BMJ：膝关节疼痛慎行关节镜

2015-06-18 MedSci MedSci原创

最新研究表明：对于因为罹患骨关节炎而感到持续膝关节疼痛的中老年患者，关节镜手术并没有明显疗效。而且更可能会造成潜在损伤。相关文章发表在近期BMJ上。此篇报道属于BMJ期刊的“过度医疗”系列之一，此系列旨在呼吁人们关注因为过度医疗而导致的健康损害和医疗资源浪费。在美国和英国，共有超过850,000的中老年患者因为持续膝关节疼痛而接受了关节镜手术，然而这类手术的相关循证证据等级

最新研究表明：对于因为罹患骨关节炎而感到持续膝关节疼痛的中老年患者，关节镜手术并没有明显疗效。而且更可能会造成潜在损伤。相关文章发表在近期BMJ上。

此篇报道属于BMJ期刊的“过度医疗”系列之一，此系列旨在呼吁人们关注因为过度医疗而导致的健康损害和医疗资源浪费。在美国和英国，共有超过850,000的中老年患者因为持续膝关节疼痛而接受了关节镜手术，然而这类手术的相关循证证据等级很低。在所有已经发表的文章中，无一可以证明手术较保守治疗可以对病情有明显的改善。尽管这样，许多医学人士仍相信手术疗效。

研究人员回顾了关于中老年持续膝部疼痛治疗的18组对照研究，这些研究包含了不同的对照组，包括安慰剂手术和功能锻炼。在那些结论是手术结局利大于弊的文章中，大部分研究设计都缺少盲法，而结论是手术对患者弊大于利的文章又都普遍质量不高。

共有9篇随机对照试验报道手术可以改善症状。文章中包含的一共1,270位患者平均年龄是48-63岁，随访时间从3到24个月不等。整体来说，手术只在术后3到6个月对疼痛症状有些许改善，而且这种改善只持续到术后6个月。对于患者关节功能的改善，手术与否并无差异。进一步的研究发现，一部分接受关节镜手术患者术后可以发生深静脉血栓，深静脉血栓又可以进一步导致感染，肺动脉栓塞甚至死亡。

作者认为，关节镜手术这类治疗本身是有创操作，治疗效果却不显著。尤其是跟锻炼疗法相比更是收获甚微。对于现有研究的总结，总而言之，就是对于膝部疼痛的中老年患者，无论有没有骨关节炎的体征，关节镜手术治疗都无法保证足够的疗效。

牛津大学的Andy Carr教授评论说：“当一种治疗方案对于患者疗效甚微时，只要有一丝可能对患者产生严重伤害，医生都不应该选择这种方案。”他还补充说：“就目前此手术的开展规模来说，只要减少或者停止这类手术，那么许多患者的生命就可以被挽救，每年深静脉血栓的发病率也会降低。”

他认为，我们正处在一个节点上，反对关节镜手术治疗膝关节疼痛的证据正在不断积累，很快就会有足够的证据突破目前关于研究质量，偏倚和既得利益的束缚。到那时，新的观点将会推翻目前的结论，成为新的治疗指南。

原始出处：

Thorlund JB1, Juhl CB2, Roos EM3, Lohmander LS4.Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms.BMJ. 2015 Jun 16;350:h2747. doi: 10.1136/bmj.h2747.

Carr A1.Arthroscopic surgery for degenerative knee.BMJ. 2015 Jun 16;350:h2983. doi: 10.1136/bmj.h2983.

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2016-01-07 gaoxiaoe

#BMJ#

81 0
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2015-09-09 Bobby7868

关节镜在临床上应用很广

163 0
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2016-05-30 gaoxiaoe

#关节疼痛#

77 0
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2015-08-05 hlycom3356

给作者点赞

172 0
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2015-08-05 hlycom3356

这篇文章很实用

138 0
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2015-10-05 dangious

#膝关节疼痛#

96 0
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2015-07-12 文刀

涨知识

168 0
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2015-07-06 1dd8b6dcm11(暂无匿称)

学习了，过度医疗不只在中国严重，看来国外也普遍存在~

168 0
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2015-06-25 huaxipanxing

看看

138 0
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2015-06-21 18619c0a62m

？

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