髋关节疼痛和髋关节骨性关节炎实践指南 髋关节疼痛和髋关节骨性关节炎实践指南 DIAGNOSIS/CLASSIFICATION 2017 Recommendation Clinicians should use the following criteria to classify adults over the age of 50 years into the International Statistical Classification of Diseases and Related Health Problems (ICD) category of coxarthrosis and the associated International Classification of Functioning, Disability and Health (ICF) impairment-based category of hip pain (b28016 Pain in joints) and mobility deficits (b7100 Mobility of a single joint): moderate anterior or lateral hip pain during weightbearing activities, morning stiffness less than 1 hour in duration after wakening, hip internal rotation range of motion less than 24° or internal rotation and hip flexion 15° less than the nonpainful side, and/or increased hip pain associated with passive hip internal rotation. DIFFERENTIAL DIAGNOSIS 2017 Recommendation Clinicians should revise the diagnosis and change their plan of care, or refer the patient to the appropriate clinician, when the patient’s history, reported activity limitations, or impairments of body function and structure are not consistent with those presented in the diagnosis/classification section of this guideline, or when the patient’s symptoms are not diminishing with interventions aimed at normalization of the patient’s impairments of body function. EXAMINATION – OUTCOME MEASURES: ACTIVITY LIMITATION/SELF-REPORT MEASURES 2017 Recommendation Clinicians should use validated outcome measures that include domains of hip pain, body function impairment, activity limitation, and participation restriction to assess outcomes of treatment of hip osteoarthritis. Measures to assess hip pain may include the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale, Brief Pain Inventory (BPI), pressure pain threshold (PPT), and pain visual analog scale (VAS). Activity limitation and participation restriction outcome measures may include the WOMAC physical function subscale, the Hip disabi ity and Osteoarthritis Outcome Score (HOOS), Lower Extremity Functional Scale (LEFS), and Harris Hip Score (HHS). EXAMINATION – ACTIVITY LIMITATION/PHYSICAL PERFORMANCE MEASURES 2017 Recommendation To assess activity limitation, participation restrictions, and changes in the patient’s level of function over the episode of care, clinicians should utilize reliable and valid physical performance measures, such as the 6-minute walk test, 30-second chair stand,stair measure, timed up-and-go test, self-paced walk, timed singleleg stance, 4-square step test, and step test. Clinicians should measure balance performance and activities that predict the risk of falls in adults with hip osteoarthritis,especially those with decreased physical function or a high risk of falls because of past history. Recommended balance tests for patients with osteoarthritis include the Berg Balance Scale, 4-square step test, and timed single-leg stance test. Clinicians should use published recommendations from the Academy of