膝关节骨性关节炎患者指南
Knee Osteoarthritis(OA) is a common problem for many people after middle age. OA is sometimes referred to as degenerative, or wear and tear,arthritis. OA commonly affects the knee joint. In fact, knee OA is the most common cause of disability in the United States. In the past, people were led to believe that nothing could be done for their problem. Now doctors have many ways to treat knee OA so patients have less pain, better movement, and enhanced quality of life.
膝关节骨性关节炎（OA）是许多人中年后常见的问题，骨性关节炎有时被称为退行性或磨损性关节炎。OA常影响膝关节，事实上，膝关节骨关节炎是美国最常见的致残原因。过去，人们认为他们的问题无法解决，现在医生有很多方法治疗膝关节骨性关节炎，这样患者可以减轻疼痛，更好的运动，以及提高生活质量。
This guide will help you understand
这份指南将帮助你了解
· how OA develops OA
· 骨性关节炎是怎样出现和发展的？
· how OA of the knee causes problems
· 膝关节OA会引起哪些问题？
· how doctors treat the condition
· 医生如何治疗这种病？
解剖
Which parts of the knee are affected?
膝关节哪些部位受累？
The main problem in OA is degeneration of the articular cartilage. Articular cartilage is the smooth lining that covers the ends of the leg bones where they meet to form the knee joint. The cartilage gives the joint freedom of movement by decreasing friction. The layer of bone just below the articular cartilage is called subchondral bone.
OA的主要问题是关节软骨的退变。膝关节是由大腿和小腿的骨末端交会形成的，骨端有光滑的关节软骨覆盖。软骨通过减少摩擦从而使关节能自由运动，关节软骨下的骨被称为软骨下骨。
When the articular cartilage degenerates, or wears away, the bone underneath is uncovered and rubs against bone. Small outgrowths called bone spurs or osteophytes may form in the joint.
当关节软骨退变或磨损，下面的骨头裸露并且相互摩擦。骨刺或者骨赘可能会在关节中形成。
Related Document: A Patient’s Guide to Knee Anatomy
相关阅读： 英汉对照骨科患者指南045：膝关节解剖
How does knee OA develop?
膝OA如何发生并进展？
OA of the knee can be caused by a knee injury earlier in life. It can also come from years of repeated strain on the knee. Fractures of the joint surfaces, ligament tears, and meniscal injuries can all cause abnormal movement and alignment, leading to wear and tear on the joint surfaces. Not all cases of knee OA are related to a prior injury, however. Scientists believe genetics makes some people prone to developing degenerative arthritis. Obesity is linked to knee OA. Losing only 10 pounds can reduce the risk of future knee OA by 50 percent.
膝OA可由早期膝关节的损伤引起，也会由膝关节多年反复劳损引起。关节面骨折，韧带撕裂，半月板损伤都能引起异常运动及关节僵直，导致关节面磨损。并非所有膝关节骨性关节炎都与之前的损伤有关。科学家认为遗传会使一些人容易发生退行性关节炎。肥胖与膝关节OA有关，仅仅减轻10磅就可以使膝关节OA风险降低50%。
Scientists believe that problems in the subchondral bone may trigger changes in the articular cartilage. Normally, the articular cartilage protects the subchondral bone. But some medical conditions can make the subchondral bone too hard or too soft, changing how the cartilage normally cushions and absorbs shock in the joint.
科学家认为，软骨下骨的问题可能引发关节软骨的变化。通常来说，关节软骨保护软骨下骨。但一些医疗措施可以使软骨下骨太硬或太软，改变了关节中软骨正常缓冲和吸收冲击的功能。
What does knee OA feel like?
患有膝OA会有什么样的感觉？
Knee OA develops slowly over several years. The symptoms are mainly pain, swelling, and stiffening of the knee. Pain is usually worse after activity, such as walking. Early in the course of the disease, you may notice that your knee does fairly well while walking, then after sitting for several minutes your knee becomes stiff and painful. As the condition progresses, pain can interfere with simple daily activities. In the late stages, the pain can be continuous and even affect sleeppatterns.
膝OA在很多年中发展缓慢，症状主要有疼痛，肿胀，以及膝关节僵硬，通常活动后疼痛加重，如步行。病程早期，你可能注意到你的膝关节在行走时还不错，但坐几分钟后，膝关节变得僵硬疼痛，随着病情的发展，疼痛会影响简单的日常活动。在晚期，疼痛持续甚至影响正常睡眠。
How do doctors identify OA?
医生如何诊断OA？
The diagnosis of OA can usually be made on the basis of the initial history and examination.
