是一个初步调查，是否饮食结构与膝骨关节炎有关需进一步调查分析，力求从饮食结构上的调整来改善这一疾病的发生与进展。

3.4.2蹲式与坐式马桶：本文从换纸家庭使用蹲式与坐式马桶做了一项调查，其中396例占72%的患者家庭目前使用的坐式马桶。

这与推理的结果不太一致，一般认为下蹲次数增多会加重膝关节磨损，更易导致膝关节骨关节炎的发生。

但这些患者中有190例约48%的患者是由于膝关节疼痛，下蹲功能受限，从而改用坐式马桶以减轻疼痛。

3.4.3住房条件及上下楼次数本调查主要从患者住房条件与患病程度有无关系，将患者分为3组，甲组：家住电梯房、平房或2层以下的楼房；乙组：家住3层以上，每天上下楼不多于2次；丙组：家住3层以上，每天上下楼2次以上。

即家住电梯房、平房或2层以下的楼房的患者与家住3层以上，每天上下楼不多与2次的患者相比，对膝关节患者的HSS评分影响无明显差异，但前者与家住3层以上，每天上下楼2次以上的患者HSS评分有显著性差异，上下楼次数的多少对HSS评分亦有较大影响。

如果以HSS评分作为膝关节骨关节炎的严重程度的指标，则患者上下楼次数越多，膝骨关节炎越严重。

3.4.4日常主要出行方式经调查显示日常出行主要靠步行的176例患者占32%，骑自行车的110例患者约20%，乘公交车、私家车或出租车的264例患者占48%。

分别经两独立样本t检验，未发现不同出行方式之间有显著性差异。

3.5病变局部特征3.5.1局部特征本调查从疼痛程度、诱因、性质、压痛部位等方面进行调查结果如下：本组病例中患者均以膝关节疼痛为主诉前来就诊，患者自觉疼痛程度构成比：轻度:人数:214 人,占比:39%中度:人数:237人, 占比:43%重度:人数:99人, 占比:18%疼痛诱因构成比：上楼痛:人数：121人，占比：22%下楼痛:人数：159人，占比：29%下蹲站起痛:人数：98人，占比：18%走平路痛:人数：83人，占比：15%静息痛:人数：39人，占比：7%其他:人数：50人，占比：9%疼痛性质构成比：酸痛:人数：138人，占比：25%胀痛:人数：186人，占比：34%刺痛:人数：61人，占比：11%冷痛:人数：98人，占比：18%窜痛:人数：28人，占比：5%其他:人数：39人，占比：7%双膝关节压痛部位分布构成比：髌周压痛:人数：94人，占比：17%髌骨下方:人数：55人，占比：10%内侧间隙:人数：131人，占比：24%内侧副韧带附着处:人数：93人，占比：17%外侧间隙:人数：66人，占比：12%膝后腘窝区:人数：50人，占比：9%压痛不明显:人数：61人，占比：11%本次调查的550例患者中以膝关节轻中度疼痛多见，上下楼及下蹲站起疼痛是主要诱因，疼痛性质-胀痛、酸痛、冷痛最多见，压痛部位无以内侧间隙及内侧副韧带附着处多见。