Geriatric Physical Therapy of the American Physical Therapy Association6 to guide fall risk management in patients with hip osteoarthritis to assess and manage fall risk. EXAMINATION – PHYSICAL IMPAIRMENT MEASURES 2017 Recommendation When examining a patient with hip pain/hip osteoarthritis over an episode of care, clinicians should document the flexion, abduction, and external rotation (FABER or Patrick’s) test and passive hip range of motion and hip muscle strength, including internal rotation,external rotation, flexion, extension, abduction, and adduction. INTERVENTIONS – PATIENT EDUCATION 2017 Recommendation Clinicians should provide patient education combined with exercise and/or manual therapy. Education should include teaching activity modification, exercise, supporting weight reduction when overweight, and methods of unloading the arthritic joints. INTERVENTIONS – FUNCTIONAL, GAIT, AND BALANCE TRAINING 2017 Recommendation Clinicians should provide impairment-based functional, gait, and balance training, including the proper use of assistive devices (canes, crutches, walkers), to patients with hip osteoarthritis and activity limitations, balance impairment, and/or gait limitations when associated problems are observed and documented during the history or physical assessment of the patient. Clinicians should individualize prescription of therapeutic activities based on the patient’s values, daily life participation, and functional activity needs. INTERVENTIONS – MANUAL THERAPY 2017 Recommendation Clinicians should use manual therapy for patients with mild to moderate hip osteoarthritis and impairment of joint mobility,flexibility, and/or pain. Manual therapy may include thrust, nonthrust,and soft tissue mobilization. Doses and duration may range from 1 to 3 times per week over 6 to 12 weeks in patients with mild to moderate hip osteoarthritis. As hip motion improves, clinicians should add exercises including stretching and strengthening to augment and sustain gains in the patient’s range of motion, flexibility, and strength. INTERVENTIONS – FLEXIBILITY, STRENGTHENING, AND ENDURANCE EXERCISES 2017 Recommendation Clinicians should use individualized flexibility, strengthening, and endurance exercises to address impairments in hip range of motion, specific muscle weaknesses, and limited high (hip) muscle flexibility. For group-based exercise programs, effort should be made to tailor exercises to address patients’ most relevant physical impairments. Dosage and duration of treatment for effect should range from 1 to 5 times per week over 6 to 12 weeks in patients with mild to moderate hip osteoarthritis. INTERVENTIONS – MODALITIES 2017 Recommendation Clinicians may use ultrasound (1 MHz; 1 W/cm2 for 5 minutes each to the anterior, lateral, and posterior hip for a total of 10 treatments over a 2-week period) in addition to exercise and hot packs in the short-term management of pain and activity limitation in individuals with hip osteoarthritis. INTERVENTIONS – BRACING 2017 Recommendation Clinicians should not use bracing as a first line of treatment. A brace may be used after exercise or manual therapies are unsuccessful in improving participation in activities that require turning/pivoting for patients with mild to moderate hip osteoarthritis, especially in those with bilateral hip osteoarthritis. INTERVENTIONS – WEIGHT LOSS 2017 Recommendation In addition to providing exercise intervention, clinicians should collaborate with physicians, nutritionists, or dietitians to support weight reduction in individuals with hip osteoarthritis who are overweight or obese. *These recommendations and clinical practice guidelines are based on the scientific literature published prior to April 2016. Please refer to our previously published guidelines on “Hip Pain and Mobility Deficits – Hip Osteoarthritis” for literature reviewed prior to 2009. 指南目录 “腰椎间盘突出症的康复治疗”中国专家共识 2017急性深静脉血栓形成诊断和治疗指南 2017年GOLD慢性阻塞性肺疾病定义和诊断的全球策略解读 2017年最新克罗恩病治疗指南 2017年最新溃疡性结肠炎治疗指南 2017 ADA糖尿病视神经病变最新指南推荐 儿童及成人惊厥性癫痫持续状态(CSE)的治疗 中国急/慢性非特异性腰背痛诊疗专家共识 中国帕金森病的诊断标准(2016版) 中国血管性认知障碍诊疗指导规范 2016年中国偏头痛防治指南 阿尔茨海默病诊疗指南 关于肥厚型心肌病诊断和猝死防治建议 心房颤动诊疗指南 2016 ESC 和 AHA/AHA/HFSA慢性心力衰竭新指南解读
慢性髋关节疼痛ACR适宜性标准 慢性髋关节疼痛ACR适宜性标准 1. Radiographs of the pelvis and hip should be the fi rst test ordered for the evaluation of patients with chronic hip pain. 2. MRI hip without IV contrast or US hip is appropriate in patients with chronic hip pain when radiographs are negative, equivocal, or nondiagnostic and there is suspicion for an extraarticular noninfectious soft tissue abnormality such as tendonitis. 3. MRI hip without IV contrast, MR arthrography, or CT arthrography is appropriate in patients with chronic hip pain when radiographs are negative, equivocal, or nondiagnostic and there is a suspicion for impingement. 4. MR arthrography or CT arthrography is appropriate in patients with chronic hip pain when radiographs are negative, equivocal, or nondiagnostic and a labral tear is suspected. 5. MRI hip without IV contrast, MR arthrography, or CT arthrography is appropriate after radiographs in patients with chronic hip pain to evaluate articular cartilage. 6. MRI hip with or without IV contrast or hip aspiration is appropriate after positive radiographs in patients with chronic hip pain with suspected arthritis when infection is a consideration. 7. MRI hip without IV contrast is appropriate in patients with chronic hip pain when radiographs are suggestive of pigmented villonodular synovitis or osteochondromatosis. 8. MRI hip without IV contrast image – guided anesthetic with or without corticosteroid is appropriate to exclude the hip as the source of pain in patients with chronic hip pain and low back, pelvic, or knee pathology with negative or equivocal radiographs or radiographs showing mild osteoarthritis. CT hip without contrast is the preferred modality for computer-navigated surgery. 指南目录 “腰椎间盘突出症的康复治疗”中国专家共识 2017急性深静脉血栓形成诊断和治疗指南 2017年GOLD慢性阻塞性肺疾病定义和诊断的全球策略解读 2017年最新克罗恩病治疗指南 2017年最新溃疡性结肠炎治疗指南 2017 ADA糖尿病视神经病变最新指南推荐 儿童及成人惊厥性癫痫持续状态(CSE)的治疗 中国急/慢性非特异性腰背痛诊疗专家共识 中国帕金森病的诊断标准(2016版) 中国血管性认知障碍诊疗指导规范 2016年中国偏头痛防治指南 阿尔茨海默病诊疗指南 关于肥厚型心肌病诊断和猝死防治建议 心房颤动诊疗指南 2016 ESC 和 AHA/AHA/HFSA慢性心力衰竭新指南解读
