Knee osteoarthritis is a common chronic arthritis disease in knee surgery, more than 50% of outpatient knee pain patients are osteoarthritis, the weather is getting colder, and there are more patients who suffer from knee pain. In this issue of the big coffee health class, Yangtze Evening News invited Qin Jian, director of the Department of Orthopedics of Yifu Hospital Affiliated to Nanjing Medical University, to give you a detailed introduction to the "knowledge points" of knee osteoarthritis conservation and surgical treatment.
Correspondent Nie Jing
Yangzi Evening News/Purple Cow News reporter Yang Yan
Filmed by Yang Zehua
Big coffee and small biography
Qin Jian
Director of the Department of Orthopedics, Chief Physician, Doctor of Medicine, Master Supervisor of Shaw Hospital Affiliated to Nanjing Medical University, engaged in clinical medical work for more than 20 years, the research direction is the clinical research of artificial joint replacement and sports medicine, and has received professional technical training in artificial joint replacement at the Queen Mary Hospital of the University of Hong Kong and the Affiliated Hospital of Oregon Health and Science University in the United States, and has been committed to the clinical diagnosis and treatment of osteoarticular diseases. He is currently a member of the Joint Surgery Group of the National Association of Integrative Traditional Chinese and Western Medicine, a director of the Rheumatology Professional Committee of the Chinese Rehabilitation Medicine Association, and a member of the Standing Committee of the Orthopedic Branch of the Guangzhou Medical Doctor Association.
Good at sports medicine arthroscopic minimally invasive surgery and various types of artificial joint replacement surgery, in the meniscal, ligament injuries have accumulated a wealth of clinical experience, for the elderly patients in the diagnosis and treatment of joint bone disease has a deep achievement, especially for ankylosing spondylitis and rheumatoid arthritis patients with high difficult joint replacement has a high success rate, advocate and can achieve early rapid functional recovery, and can complete the shoulder, elbow, wrist, ankle and other small joints of minimally invasive microscopic treatment, is the earliest in China to carry out "articular bone disease painless, no incision, One of the surgeons of the concept of "no blood transfusion treatment".
The initial use of "painkillers" can work for a long time
The clinical manifestations of osteoarthritis of the knee joint are often manifested as pain, swelling, dysfunction, etc., and when the disease develops, the patient may be painful when walking on the flat ground, and the knee joint will also be deformed. Lifestyle changes and exercise styles are generally recommended early in the onset of pain, and if the patient still feels moderate pain after a lifestyle intervention, medication is required, and patients are usually advised to take oral NSAIDs.
Some patients are afraid when they hear "painkillers" and "anti-inflammatory drugs", and always feel that "it is a three-point poison of medicine", preferring to paste plasters rather than oral drugs, Director Qin Jian said that this is definitely a misunderstanding. The "power" of the plaster can only achieve the epidermis, which is not deep into the joint cavity, and has no therapeutic effect on osteoarthritis. The oral "anti-inflammatory drugs" of osteoarthritis patients are not the same as antibiotics, which eliminate physical inflammation and are not short-term effective analgesics. Qin Jian said that by blocking the source of inflammation, many patients can get long-term relief, and even after stopping the drug, they may no longer have pain for months or even years. Therefore, for patients with knee osteoarthritis in the early stage, it is a pity to take medicine when it is time to take medicine, and it is a pity to miss the "window period" of drug treatment.
Stem cell therapy will be the "ceiling" of conservative treatment
When the disease develops to the middle stage, taking medicine does not work, you can consider injection treatment, that is, everyone's "injection", "injection" has also experienced several drug changes. "The initial injection is a blockade, that is, the hormone drug is injected into the joint cavity, and the pain disappears immediately after a needle, and it can also be relieved for a period of time, but the disadvantage is that it cannot be used repeatedly." Director Qin Jian, later common injection methods are also injection of sodium hyaluronate, sodium hyaluronate is equivalent to the lubricant of the joint, but clinically verified, this method is only more effective for patients in the early and middle stages. Another kind of "injection" that patients are very interested in is to centrifuge from the blood, precipitate and isolate growth factors, beat back into the knee joint to repair cartilage, control inflammation, this method is very popular but there is a certain controversy, some patients are not ideal, may be related to the individual patient and the stage of the disease, need doctors to grasp the indications.
