退化性膝關節炎再生醫學治療及醫病共享決策之應用

Applications of Shared Decision Making for Regenerative Treatment of Knee Osteoarthritis

關於退化性膝關節炎的治療，隨不同等級退化程度而有不同治療方式。第一線治療方式如訓練股四頭肌等復健之外，非類固醇類止痛藥、關節內玻尿酸注射、關節內血小板濃縮液注射等也屬非手術治療方式之一。手術治療如高位脛骨截骨術、單腔室膝關節置換術、全關節置換術則為手術治療選項。自體間質幹細胞（mesenchymal stem cells, MSCS）則在近年來特管辦法修正通過後，開始應用於治療退化性膝關節炎。財團法人醫院評鑑暨醫療品質策進會多年來推動醫病共享決策（shared decision making, SDM）藉由醫病溝通及決策輔助工具（patient decision aid, PDA）可以幫助退化性膝關節炎病人做出合適的醫療決定，並降低病人焦慮程度，未來將持續把再生醫學治療選項透過醫病共享決策模式應用於適合病人。

According to the severity of osteoarthritis (OA) of knee, there are different treatment choices. The first line treatments are lifestyle modification, physical therapy, and pharmacological treatments. The non-surgical treatments also include intra-articular hyaluronic acid and platelet-rich plasma (PRP) injection. The surgical treatments for higher grade OA of knee include high tibial osteotomy (HTO), uni-compartment knee arthroplasty and total knee arthroplasty. Furthermore, autologous mesenchymal stem cells (MSCs) have been approved recently for the treatment of the OA knee in Taiwan. Shared Decision Making (SDM) was advocated by Joint Commission of Taiwan (JCT) for many years. Through SDM and patient decision aid (PDA), patients could make their preferred decisions when facing OA knee as well as to decrease the concerns and anxiety of patients. SDM and PDA can be applied in choosing regenerative medicine treatments of proper patient with OA knee in the future.