骨关节炎阶梯化治疗，方兴未艾！

Thriving concept of stepped therapy for osteoarthritis

摘要:

骨关节炎治疗需选择阶梯化及个体化治疗，包括基础治疗、药物治疗、修复性治疗、重建治疗。基础治疗是首选。药物治疗需循序渐进，非甾体类消炎药物首先外用，必要时口服，若疗效不佳考虑关节腔内注射玻璃酸钠、富血小板血浆、脂肪干细胞，应谨慎应用曲马多等药物。修复性治疗常用力线矫正手术，3D打印辅助胫骨高位截骨术能实现术中精准截骨，矫正下肢力线。重建治疗主要是关节置换手术，膝关节单髁置换较全膝关节置换术后恢复快，并发症少，但翻修率高；双髁置换术后并发症、疼痛和功能评分与全膝关节置换术相当，且有望获得更好的步态。随着计算机技术的发展，机器人、混合现实、3D打印等数字化辅助技术广泛应用于关节置换手术，人工关节材料的研究是永恒的热点。

Abstract:

Osteoarthritis treatment needs to follow a stepped program, including basic treatment, drug therapy, repair therapy, and reconstruction therapy. Primary treatment is preferred. Pharmacological treatment is gradual, with non-steroidal anti-inflammatory drugs first used topically and orally if necessary, and intra-articular injection of Sodium Hyaluronate, PRP, adipose stem cells, and cautious application of tramadol and other drugs are considered if the efficacy is poor. Repair treatment is commonly used for force line correction surgery. 3D printing-assisted tibial high osteotomy can realize intraoperative precise osteotomy and correct the force line of the lower limb. Reconstructive treatment is mainly joint replacement surgery. Unicompartmental knee arthroplasty has faster recovery and fewer complications than total knee arthroplasty, but the revision rate is high; postoperative complications, pain and functional scores of bi-unicompartmental knee arthroplasty are comparable to total knee arthroplasty, but better gait is expected. With the development of computers, digital assisted technologies such as robotics, mixed reality, and 3D printing are widely used in joint replacement surgery, and the research of artificial joint materials is an eternal hot spot.