Director Qin Jian told the Yangtze Evening News/Purple Cow News reporter that the means of updating is to repair joints through stem cells, but this method is still in clinical research. Stem cells are a kind of universal cells, after the stem cells extracted by the human body are expanded, after injection into the joint cavity, they can be "targeted" into chondrostocytes for repair, which will improve the repair to the cellular level, which is a "living" drug. Because cells are active, theoretically the effect will be more significant and long-lasting. If this technology can be widely applied to the clinic in the future, it will become a "ceiling" for conservative treatment.
Joint replacement is like wearing "braces" on a joint
When the condition is more severe and conservative treatment does not work, the patient needs to undergo surgery. Minimally invasive surgery is to drill the arthroscope deep into the joint cavity, rinse with a large amount of normal saline, and remove the worn "debris", which is equivalent to doing a "cleaning" of the room of the joint cavity. However, if there is a large amount of damage in the joint cavity, structural damage has occurred, there is no way to repair it through minimally invasive surgery, and the ultimate solution is artificial joint replacement.
Many patients feel quite scary when they hear about joint replacement, thinking that they have to break the bone and reattach it, in fact, artificial joint replacement is not so rough. "Just like the surface of the tooth is worn, we give another braces, but the root of the tooth is still retained, the joint replacement does not move to the bone, it is to remove the surface of the joint that has been worn out, and then wrap an artificial metal shell, just like putting a brace on the bad tooth, the operation can be completed in more than an hour."
Joint replacement includes the replacement of all joints, and there are also the replacement of damaged parts. After the replacement of the artificial joint can complete 90% of the original joint function, the rehabilitation period is about two months, after two months the patient can completely live on their own, from walking the flat road slowly transition to climbing stairs, etc., usually half a year later and normal people are no different, many foreign patients who have changed joints, but also climbing, running marathons. Replacement of artificial joints will also face weight and wear, but generally use 15-20 years without problems, many patients actually use, are more than this age.
The joints are not good, don't dance square dance and tai chi for a long time
Director Qin Jian told reporters that in the past, the age of onset of osteoarthritis was more than 70 or 80 years old, but now the trend of rejuvenation is obvious, and the cumulative strain caused by long-term heavy physical labor, the history of knee soft tissue injury, endocrine and metabolic abnormalities, knee varus (O-type legs) caused by genetic factors, overweight, etc., will increase the incidence of knee osteoarthritis.
In addition, it should be noted that improper exercise will also increase the condition of osteoarthritis of the knee joint. For example, many people now like to dance square dance to exercise, often more than one or two hours of dance, which means that the joint continuous use time is too long, especially on the harder cement floor to dance square dance, the pressure on the knee will be greater. Tai Chi, Baduanjin, etc., which look "soothing", actually have a lot of knee bending movements, if the knee joint itself is not good, do not practice tai chi during the attack period, so as not to aggravate the disease.
Clinically, many patients will ask whether they can eat a little health care products that protect joints, such as calcium tablets, chondroitin, "ammonia sugar", etc., and many bone and joint health products have become a hot spot for overseas purchasing. Director Qin Jian said that calcium tablets treat osteoporosis and have nothing to do with osteoarthritis, so eating calcium tablets alone cannot "save" the joints. The so-called glucosamine, chondroitin, etc., can be eaten, for patients in the early stage of osteoarthritis will have a certain effect, but after the development of the disease, these oral health products will certainly be ineffective, patients still have to go to the hospital to clarify the condition, according to the condition to choose the most appropriate treatment.
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