首页 中华疼痛学杂志 2024年20卷03期 中国骨关节炎诊疗指南（2024版）
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中国骨关节炎诊疗指南（2024版）
中国骨关节炎诊疗指南专家组 
中国老年保健协会疼痛病学分会
黄东
冯泽国
胡蓉
李艳华
梁立双
刘庆
刘堂华
马柯
王林
王锁良
杨晓秋
张小梅
张英
刘延青 
作者及单位信息
·
DOI： 10.3760/cma.j.cn101658-20240618-00074
Chinese guidelines for diagnosis and treatment of osteoarthritis (2024 edition)
Expert Group of Chinese Guidelines for Diagnosis and Treatment of Osteoarthritis
The Pain Disease Branch of the Chinese Aging Well Association
Huang Dong
Feng Zeguo
Hu Rong
Li Yanhua
Liang Lishuang
Liu Qing
Liu Tanghua
Ma Ke
Wang Lin
Wang Suoliang
Yang Xiaoqiu
Zhang Xiaomei
Zhang Ying
Liu Yanqing
Authors Info & Affiliations
Expert Group of Chinese Guidelines for Diagnosis and Treatment of Osteoarthritis
The Pain Disease Branch of the Chinese Aging Well Association
Huang Dong
Department of Painology, Xiangya Third Hospital of Central South University, Changsha City, Hunan Province 410000, China
Feng Zeguo
Department of Painology, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing City 100853, China
Hu Rong
Department of Painology, Xiangya Third Hospital of Central South University, Changsha City, Hunan Province 410000, China
Li Yanhua
Department of Painology, The First People's Hospital of Yunnan Province, Kunming City, Yunnan Province 650034, China
Liang Lishuang
Department of Painology, Qilu Hospital of Shandong University, Jinan City, Shandong Province 250012, China
Liu Qing
Department of Painology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou City, Sichuan Province 646000, China
Liu Tanghua
Pain Disease Research Institute, Zhongguancun Sino US Precision Medicine Technology Research Institute, Beijing City 100080, China
Ma Ke
Department of Pain, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai City 200092, China
Wang Lin
Department of Painology, The Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province 550004, China
Wang Suoliang
Department of Painology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an City, Shaanxi Province 710061, China
Yang Xiaoqiu
Department of Painology, The First Affiliated Hospital of Chongqing Medical University, Chongqing City 400042, China
Zhang Xiaomei
Department of Painology, The First Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan Province 650032, China
Zhang Ying
Department of Painology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou City, Sichuan Province 646000, China
Liu Yanqing
Department of Painology, Beijing Tiantan Hospital, Capital Medical University, Beijing City 100070, China
·
DOI： 10.3760/cma.j.cn101658-20240618-00074
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摘要
骨关节炎（OA）是常见的慢性疼痛疾病之一，其特征是慢性疼痛和活动能力丧失，极大影响人民群众生活质量。随着我国人口老龄化程度的不断加剧，OA的患病率有逐渐上升的趋势。为规范OA的诊断及治疗，中国老年保健协会疼痛病学分会牵头组织相关专家，在中华医学会骨科学分会关节外科学组的《中国骨关节炎指南（2018、2021年版）》基础上，参考最新文献和大量高质量证据，结合我国疼痛医学和传统医学的诊疗经验，提出"依据OA的临床分期指导治疗"，并对"OA阶梯化治疗"等级进行优化。经多次讨论、审稿以及专家匿名投票，制定了《中国骨关节炎诊疗指南（2024版）》，以期为OA的诊疗提供最新的规范化方案，实现"防治慢性疼痛疾病，保障人民群众健康"的目标。
骨关节炎;慢性疼痛;诊断;治疗;指南
ABSTRACT
Osteoarthritis (OA) is one of the common chronic pain diseases, with chronic pain and loss of mobility, and greatly affects people's quality of life. With the increasing of aging population in China, the incidence of OA rises gradually. To standardize the diagnosis and treatment of OA, the Pain Disease Branch of the Chinese Aging Well Association organized relevant experts, based on the "Chinese Osteoarthritis Guidelines (2018, 2021 editions)" published by the Joint Surgery Group of the Orthopedic Branch of the Chinese Medical Association, and further referring to the latest literature and a vast array of high-quality evidence, combined with the diagnosis and treatment experience of pain medicine and traditional medicine in China, the panel advocated the perspective centered on "treating osteoarthritis according to its clinical staging". Through optimizing the framework of the "OA ladder treatment", ensuring the most up-to-date understanding of the disease and its management, following extensive discussions, reviews, and anonymous expert voting, the experts compiled the "Chinese Osteoarthritis Diagnosis and Treatment Guidelines (2024 edition)", to provide the most up-to-date, standardized approach for diagnosing and treating OA, and to achieve the goals of "prevent and manage chronic pain diseases, safeguarding the health of the population" .
