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中华老年骨科与康复电子杂志 ›› 2020, Vol. 06 ›› Issue (04) : 243 -247. doi: 10.3877/cma.j.issn.2096-0263.2020.04.010

所属专题: 文献

综述

中枢敏化及其对膝关节骨关节炎临床治疗的影响
郑义1, 康凯1, 王智杰1, 王娟1,()   
  1. 1. 050051 石家庄,河北医科大学第三医院关节二科
  • 收稿日期:2020-03-15 出版日期:2020-08-05
  • 通信作者: 王娟
  • 基金资助:
    中国医学科学院中央级公益性科研院所基本科研业务费专项资金资助(2019PT320001); 国家自然科学基金委(91949203)

Central sensitization and its effect on the clinical treatment of knee osteoarthritis

Yi Zheng1, Kai Kang1, Zhijie Wang1, Juan Wang1,()   

  1. 1. The Second Department of Arthrosis, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
  • Received:2020-03-15 Published:2020-08-05
  • Corresponding author: Juan Wang
引用本文:

郑义, 康凯, 王智杰, 王娟. 中枢敏化及其对膝关节骨关节炎临床治疗的影响[J]. 中华老年骨科与康复电子杂志, 2020, 06(04): 243-247.

Yi Zheng, Kai Kang, Zhijie Wang, Juan Wang. Central sensitization and its effect on the clinical treatment of knee osteoarthritis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2020, 06(04): 243-247.

骨关节炎的疼痛可触发外周痛觉感受器,并在中枢神经系统内进行调节,导致中枢敏化。中枢敏化是膝关节骨关节炎慢性疼痛的一个重要机制。降低中枢痛觉敏化可有效缓解膝关节骨关节炎及全膝关节置换术后的疼痛,减少阿片类药物用量,改善患者预后。本文就中枢敏化的概念、形成机制、临床特点和评估及药物治疗等方面进行综述,以期提高临床医生对中枢敏化的认识和重视,从而给予患者有效治疗。

Osteoarthritis pain triggers peripheral nociceptors and regulates them in the central nervous system, leading to central sensitization, an important mechanism for chronic pain in knee osteoarthritis. Lowering central pain sensitization can effectively alleviate pain caused by knee osteoarthritis and total knee arthroplasty, thus reducing the usage of opioids and improving patient prognosis. This article reviews the concepts of central sensitization, its formation mechanism, clinical characteristics, evaluation, and drug treatment, with a view to improving clinicians' awareness and emphasis on central sensitization, which will result in more effective treatment.

图1 CSS常见的病理生理机制是中枢致敏。目前CSS家族的常见的成员有纤维肌痛、紧张性头痛、肠易激综合征、肌筋膜疼痛综合征、女性尿道综合征、创伤后应激综合征
图3 中枢敏化。随着在躯体感觉通路中诱导中枢敏化并增强突触效能减少抑制作用,中枢放大作用会增强对有害刺激的振幅,持续时间和空间范围的疼痛反应,而通常无效的突触增强会增加潜意识的输入,低阈值感官输入现在可以激活疼痛通路。两条平行的感觉通路汇合在一起
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