上周末赴上海九院骨科参加了王友教授主办的髋膝关节置换导航技术学习班，受益匪浅。 第一位做演讲的专家是：美国纽约Donald M. Kastenbaum医生，著名的髋关节置换、膝关节置换与膝关节镜手术专家。有3000多台关节置换手术经验。 http://www.orthobi.com/physician-kastenbaum.htm Dr. Donald M. Kastenbaum, MD Minimally Invasive Hip Knee Replacement; Arthroscopic Knee Surgery; Sports Medicine Dr. Kastenbaum is an authority in the field of orthopaedic surgery and a recognized expert in hip and knee surgery. He has performed more than 3,000 total hip and total knee replacements and has helped develop several total hip and knee prostheses that are in use worldwide. He also has extensive experience in treating sports-related injuries and performing arthroscopic surgery of the knee. A native New Yorker, Dr. Kastenbaum earned his medical degree from the University of Health Sciences—The Chicago Medical School. After interning in general surgery at Lenox Hill Hospital, he completed a residency in orthopaedic surgery at the Hospital for Joint Diseases Orthopaedic Institute. He then completed fellowships in sports medicine at New York University Medical Center, and total hip and knee replacement surgery at the London Hospital Medical College. After completing his specialty training, Dr. Kastenbaum returned to New York to join the staff of the Hospital for Joint Diseases Orthopaedic Institute as an attending physician. He also served as a clinical instructor in orthopaedic surgery at Mount Sinai School of Medicine. In 1995, Dr. Kastenbaum was recruited to Beth Israel Medical Center and named Section Chief, Adult Reconstructive Joint Surgery. In 1996, he created the hospital’s first Comprehensive Arthritis Center of which he was named Co-Director and Surgeon-In-Chief. This unique facility provided comprehensive orthopaedic and rheumatologic care, including physical therapy, under one roof. In 2002, Dr. Kastenbaum was asked to join the Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, and was named the Associate Chairman of the Department of Orthopaedic Surgery. In 2005, he was named Vice Chairman of the Department of Orthopaedic Surgery. In addition to his very busy clinical practice, Dr. Kastenbaum lectures and operates worldwide. He has trained more than 30 Asian Orthopaedic Fellows and returns to China yearly to perform complicated hip and knee surgical procedures. At Beth Israel, Dr. Kastenbaum has served as President of the Medical Board, continues to serve as the Chairman of the Committee on Surgery, was named Medical Director of Perioperative Services in August 2006 and Assistant Vice President/Medical Director of Perioperative Services in November 2007. Donald M. Kastenbaum医生主要介绍了关节置换手术导航的历史、膝关节置换手术导航技术与髋关节置换手术导航技术。内容丰富，可以学到很多东西。九院骨科岳冰医师的英文翻译非常流利、顺畅，为该演讲增色很多。 