Osteoarthritis;Chronic pain;Diagnosis;Therapy;Guide
Liu Yanqing, Email:
mocdef.6ab21yyttqyl
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引用本文
中国骨关节炎诊疗指南专家组,中国老年保健协会疼痛病学分会,黄东,等. 中国骨关节炎诊疗指南（2024版）[J]. 中华疼痛学杂志,2024,20(03)：323-338.
DOI:10.3760/cma.j.cn101658-20240618-00074PERMISSIONS
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指南制订流程和方法
一、指南发起机构与专家组成员
由中国老年保健协会疼痛病学分会牵头组织国内相关学科专家，组成《中国骨关节炎诊疗指南》专家组制订本指南。指南自2024年3月启动至2024年6月定稿，历经2次中期审稿会，期间线上、线下反复讨论、投票，最终于2024年6月15日定稿。本指南专家组成员均填写了利益声明表，不存在与本指南直接相关的利益冲突。
二、指南使用者与应用的目标人群
本指南供不同等级医院的疼痛科、麻醉科、神经内科、神经外科、骨科、风湿免疫科、康复科、中医科医师和临床药师等进行参考，实际需根据患者具体情况酌情参考应用，提倡对骨关节炎的"个体化、规范化"诊疗，助力推动"慢性疼痛疾病防治，保障人民群众健康"。
三、证据的检索
根据临床问题检索MEDLINE、Cochrane Library、CBM、万方和CNKI数据库，按照系统评价、随机对照试验（randomized controlled trial, RCT）、队列研究和病例对照研究的顺序选择循证医学证据。
四、证据的评价与分级
本指南采用推荐意见分级评估、制订及评价（Grading of Recommendations Assessment, Development and Evaluation, GRADE）方法（https://www.gradeworkinggroup.org/）对证据质量和推荐意见的推荐强度进行分级，专家组按证据评价结果，对指南涉及骨关节炎治疗的40余种方法初步形成推荐意见，使用基于网络的数据平台"金数据"（https://www.jinshuju.net）对推荐意见进行匿名投票，根据投票结果，严格遵循GRADE方法，形成最终推荐意见。见
表1
。
| 级别 | 说明 |
|---|---|
| 证据质量 | |
| 高质量(A) | 非常有把握估计值接近真实值 |
| 中等质量(B) | 对估计值有中等把握：估计值有可能接近真实值，但也有可能差别很大 |
| 低质量(C) | 对估计值的把握有限：估计值可能与真实值有很大差别 |
| 极低质量(D) | 对估计值几乎没有把握：估计值与真实值极大可能有很大差别 |
| 推荐强度 | |
| 强推荐(1) | 大部分患者在此种情况下会选择使用推荐方案，只有少数患者不会；大多数医生应该接受干预措施；70%以上专家组成员赞成 |
| 弱推荐(2) | 大部分患者在此种情况下会选择使用推荐方案，还有很多患者不会；医生亲自仔细查找证据或证据摘要，准备与患者就证据以及他们的价值观和意愿进行讨论；50%～70%专家组成员赞成 |
| 没有明确推荐意见(3) | 利弊相当；未确定目标人群；制定推荐意见的证据不足；50%以下专家组成员同意 |
展开表格
本指南推荐意见的证据等级和推荐等级
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备注信息
A
刘延青, Email:
mocdef.6ab21yyttqyl
B
（除第一作者和通信作者外，其他作者按姓氏首拼排序）
C
所有作者均声明无利益冲突
D
中国骨关节炎诊疗指南专家组,中国老年保健协会疼痛病学分会.中国骨关节炎诊疗指南(2024版)[J].中华疼痛学杂志, 2024, 20(3): 323-338. DOI: 10.760/cma.j.cn101658-20240618-00074.
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