目的

探讨膝关节骨关节炎（KOA）患者行关节镜治疗后配合冲击波（ESW）干预对患者血清肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）的影响及两者与患者膝关节功能的关系。

方法

纳入标准：Kellgren-Lawrence分级为Ⅰ、Ⅱ级；单侧发病；近1个月内膝痛反复发作；排除标准：合并骨质疏松症者；有关节镜禁忌证者；有严重膝关节内外翻畸形者；下肢肌力不足V级者。采取前瞻性研究，选择2022年6月至2023年6月成都市第二人民医院康复医学科收治的110例KOA患者作为研究对象，按随机数字表法分为两组，各55例。对照组采取关节镜治疗配合常规干预，观察组在对照组基础上联合ESW干预，均治疗5周；干预后随访24周。比较两组不同时点（干预前、干预12周、干预24周）膝关节恢复情况，包括视觉模拟评分（VAS）、膝关节功能评分（Lysholm评分）、膝关节活动范围（ROM）；干预前、干预24周时炎症水平（TNF-α、IL-1β）；采用双变量 相关性Pearson分析膝关节OA患者血清TNF-α、IL-1β水平与膝关节恢复的关系。

结果

治疗12周、24周时，两组VAS评分低于干预前，呈下降趋势，观察组低于对照组，Lysholm评分、ROM高于干预前，呈上升趋势，观察组高于对照组，两组时点、组间及交叉比较（VAS F=5.711、932.505、3.672，Lysholm评分F=64.898、664.241、20.591，ROM F=400.230、1026.558、77.387，均为P＜0.05）；干预后，两组TNF-α、LI-1β低于干预前，观察组低于对照组（t=11.212、5.065，P＜0.05）；采用双变量相关性Pearson分析结果显示，膝关节OA患者血清TNF-α、IL-1β水平与VAS水平呈正相关（r=0.356、0.205，均为P＜0.05），与Lysholm评分、ROM呈负相关（TNF-α r=-0.429、-0.574， IL-1β r=-0.339、-0.369，均为P＜0.05）。

结论

KOA患者行关节镜干预后配合ESW干预能够有效缓解患者膝关节疼痛，提高膝关节活动范围，提升膝关节功能，降低机体炎症反应，且血清TNF-α、IL-1β水平与膝关节功能相关。

Objective

To investigate the effect of shock wave （ESW） intervention on serum tumor necrosis factor-α （TNF-α） and interleukin-1β （IL-1β） in patients with knee osteoarthritis （KOA） after arthroscopic treatment and their relationship with knee joint function.

Methods

A prospective study was conducted according to the inclusion criteria ： Kellgren-Lawrence grade I and II ； unilateral onset ； knee pain recurred in the past one month. Exclusion criteria ： osteoporosis ； arthroscopic contraindications ； severe knee varus and valgus deformity. A total of 110 patients with KOA admitted to Department of Rehabilitation Medicine，Chengdu Second People’s Hospital from June 2022 to June 2023 were selected as the research objects. They were divided into two groups according to the random number table method， 55 cases in each group. The control group was treated with arthroscopy combined with routine intervention， and the observation group was treated with ESW intervention on the basis of the cont rol group for five weeks. The patients were followed up for 24 weeks after intervention. The recovery of knee joint at different time points ［visual analogue scale （VAS）， knee joint function score （Lysholm）， knee joint range of motion （ROM）］was compared between the two groups. The levels of inflammation （TNF-α， IL -1β） were measured before and 24 weeks after intervention. The relationship between serum TNF-α， IL -1β levels and knee joint recovery in patients with KOA was analyzed by bivariate correlation Pearson.

Results

At 12 weeks and 24 weeks of treatment， the VAS scores of the two groups were lower than those before the intervention and showed a downward trend. The observation group was lower than the control group. The Lysholm score and ROM were higher than those before the intervention and showed an upward trend. The observation group was higher than the control group. The time points， groups and crosscomparisons between the two groups （VAS F=5.711， 932.505， 3.672； Lysholm score F=64.898， 664.241，20.591； ROM F=400.230， 1026.558， 77.387； all P＜0.05）. After intervention， TNF-α， IL-1β in the two groups were lower than those before intervention， and those in the observation group were lower than those in the control group （t=11.212，5.065， both P＜0.05）. The results of bivariate correlation Pearson analysis showed that the serum levels of TNF-α and IL-1β in patients with KOA were positively correlated with VAS level（r =0.356， 0.205， both P＜0.05）， and negatively correlated with Lysholm score and ROM （TNF-α r=-0.429，-0.574； IL-1β r=-0.339， -0.369； both P＜0.05）.

Conclusions

Arthroscopic intervention combined with ESW intervention in KOA patients can effectively relieve knee joint pain， improve knee joint range of motion，improve knee joint function， and reduce the body’s inflammatory response. Serum TNF-α and IL-1β levels are related to knee joint function.