根据原始病史和检查，往往可以作出OA的诊断。
X-rays can help in the diagnosis and may be the only special test required in the majority of cases. X-rays can also help doctors rule out other problems, since knee pain from OA may be confused with other common causes of knee pain, such as a torn meniscus or kneecap problems. In some cases of early OA, X-rays may not show the expected changes.
X射线有助于诊断，并且可能是大多数病例中唯一需要的特殊检查。X射线可以帮助医生排除其他问题，因为来自于OA的膝关节疼痛可能与其他常见的膝关节疼痛原因混淆，如半月板撕裂或髌骨病变。在一些早期OA的病例中，X射线不能显示预期的改变。
Magnetic resonance imaging (MRI) may be ordered to look at the knee more closely. An MRI scan is a special radiological test that uses magnetic waves to create pictures that look like slices of the knee. The MRI scan shows the bones, ligaments, articular cartilage, and menisci. The MRI scan is painless and requires no needles or dye.
医生可能会申请磁共振成像（MRI）以更清晰地显示膝关节。磁共振成像扫描是一种特殊的影像检查，利用磁力线来生成图像，对膝关节进行分层显示。MRI扫描能显示骨骼、韧带、关节软骨和半月板。MRI扫描是无痛的，不需要穿刺及造影。
If the diagnosis is still unclear, arthroscopy may be necessary to actually look inside the knee and see if the joint surfaces are beginning to show wear and tear.Arthroscopy is a surgical procedure in which a small fiber-optic TV camera is inserted into the knee joint through a very small incision, about one-quarter of an inch long. The surgeon can move the camera around inside the joint while watching the pictures on a TV screen. The structures inside the joint can be poked and pulled with small surgical instruments to see if there is any damage.
如果诊断仍不清楚，可能需要进行关节镜检查，以真实地看到膝关节内部，看看关节表面是否开始磨损和撕裂。关节镜是一种外科手术，一个小型光纤电视摄像机通过一个非常小的切口插入膝关节，大约1/4英寸长。外科医生可以在关节内移动摄像机，然后在电视屏幕上看到图像。可以使用一些小型手术器械拨开或推开关节内的结构，看看有没有损伤。
What can be done for the condition?
膝关节骨性关节炎的治疗方法有哪些？
OA can’t be cured, but therapies are available to ease symptoms and to slow down the degeneration. Recent information shows that mild cases of knee OA may be maintained and in some cases improved without surgery.
OA无法彻底治愈，但一些疗法可以缓解症状，减缓退化。最近的信息表明，轻度膝关节OA病例，可以维持，在有些病例，不做手术也可以改善。
Medication
药物
Your physician may prescribe medicine to help control your pain. Acetaminophen (Tylenol?) is a mild pain reliever with few side effects. Some people may also get relief of pain with anti-inflammatory medication, such as ibuprofen and aspirin. Newer anti-inflammatory medicines called COX-2 inhibitors show promising results and don’t cause as much stomach upset and other intestinal problems.
你的医生可能会开药来控制你的疼痛。对乙酰氨基酚（泰诺）是一种温和的止痛药并且副作用少。有些人也可以用消炎药，如布洛芬和阿司匹林来缓解疼痛。新的抗炎药物称为COX-2抑制剂，展现出了可喜的成果，不会引起胃部不适及其它肠道问题。
Related Document: A Patient’s Guide to Medications for Arthritis
相关阅读：关节炎用药患者指南（翻译招募中，有意者请留言）
Medical studies have shown that glucosamine and chondroitin sulfate can also help people with knee OA. These supplements seem to have nearly the same benefits as anti-inflammatory medicine with fewer side affects. Many doctors feel the research supports these supplements and are encouraging their patients to use them.
医学研究表明，氨基葡萄糖和硫酸软骨素也对膝关节OA患者有益。这些补充的药物似乎和消炎药物同样有效，且副作用较少。许多医生觉得研究支持这些补充药物，并且鼓励患者使用它们。
Related Document: A Patient’s Guide to Glucosamine and Chondroitin Sulfate for Knee Osteoarthritis
相关资料 膝关节骨性关节炎使用氨基葡萄糖和硫酸软骨素治疗患者指南（翻译招募中，有意者请留言）
If you aren’t able to get your symptoms under control, a cortisone injection may be prescribed. Cortisone is a powerful anti-inflammatory medication, but it has secondary effects that limit its usefulness in the treatment of OA. Multiple injections of cortisone may actually speed up the process of degeneration.