第二位做演讲的专家是：上海交通大学 王成焘教授 http://202.120.33.37/10XZ/detail/detail_03.htm 王成焘教授于1962毕业于上海交通大学机车车辆工程系，毕业后留机械工程系机械设计教研室任教，1981-1983由学校派送联邦德国Karlsruhe大学进修，回国后先后担任研究所所长、机械工程系副主任、主任，上海交通大学汽车科学与工程研究院执行院长、生物医学制造与生命质量工程研究所所长等职务，是国务院批准的博士生导师。他在上海交通大学读书，并且在上海交通大学从教近48年。近年来王成焘教授在机械工程与现代医学相结合方面做出了大量工作，在制造领域与医学界广受赞誉，在国际上也具有一定的影响，为我校争得了声誉。 一、上世纪九十年代王成焘教授在国内机械工程学科率先进行改革，调整学科结构，引进中青年骨干教师，为后来我校机械工程学科的快速发展奠定了坚实基础。 王成焘老师在担任机械工程系主任期间（1994－1998年），系的基层组织为教研室，科研力量较弱且分散，王教授以极大的工作热情和务实的工作态度，团结广大老师，整合资源，在国内的机械工程学科率先提出了机械制造、机械设计、机电控制、车辆工程这样四项的二级学科结构，并在机械工程进行改革，引进中青年师资，瞄准国家863等国家目标整合学科团队，凝练方向，为1998年建立机械工程学院打下了结构和学科的基础。在王教授担任系主任期间，他开始与密西根大学倪军教授建立联系，并率队访问密西根大学，这些均为今后机械工程学院开展与密西根大学的合作打下基础。 王成焘老师在担任上海交通大学汽车工程研究院的执行院长，以学校的各个与汽车相关的学科为基础，在汽车工程研究的起始期间艰难的环境下，创业守成，构建了一个学科平台，投入巨大的精力，取得了公认的成绩，这也为今后汽车工程学科的发展壮大打下了坚实基础。 二、王成焘教授开创了制造领域与医学领域结合的成功范例，是我校率先开展医工结合研究的表率，是我国数字化临床技术的积极推进者 1. 王成焘教授建设性地开展 “中国力学虚拟人”相关研究，构建了“人体骨肌系统生物力学－生物摩擦学－骨外科植入物工程设计”理论体系，建立我国标准人体骨肌系统力学模型与仿真工具，开发了CMVHuman “中国力学虚拟人”大型软件并建立国际力学虚拟人网站； 2. 王成焘教授开创性地在人工关节摩擦学、生物力学、结构设计等领域开展了大量的研究工作,致力于将计算机技术与骨外科临床相结合，开展个性化人工关节设计制造与临床应用方面的研究，达到国际先进水平，使一批特殊患者恢复了健康。相关科研成果先后获上海市科技进步一等奖和国家科技进步奖二等奖，均为第一完成人； 3. 王成焘教授首创性地开展临床数字医学技术和骨外科手术导航技术研究，开发出支持我国医生自主创新导航手术的技术平台和软硬件系统，从而构成完整的骨外科临床数字技术系统，通过医工合作取得很好的临床效果，为推进我国可持续创新骨科导航产业的建设做出了突出贡献 王成焘教授此次主要讲授了他的研究团队在和医院联合，在手术导航方面做的研究和实践，内容丰富，启迪思维。王教授的两位博士，陈晓军博士 也是后起之秀，在相关领域做了很多有意义的探索和实践。 第三位演讲专家是：上海九院骨科 膝关节外科专家 王友 教授 王友，男，骨关节组主任医师，教授。上海交通大学医学院附属九院骨科副主任、Stryker关节镜培训中心副主任，上海交大医学院附属九院临床医学院医学英语教研室副主任。1985年毕业于上海第二医科大学医疗系，1997年获医学博士学位。1993年赴韩国汉城庆熙大学医疗中心骨科进修，1998年赴法国鲁昂大学医疗中心膝关节外科与运动医学研究所进修，2002年至2004年多次赴美国、澳大利亚、英国、德国等关节外科医疗中心访问学习。在膝关节疾病、肩膝关节运动损伤的诊断、治疗方面有较深入研究。 目前兼任中华医学会骨科分会《关节镜学组》委员、中华医学会运动医疗分会委员、中华医学会运动医疗分会《下肢创伤学组》委员、中国康复医学会《人工关节学组》委员、上海生物医学工程假体工程专业委员会委员、上海医学会骨科专业委员会委员、上海医学会运动医学专业委员会副主任委员、上海医学会骨科分会《关节镜学组》副组长、上海医学会骨科分会《人工关节学组》委员、上海康复医学工程研究会常委兼秘书长。同时，为《中华创伤杂志-英文版》编委、《骨与关节损伤杂志》编委、《中国骨与关节杂志》编委、《国际骨科学杂志》编委、《中华外科杂志》和《中华骨科杂志》通讯编委。 王友教授主要全面讲述了膝关节置换手术的计算机导航技术应用，演讲生动形象，深入浅出，指出了很多问题的要害，有膝关节名家风范。 俞超医师、李惠武医师、王金武医师还分别做了精彩演讲。 周日下午，在复旦大学医学院解剖教研室5楼，我们学员们在王友教授指导下在新鲜尸体上进行了膝关节置换的导航辅助下的膝关节置换手术。大家积极参与，找手感，感觉收获很大。 感谢上海九院骨科王友教授举办的这次髋膝关节置换导航技术学习班与工作坊！ 高绪仁：每天以解决膝关节问题为乐：）每天为我的膝关节事业添砖加瓦:) 江苏省徐州医学院附属医院骨科 膝关节医师 高绪仁
西班牙 Escalante Y 等于 2010 年 1 月的 J Back Musculoskelet Rehabil （腰背及肌肉骨骼康复）杂志上撰文，回顾了体育锻练与成人下肢骨性关节炎疼痛缓解。 文中称： 骨性关节炎是一种退变性关节疾病。 膝关节和髋关节最容易发生骨性关节炎。 治疗方法主要分为 3 类：药物疗法、非药物疗法、手术疗法。 这三类疗法可以单独使用，也可以联合使用。 在过去的几年间，在非药物疗法中，人们发现体育锻练可能减轻膝关节和髋关节得疼痛。 本系统回顾的目的就是总结在减轻膝关节疼痛和髋关节疼痛中体育锻练有效性的证据及体育锻练的具体方案。 本文主要结论如下： 1 、虽然说体育锻练被推荐应用于减轻膝关节骨性关节炎及髋关节骨性关节炎患者的疼痛，但是还几乎没有谁进行过随机的临床研究。 2 、各种体育锻练方案（具体内容、持续时间、频率、间隔时间）差异很大。 3 、总的来说，基于太极的体育锻练比其它混合型的体育锻练项目有更好的效果，但是还没有发现有明显的差异性。 J Back Musculoskelet Rehabil. 2010 Jan 1;23(4):175-86. Physical exercise and reduction of pain in adults with lower limb osteoarthritis: A systematic review. Escalante Y , Saavedra JM , Garca-Hermoso A , Silva AJ , Barbosa TM . Facultad de Ciencias del Deporte, AFIDES Research Group, Universidad de Extremadura, Spain. 启发：膝关节骨性关节炎患者膝关节疼痛。如何进行体育锻练从而缓解膝关节疼痛呢？太极拳也许可以帮助我们的膝关节骨性关节炎患者减轻疼痛。但是疗效是否确切？适合哪一类人群？锻练的时间长短？锻练的间隔时间长短？这些都是我们今后需要进一步观察和研究的问题。 江苏省徐州医学院附属医院骨科 膝关节方向 高绪仁 编译
标签: 髋关节
