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中国骨关节炎疼痛管理临床实践指南（2020年版）
中华医学会骨科学分会关节外科学组
作者及单位信息
·
DOI： 10.3760/cma.j.cn121113-20200403-00215
Chinese clinical practice guideline for pain management in osteoarthritis (2020 edition)
Joint Surgery Branch of the Chinese Orthopedic Association
Wang Kunzheng
Lei Guanghua
Hu Yongcheng
Authors Info & Affiliations
Joint Surgery Branch of the Chinese Orthopedic Association
Wang Kunzheng
Lei Guanghua
Hu Yongcheng
·
DOI： 10.3760/cma.j.cn121113-20200403-00215
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摘要

骨关节炎（osteoarthritis，OA）是常见的关节疾病。疼痛是OA患者就医的首要主诉，因此有必要对OA的疼痛管理进行规范。本指南的制订过程参考世界卫生组织推荐的指南制订方法。由多学科专家组成指南制订小组，通过多轮针对临床医生的在线问卷调研确定指南中需要定义的重要临床问题。对OA领域已发布的相关指南、系统评价以及临床随机对照研究进行文献综述，并对相关证据进行评价。经过多轮德尔菲投票确定指南的推荐意见及其推荐强度。最终形成14条推荐意见，涉及OA疼痛管理的非药物治疗（运动治疗、健康教育、体重管理等）和药物治疗（外用及口服非甾体抗炎药、度洛西汀、关节腔药物注射等）多方面干预措施。以期为我国OA疼痛管理的实践提供临床指导和帮助。

骨关节炎;临床实践指南;中国
ABSTRACT

Osteoarthritis (OA) is the most prevalent disorder of articulating joints in humans. Pain is the predominant symptom for people with OA mandating the development of evidence-based recommendations for pain management. The present clinical practice guideline was developed according to WHO guideline handbook. A Guideline Working Group was established. The clinical questions and importance of these questions were framed according to several round online survey intended to get the clinical questions from doctors. A systematic review of existing guidelines for the management of OA and of systematic reviews and high-quality randomized control trials published recently were undertaken to evaluate evidence quality. Consensus recommendations regarding assessment and pain treatment and strength of recommendations were produced following several round Delphi exercises. Finally, a total of 14 recommendations, including pharmaceutical and non-pharmaceutical interventions, were developed. This guideline can provide guidance and help for clinicians in clinical practice of OA pain management in China.

Osteoarthritis;Clinical practice guideline;Chinese
Wang Kunzheng, Email: mocdef.3ab615591hzkw
Lei Guanghua, Email: nc.defudabe.uscauhgnaug_iel
Hu Yongcheng, Email: mocdef.6ab21uhgnehcgnoy
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引用本文

中华医学会骨科学分会关节外科学组. 中国骨关节炎疼痛管理临床实践指南（2020年版）[J]. 中华骨科杂志,2020,40(08)：469-476.

DOI:10.3760/cma.j.cn121113-20200403-00215

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一、指南制订背景
骨关节炎（Osteoarthritis，OA）是由多种因素引起关节软骨纤维化、皲裂、溃疡和脱失而导致的以关节疼痛为主要症状的退行性疾病，常累及膝关节、髋关节、脊柱和手等部位；其病理特点为关节软骨变性破坏、软骨下骨硬化或囊性变、关节边缘骨质增生、滑膜炎症、关节囊挛缩、韧带松弛或挛缩等。好发于中老年人，65岁及以上人群中超过半数者罹患OA [ 1 ]。中国健康与养老追踪调查研究（China Health and Retirement Longitudinal Study，CHARLS）的结果显示，我国45岁及以上人群中仅症状性膝关节OA的患病率就高达8.1% [ 2 ]。疼痛严重影响患者生活质量，甚至间接增加心血管事件的发生率及全因死亡率 [ 3 , 4 , 5 ]。疼痛作为OA最主要的症状，已成为骨骼肌肉系统疾病负担的主要来源之一 [ 6 ]，尤其我国膝关节OA的疾病负担较重 [ 7 ]。因此，科学有效地管理OA疼痛对缓解疼痛症状、降低疾病负担、提高生活质量至关重要。
OA疼痛属慢性疼痛，包括外周感受性疼痛和中枢敏化性疼痛 [ 8 ]。外周水平的痛觉感受来源于关节组织、外周神经和神经根等，而中枢水平的痛觉感受来源于大脑和脊髓。外周感受性疼痛的主要机制为局部炎症介质的释放，现已证实多种炎症因子如白细胞介素-1等参与了OA的疼痛过程 [ 9 ]。中枢性疼痛主要机制为中枢敏化 [ 10 ]。尽管OA疼痛机制的研究不断深入，疼痛管理的方法也逐渐增多，但具体到每一例患者对不同干预措施的反应存在差异 [ 11 ]。有54％的膝关节OA疼痛患者经治疗后仍有持续性中至重度疼痛，且该部分患者更容易出现功能丧失和生活质量降低 [ 12 ]。因此，如何实施科学有效的OA疼痛管理依然是临床难题，亟待有一部针对OA疼痛管理的权威性的指南对镇痛方案的选择与实施进行规范和指导。中华医学会骨科学分会关节外科学组和中华骨科杂志编辑部组织专家严格依据指南制订的方法和流程制订了本指南。
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备注信息
A
王坤正，Email: mocdef.3ab615591hzkw
B
雷光华，Email: nc.defudabe.uscauhgnaug_iel
C
胡永成，Email: mocdef.6ab21uhgnehcgnoy
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