如果你的症状得不到控制，医生可能会建议注射可的松。可的松是一种强大的抗炎药物，但它有副作用，限制了其在OA治疗中的使用。多次注射可的松会加速退变过程。
Repeated injections also increase the risk of developing a knee joint infection, called septic arthritis. Any time a joint is entered with a needle, there is the possibility of an infection. Most physicians use cortisone sparingly, and avoid multiple injections unless the joint is already in the end stages of degeneration, and the next step is an artificial knee replacement.
重复注射也会增加膝关节感染的风险，被称为化脓性关节炎。任何时候用针进入关节，都有感染的可能。大多数医生使用可的松都很节制，避免多次注射，除非关节已经处于退变末期，下一步就需要人工膝关节置换。
A new type of injectable medication has become available in the United States.Hyaluronic acid has been used in Europe and Canada for several years. Doctors inject three to five doses into the joint over a one-month period. The medicine helps lubricate the joint, ease pain, and improve people’s ability to get back to some of the activities they enjoy. Some people have had good results for up to eight months after getting these treatments.
一种新型的注射药物已经在美国上市。透明质酸在欧洲及加拿大已经使用了很多年，医生在一个多月的时间内，在关节内注射3~5剂。这种药有助于润滑关节，缓解疼痛，改善人们的能力，并且能使他们回到喜欢的一些活动中。有些人这样治疗八个月后有着良好的效果。
Related Document: A Patient’s Guide to Viscosupplementation for Knee Osteoarthritis
相关阅读 透明质酸治疗膝关节OA患者指南（翻译招募中，有意者请留言）
Physical Therapy
物理治疗
Physical therapy plays a critical role in the nonoperative treatment of knee OA. A primary goal is to help you learn how to control symptoms and maximize the health of your knee. You will learn ways to calm pain and symptoms, which might include the use of rest, heat, or topical rubs.
物理治疗在膝关节骨性关节炎非手术治疗中起着至关重要的作用。主要的目标是帮助你学会如何控制症状和最大限度地提高你的膝关节的健康。你将学会缓解疼痛和症状的方法，包括休息，热疗以及局部摩擦。
Physical therapists teach their patients how to protect the arthritic knee joint. This starts with tips on choosing activities that minimize impact and twisting forces on the knee. People who modify their activities can actually slow down the effects of knee OA. For instance, people who normally jog might decide to walk, bike, or swim to reduce impact on their knee joint. Sports that require jumping and quick starts and stops may need to be altered or discontinued to protect the knee joint.
理疗师教病人如何保护膝关节炎，从选择活动的诀窍开始，这将减少膝盖上的冲击力和扭转力。人们通过改变活动，确实能减缓了膝OA的影响。例如，通常慢跑的人可能会决定步行，骑自行车，或游泳，以减少对他们膝关节的影响。需要跳跃和快速开始和停止的运动，可能需要改变或中止，以保护膝关节。
Shock-absorbing insoles placed in your shoes can also reduce impact and protect the joint. In advanced cases of knee OA or when the knee is especially painful, a cane or walker may be recommended to ease joint pressure when walking. People who walk regularly are encouraged to choose a soft walking surface, such as a cinder or grass track.
在你的鞋子里垫上减震鞋垫也可以减少震荡，保护关节。在晚期膝关节骨性关节炎或膝关节特别痛的时候，在行走时可以建议拄拐或用学步车，以减轻膝关节压力。经常散步的人鼓励选择柔软的行走表面，如煤渣或草地跑道。
A new type of knee brace, called a knee unloading brace, can help when OA is affecting one side of the knee joint. For example, a bowlegged posture changes the way the knee joint lines up. The inside (medial) part of the knee joint gets pressed together. The cartilage suffers more damage, and greater pain and problems occur. The unloading brace pushes against the outer (lateral) surface of the knee, causing the medial side of the joint to open up. In this way, the brace shares the pressure and unloads the arthritic medial side of the joint. A knee unloading brace can help relieve pain and allow people to do more of their usual activities.
一种新型的膝关节支架，称为膝关节卸力支具，可以帮助膝关节的一侧受OA影响的患者。例如，一个弓形腿的姿势改变了膝关节线。膝关节的内侧被压到了一起。软骨受到更大的损害，更严重的疼痛和问题发生了。卸载支具推膝外侧（外侧）表面，造成关节内侧张开。这样，支具分担了压力并且卸载了关节内侧压力。膝关节卸力支具可以帮助减轻疼痛，并允许人们做更多的日常活动。
For mild cases of knee OA, you may be given a heel wedge to wear in your shoe. By tilting the heel, the wedge alters the way the knee lines up, which works like the unloading brace mentioned above to take pressure off the arthritic part of the knee.
