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中国髌股关节骨关节炎诊疗指南（2020年版）
国家老年疾病临床医学研究中心（湘雅医院）
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.cn121113-20200903-00545
Chinese clinical practice guideline for patellofemoral osteoarthritis (2020 edition)
National Clinical Research Center for Geriatric Disorders (Xiangya Hospital);
Joint Surgery Branch of the Chinese Orthopaedic Association
Lei Guanghua
Wang Kunzheng
Hu Yongcheng
Authors Info & Affiliations
National Clinical Research Center for Geriatric Disorders (Xiangya Hospital);
Joint Surgery Branch of the Chinese Orthopaedic Association
Lei Guanghua
Wang Kunzheng
Hu Yongcheng
·
DOI： 10.3760/cma.j.cn121113-20200903-00545
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摘要

髌股关节骨关节炎（patellofemoral osteoarthritis，PFOA）是膝关节骨关节炎的一种重要亚型，人群患病率高、疾病负担重。既往膝关节骨关节炎临床诊疗指南主要针对胫股关节骨关节炎制订，而近年来PFOA受到越来越多的关注，因此有必要对PFOA的临床诊断和治疗进行规范。本指南制订小组由骨科临床专家组成，采用世界卫生组织推荐的指南制订方法，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；而后针对PFOA领域已发表的相关系统评价、临床试验以及观察性研究进行文献综述，并对相关证据进行质量评价；经过多轮德尔菲法投票确定指南的推荐意见及其推荐强度；最终形成了12条推荐意见，涵盖PFOA的诊断（症状、体征和影像学改变）、非手术治疗（基础治疗和药物治疗）以及手术治疗（修复性手术和重建手术）等管理措施。本指南旨在为我国PFOA的临床诊疗实践提供指导和帮助。

ABSTRACT

Patellofemoral osteoarthritis (PFOA) is a subtype of knee osteoarthritis, featuring high prevalence and heavy disease burden. Previous clinical practice guidelines of knee osteoarthritis mainly focused on tibiofemoral joint osteoarthritis, whereas PFOA has drawn more attention in recent years. Therefore, it is necessary to standardize the diagnosis and treatment of PFOA in the clinical setting. The Guideline Working Panel, consisted of clinical specialists in the field of orthopaedic joint surgery, adopted methods in accordance to WHO guideline handbook when making the present guideline. Firstly, several rounds of online survey of clinicians was conducted to determine important clinical questions. After reviewing of the literatures concerning published systematic reviews, clinical trials, and observational studies in the field of PFOA and evaluation of quality of the evidence found, determination of consensus recommendations and strength of these recommendations were performed following several rounds of Delphi process. Ultimately, a total of 12 recommendations, involving the diagnosis (symptoms, signs and imaging changes), non-surgical (primary treatment and pharmacotherapy) and surgical interventions (repair and reconstruction) of PFOA, were developed. The present guideline aimed to guide decision-making of diagnosis and treatment of PFOA in clinical practices in China.

Corresponding author: Lei Guanghua, Email: nc.defudabe.uscauhgnaug_iel
Wang Kunzheng, Email: mocdef.3ab615591hzkw
Hu Yongcheng, Email: mocdef.6ab21uhgnehcgnoy
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引用本文

国家老年疾病临床医学研究中心（湘雅医院）,中华医学会骨科学分会关节外科学组. 中国髌股关节骨关节炎诊疗指南（2020年版）[J]. 中华骨科杂志,2020,40(18)：1227-1234.

DOI:10.3760/cma.j.cn121113-20200903-00545

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一、指南制订背景
膝关节骨关节炎是中老年人最常见的运动系统退行性疾病，其病理特征主要包括关节软骨变性破坏、软骨下骨硬化或囊性变、关节边缘骨质增生、滑膜病变、关节囊挛缩、韧带松弛或挛缩以及肌肉萎缩等[ 1 ]。根据病变部位不同可将膝关节骨关节炎分为单纯胫股关节骨关节炎（tibiofemoral osteoarthritis，TFOA）、单纯髌股关节骨关节炎（patellofemoral osteoarthritis，PFOA）、TFOA合并PFOA三种亚型。目前国内外关于膝关节骨关节炎的研究主要集中在TFOA，针对PFOA的研究相对较少。然而，PFOA在社区老年人群中具有较高的患病率[ 2 , 3 ]，我国50岁及以上人群中PFOA的患病率高达23.9%，其中男性为20.5%、女性为25.8%[ 4 ]。
PFOA有独特的临床表现和病理特点，随其流行病学、危险因素及临床诊疗研究的不断深入，PFOA越来越受到国内外学者的广泛关注和重视[ 5 , 6 , 7 ]。为了及时总结PFOA诊断、鉴别诊断、治疗新理念以及循证医学研究的最新进展，自2020年2月开始，国家老年疾病临床医学研究中心（湘雅医院）、中华医学会骨科学分会关节外科学组以及《中华骨科杂志》编辑部组织国内骨科领域相关专家，遵循科学性、实用性和先进性原则，参考国际PFOA相关共识，并结合最新的PFOA研究进展制订了本指南，以期优化PFOA诊疗策略、规范骨科医生临床诊疗实践。
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备注信息
A
通信作者：雷光华，Email:nc.defudabe.uscauhgnaug_iel；
B
王坤正，Email: mocdef.3ab615591hzkw；
C
胡永成，Email: mocdef.6ab21uhgnehcgnoy
D
湖南省重点研发计划 (2018SK2070, 2018SK2071, 2018SK2076)
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