【摘要】 目的 在张英泽院士“不均匀沉降理论”与“保膝阶梯化治疗”理念指导下,描述膝骨关节炎(knee osteoarthritis,KOA)住院患者不同治疗阶梯构成及年度变化趋势,并分析人群特征与治疗阶梯选择的关联。方法 回顾性纳入2018年1月1日至2024年12月31日新疆医科大学附属中医医院骨科住院病案首页中符合标准的KOA患者。提取民族、性别、年龄、出院日期、住院天数、诊断及手术操作。按“严格落在保膝”口径分层:保守治疗、关节腔注射(属保守治疗但单列)、关节镜手术(本研究口径归入非保膝手术)、保膝手术(截骨类:胫骨高位截骨术/股骨截骨/腓骨楔形截骨,含联合关节镜)、置换手术[膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)或全膝关节置换术(total knee arthroplasty,TKA)]。计量资料采用Kruskal-Wallis H检验,计数资料采用Pearsonχ~2检验。结果 共纳入20 702例,女性占78.29%,平均年龄(61.52±9.93)岁,双侧KOA占86.17%。总体治疗构成:保守治疗49.82%,关节腔注射29.27%,置换手术17.08%,关节镜手术2.79%,保膝手术1.04%;保守治疗与关节腔注射合计79.09%。关节腔注射比例自2019年起明显上升(15.02%升至2024年38.83%);置换比例在12.88%～19.39%间波动;保膝手术比例总体较低,2020-2022年阶段性升高后于2023-2024年回落。不同治疗阶梯间年龄分布差异有统计学意义(H=1716.18,df=4,P<0.001),住院天数分布差异有统计学意义(H=623.05,df=4,P<0.001);性别、侧别及民族分组与治疗阶梯选择相关(χ~2=67.83、783.72、1454.55,P<0.001)。结论 真实世界住院KOA患者治疗仍以保守/注射阶梯为主,但力线重建导向的保膝手术占比偏低且存在年度波动。基于“不均匀沉降理论”,应进一步推动“保膝前移、置换后移”的阶梯化策略,强化力线评估与保膝手术规范化可及性,以延缓疾病进展并最大程度保留膝关节功能与本体感觉。更多还原

【Abstract】 Objective To characterize real-world inpatient treatment patterns of knee osteoarthritis (KOA)under the framework of academician Yingze Zhang’s “uneven settlement theory” and stepwise knee-preserving management,and to examine associations between patient characteristics and treatment tiers.Methods We retrospectively screened inpatient discharge front-page records from the Department of Orthopaedics,Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University,from January 1,2018 to December 31,2024.Inclusion criteria were:age ≥ 40 years,length of stay 5-50 days,and diagnosis of unilateral or bilateral KOA.Extracted variables included ethnicity,sex,age,discharge date,length of stay,diagnosis,and “procedures / operations”.Treatments were tiered with a strict knee-preservation definition into:(1) conservative management;(2) intra-articular injection (a component of conservative care,analyzed separately);(3) arthroscopic procedures (non-knee-preserving in this study);(4) knee-preserving osteotomy (HTO / femoral osteotomy / fibular wedge osteotomy,including combined arthroscopy);and (5) arthroplasty (UKA / TKA).Kruskal-Wallis tests were used for continuous variables and χ~2 tests for categorical variables.Results A total of 20,702 patients were included;78.29% were female.Mean age was (61.52±9.93) years,and 86.17% had bilateral KOA.Overall distribution was:conservative management 49.82%,intra-articular injection 29.27%,arthroplasty 17.08%,arthroscopy 2.79%,andknee-preserving osteotomy 1.04%;conservative management plus injection accounted for 79.09%.Among arthroplasties,TKA comprised 54.95% and UKA 45.05%.In the osteotomy tier,osteotomy combined with arthroscopy accounted for 80.00%.Over time,intra-articular injection increased markedly (15.02% in 2019 to 38.83% in 2024),arthroplasty fluctuated between 12.88% and 19.39%,and osteotomy remained low with a transient rise in 2020-2022(2.82%,2.00%,2.61%) followed by a decline in 2023-2024 (0.29%,0.34%).Age and length of stay differed significantly across tiers (H=1716.18,df=4,P < 0.001 for age;H=623.05,df=4,P < 0.001 for length of stay).Sex,laterality (unilateral / bilateral),and ethnicity were associated with treatment tiers (χ~2=67.83,783.72,and 1454.55,all P < 0.001).Conclusions In real-world inpatient KOA care,conservative and injection-based approaches predominate,whereas alignment-restoring knee-preserving osteotomy remains underutilized and variable over time.Guided by the uneven settlement theory,advancing knee-preserving,alignment-restoring interventions and postponing arthroplasty may help maximize preservation of knee joint function and proprioception and delay disease progression.更多还原