对于轻度膝关节骨性关节炎，你可能需要穿有楔形跟的鞋。通过倾斜鞋跟，楔形改变了膝关节线，就像上面说到的卸力支具一样，减轻膝关节的压力。
Range-of-motion and stretching exercises will be used to improve knee motion. You will be shown strengthening exercises for the hip and knee to help steady the knee and give additional joint protection from shock and stress. People with knee OA who have strong leg muscles have fewer symptoms and prolong the life of their knee joint. Your therapist will also suggest tips for getting your tasks done with less strain on the joint.
运动范围和伸展训练被用来改善膝关节运动。你可能会做一些膝关节和髋关节的伸展训练来增加膝关节的稳定以及有冲撞和压力时给予关节额外的保护。腿部肌肉发达的膝OA患者，症状较少，他们的膝关节寿命较长。你的治疗师也会告诉你在工作时如何减轻关节的压力。
In some cases, surgical treatment of OA may be appropriate.
在有些病例，手术治疗OA可能是合适的选择。
In cases of advanced OA where surgery is called for, patients may also see a physical therapist before surgery to discuss exercises that will be used just after surgery and to begin practicing using crutches or a walker.
被需要进行手术的晚期OA病例，患者在手术前也可以寻求物理治疗师的帮助，讨论手术后将使用的练习，并开始使用拐杖或助行器练习。
Arthroscopy
关节镜检查
Surgeons can use an arthroscope (mentioned earlier) to check the condition of the articular cartilage. They can also clean the joint by removing loose fragments of cartilage. People have reported relief when doctors simply flush the joint with saline solution. A burring tool may be used to roughen spots on the cartilage that are badly worn. This promotes growth of new cartilage called fibrocartilage, which is like scar tissue. This procedure is often helpful for temporary relief of symptoms for up to two years.
外科医生可以使用关节镜（前面提到的）来检查关节软骨情况，他们还可以清除软骨的松散碎片来清理关节。当医生简单地用盐水冲洗关节时，有的患者减轻了。一种去毛刺工具可能被用来清除关节软骨被严重磨损的地方。这促进了新的软骨称为纤维软骨的生长，这种组织类似瘢痕组织。这一过程往往有助于暂时缓解症状长达两年。
Related Document: A Patient’s Guide to Arthroscopy
相关阅读：关节镜检查患者指南（翻译招募中，有意者请留言）
相关视频：骨科手术早知道039：关节镜（JOINT ARTHROSCOPY）
Proximal Tibial Osteotomy
胫骨高位截骨术
OA usually affects the side of the knee closest to the other knee (called the medial compartment) more often than the outside part (the lateral compartment). OA in the medial compartment can lead to bowing of the knee. As mentioned earlier, a bowlegged posture places more pressure than normal on the medial compartment. The added pressure leads to more pain and faster degeneration where the cartilage is being squeezed together.
OA通常影响靠近另一侧膝关节的一侧（称为内侧间室），比外侧的更为常见（称为外侧间室）。内侧间室骨关节炎可导致膝关节弯曲。如前所述，弓形腿的内侧间室比正常的要承受更大的压力。增加的压力导致更多的疼痛和更快的退化，软骨被挤压在了一起。
Surgery to realign the angles in the lower leg can help shift pressure to the other, healthier side of the knee. The goal is to reduce the pain and delay further degeneration of the medial compartment.
在小腿上调整手术角度，可以帮助转移压力到膝关节健康的一侧。我们的目标是减轻疼痛。
One procedure to realign the angles of the lower leg is called a proximal tibial osteotomy. In this procedure, the upper (proximal) part of the shinbone (tibia) is cut, and the angle of the joint is changed. This converts the extremity from being bowlegged to straight or slightly knock-kneed. By correcting the joint deformity, pressure is taken off the cartilage. A proper joint angle actually allows the cartilage to regrow, a process called regeneration.
在小腿上调整角度的手术被称为胫骨高位截骨术。在这个手术中，胫骨的上部（近端）被切断，关节角度被改变。这种转换将使肢体从弓形腿变直或轻微的弯曲。通过纠正关节畸形，软骨压力去除。一个适当的关节角度实际上使软骨重新生长，这一过程称为再生。
This surgical procedure is not always successful. Generally, it will reduce your pain but not eliminate it altogether. The advantage to this approach is that very active people still have their own knee joint, and once the bone heals there are no restrictions on activities.
