医学论坛网|对付“磨人”的膝骨关节炎，看看这个“新攻略”( 三 )
·一旦出现明确的胫股关节双侧骨髁膝骨关节炎或严重膝关节不稳 ， 禁忌使用支具；其中 ， 內侧髁膝骨关节炎患者若存在内侧副韧带及其他内侧或前内侧结构损伤 ， 或慢性病变导致的松弛 ， 不建议使用外翻支具；同理 ， 外侧髁膝骨关节炎患者若存在外侧副韧带及其他外侧或后外侧结构损伤 ， 或慢性病变导致松弛的 ， 不建议使用内翻支具 。
·髌股关节受累不应被视为禁忌证 。
让我们抓住每一次可能改变结局的机会吧！
参考文献：（可上下滑动查看）
[1]中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南（2018年版）[J].中华骨科杂志. 2018 ， 38（12）：705-715. DOI:10.3760/cma.j.issn.0253-2352.2018.12.001
[2]Guccione AA, Felson DT, Anderson JJ,et al. The effects of specific medicalconditions on the functionallimitations of elders in the Framingham study.Am J Public Health. 1994, 84:351-358.
[3]Cross M, Smith E, Hoy D, et al. Theglobal burden of hip and knee osteoarthritis: estimates from the global burdenof disease 2010 study. Ann Rheum Dis. 2014, 73(7): 1323-1330.
[4]Tang X, Wan SF, Zhan SY, et al. Theprevalence of symptomatic knee osteoarthritis in China results from the Chinahealth and retirement longitudinal study[J]. Arthritis Rheumatol, 2016, 68930:648-653.
[5]Huibin Long, Xinying Zeng, Qiang Liu, etal.Burden of osteoarthritis in China, 1990-2017: findings from the GlobalBurden of Disease Study 2017. Lancet Rheum, 2020, 2(3), e164-e172.
[6]中华医学会骨科分会关节外科学组,吴阶平医学基金会骨科学专家委员会. 膝骨关节炎阶梯治疗专家共识（2018年版）. 中华关节外科杂志（电子版）, 2019, 13(1) : 124-130.DOI: 10.3877/cma.j.issn.1674-134X.2019.01.024
[7]Thorstensson CA, Garelick G, Rystedt H, et al. Bettermanagement of patients with osteoarthritis: development and nationwideimplementation of an evidence-based supported osteoarthritis self-ManagementProgramme[J/OL]. Musculoskeletal Care, 2015, 13(2): 67-75. Doi:10.1002/msc.1085.
[8]Brand E, Nyland J, Henzman C, et al. Arthritis self-efficacyscale scores in knee osteoarthritis: a systematic review and meta-analysiscomparing arthritis self-management education with or without exercise[J/OL]. JOrthop Sprots Phys Ther, 2013, 43(12): 895-910. Doi: 10.2519/jospt. 2.13.4471.
[9] KM Jordan, N K Arden, M Doherty, et al. EULAR Recommendations2003: an evidence based approach to the management of knee osteoarthritis:Report of a Task Force of the Standing Committee for International ClinicalStudies Including Therapeutic Trials (ESCISIT) [J]. Annals of the RheumaticDiseases, 2003, 62:1145-1155.
[10]ConaghanP. G, DicksonJ, Grant R. L, et al. Careand management of osteoarthritis in adults: summary of NICE guidance.BMJ 2008,336:502-503.
[11] T.E. McAlidon,R.R. Bannuru, M.C. Sullivan, et al. OARSI guidelines for the non-surgicalmanagement of knee osteoarthritis. Osteoarthritis and Cartilage. 2014, 22(3):363-388.
[12] Emmanuel C,Christelle N, Aurore C, et al . A decision-making tool prescribe knee orthosesin daily practice for patient with osteoarthritis. Ann Phys Rehabil Med[J].2018, 61: 92-98.
[13] BrouwerGM, van Tol AW, Jones A, et al. Associationbetween valgus and varus alignmengt and the development andprogression of radiographic osteoarthritis ofthe knee[J]. Arthritis Rheum, 2007, 56(4): 1204-1211.
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