这种手术并不总是成功的。一般来说，它会减少你的痛苦，但不能完全消除它。这种方法的优点是，非常活跃的人仍然有自己的膝关节，一旦骨愈合就对活动没有限制。
A proximal tibial osteotomy in the best of circumstances is probably only temporary. It is thought that this operation buys some time before a total knee replacement becomes necessary. The benefits of the operation usually last for five to seven years if successful.
在最好的情况下，胫骨高位截骨可能只是暂时的。这种手术为必须要全膝关节置换延长了一些时间，手术如果成功，患者通常获益持续五至七年。
Related Document: A Patient’s Guide to Tibial Osteotomy
相关阅读：胫骨截骨术患者指南（翻译招募中，有意得请留言）
相关视频：高位胫骨截骨术（HIGH TIBIAL OSTEOTOMY）
Artificial Knee Replacement
人工膝关节置换术
An artificial knee replacement is the ultimate solution for advanced knee OA.
人工膝关节置换术是晚期膝关节骨性关节炎的最终解决方案。
Surgeons prefer not to put a new knee joint in patients younger than 60. This is because younger patients are generally more active and might put too much stress on the joint, causing it to loosen or even crack. A revision surgery to replace a damaged prosthesis is harder to do, has more possible complications, and is usually less successful than a first-time joint replacement surgery.
外科医生不愿意在60岁以下的病人身上植入新的膝关节。这是因为年轻的患者通常更活跃，可能在关节会造成太多的压力，使其松动甚至破裂。翻修手术，更换损害的假体是很困难的，有更多的可能的并发症，通常比第一次关节置换手术更有可能失败。
Related Document: A Patient’s Guide to Artificial Joint Replacement of the Knee
相关阅读：人工膝关节置换术患者指南（翻译招募中，有意者请留言）
相关视频：全膝关节置换术（TOTAL KNEE REPLACEMENT）
What should I expect after treatment?
治疗结束后还需要做些什么？
Nonsurgical treatments are used to maximize the health of your knee and to prolong the time before surgery is needed. Physical therapy may be needed to ease pain and improve mobility, strength, and function. The focus of these visits is to help you learn to control symptoms as well as learn strategies to protect your knee over the years. You will probably progress to a home program within two to four weeks.
非手术治疗是用来最大限度地提高你的膝关节健康并且延晚需要做手术的时间。物理治疗能够缓解疼痛，改善活动度，力量以及功能。这些治疗的重点是帮助你学会控制症状以及学习策略常年保护你的膝关节。你可以在两到四周内掌握家庭训练程序。
Physical therapy treatments after surgery depend on the type of surgery performed. Rehabilitation is generally slower and more cautious after knee replacement procedures and certain types of tibial osteotomies. After simple procedures such as arthroscopy, you may begin fairly aggressive exercise therapy immediately.
手术后的物理治疗取决于手术的类型。在膝关节置换术后和某些类型的胫骨截骨术后，康复往往更缓慢，需要更小心。在一些简单的手术后，例如关节镜，你可以立即开始积极的运动疗法。
Therapy treatments usually begin the next day after surgery. Your first few rehabilitation sessions are used to ease pain and swelling, help you begin gentle knee motion and thigh tightening exercises, and get you up and walking safely. You may need to use either a walker or crutches after surgery. Some patients may be instructed to limit how much weight they place on the knee for four to six weeks.
治疗通常在手术后第二天开始。你的最初几次康复是用来缓解疼痛和肿胀，帮助你开始温柔的膝关节活动和大腿收紧练习，并让你起来安全的行走。您可能在手术后需要使用助行器或拐杖。术后四到六周内，有些病人可能会被要求限制膝关节负重。
After going home from the hospital, some patients may be seen for a short period of home therapy before beginning outpatient physical therapy. Outpatient treatments are designed to improve knee range of motion and strength and to safely progress your ability to walk and do daily activities.
从医院回家后，一些患者在开始门诊理疗前可以在短期内进行家庭理疗。门诊治疗的目的是改善膝关节的运动范围和力量，安全地过渡到正常行走和做日常活动。
The therapist’s goal is to help you keep your pain under control, maximize knee mobility, and improve muscle strength and control. When you are well under way, regular visits to your therapist’s office will end. The therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.
治疗师的目标是帮助你控制你的疼痛，最大限度地发挥膝关节的活动度，改善肌肉力量和控制。当一切都顺利进行，定期的拜访理疗师可以告一段落。理疗师将一直是你的资源，但你将负责自己的练习，并把此作为长期家庭训练的一部分。
（刘强 译）
刘强，骨科专业在读硕士，师从宁夏医科大学附属医院副院长金群华教授。之前在慈溪市中医医院手外科工作。
（编辑：胡佰文）
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