切换至 "中华医学电子期刊资源库"

中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 665 -671. doi: 10.3877/cma.j.issn.1674-134X.2019.06.003

所属专题: 文献

临床论著

体外冲击波联合关节镜治疗膝骨关节炎的临床研究
李宏宇1,(), 席立成1, 黄思城1, 韦明照1, 王宏润1, 田文1   
  1. 1. 530021 南宁,广西壮族自治区人民医院骨科
  • 收稿日期:2018-12-14 出版日期:2019-12-01
  • 通信作者: 李宏宇
  • 基金资助:
    2015年度广西科学研究与技术开发计划(桂科攻1598012-10)

Clinical efficacy of extracorporeal shock wave combined with arthroscopy for treatment of knee osteoarthritis

Hongyu Li1,(), Licheng Xi1, Sicheng Huang1, Mingzhao Wei1, Hongrun Wang1, Wen Tian1   

  1. 1. Department of Orthopedics, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
  • Received:2018-12-14 Published:2019-12-01
  • Corresponding author: Hongyu Li
  • About author:
    Corresponding author: Li Hongyu, Email:
引用本文:

李宏宇, 席立成, 黄思城, 韦明照, 王宏润, 田文. 体外冲击波联合关节镜治疗膝骨关节炎的临床研究[J/OL]. 中华关节外科杂志(电子版), 2019, 13(06): 665-671.

Hongyu Li, Licheng Xi, Sicheng Huang, Mingzhao Wei, Hongrun Wang, Wen Tian. Clinical efficacy of extracorporeal shock wave combined with arthroscopy for treatment of knee osteoarthritis[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(06): 665-671.

目的

观察体外冲击波联合关节镜手术治疗早中期膝关节骨关节炎的临床疗效,以及对关节液中单核细胞趋化蛋白-1(MCP-1)、超氧化物歧化酶(SOD)和一氧化氮(NO)水平的影响。

方法

根据随机对照原则,严格按照本研究的纳入标准(K-L分期属于Ⅱ、Ⅲ级,能耐受麻醉、关节镜手术及体外冲击波治疗(ESWT)与排除标准关节感染、活动性关节结核、类风湿性关节炎或局部有伤口;严重膝关节畸形、严重骨质疏松),选取2013年02月至2016年12月于广西壮族自治区人民医院就诊的膝关节骨关节炎(KOA)患者285例分为3组,体外冲击波联合关节镜手术治疗组、单纯体外冲击波治疗组、单纯关节镜手术治疗组。分别在治疗前及治疗后3个月、6个月、12个月行Lysholm膝关节功能评分(Lysholm评分)和疼痛视觉模拟评分(VAS评分),并检测患者关节液中MCP-1、SOD和NO的水平。计量资料采用重复测量资料的方差分析,多均数两两比较采用SNK-q检验,计数资料比较采用卡方检验。

结果

治疗后3个月时:3组VAS评分及Lysholm评分均显著优于治疗前,联合组评分优于冲击波、关节镜治疗组(q1=4.091,q2=5.562,P<0.05)。3组治疗后6个月时联合组及关节镜组评分仍优于治疗前,联合组评分明显优于其他两组(q1=6.194,q2=6.064,P<0.05),冲击波组与治疗前比较,差异无统计学意义(P>0.05)。治疗后12个月时,联合组评分仍优于治疗前,冲击波及关节镜组评分与治疗前比较,差异无统计学意义(P>0.05);联合组VAS评分及Lysholm评分明显优于其他两组,冲击波组与关节镜组比较,差异无统计学意义(P>0.05)。治疗后3个月,3组MCP-1和NO水平均明显低于治疗前,SOD高于治疗前,联合组各水平与冲击波及关节镜组比较,差异有统计学意义(q1=4.065,q2=5.046,q3=5.556, P<0.05)。治疗后6个月,3组MCP-1和NO水平较治疗后3个月升高,SOD较治疗后3个月降低,联合组MCP-1和NO水平明显低于冲击波及关节镜组,SOD水平高于冲击波及关节镜组(q1 =4.929,q2 =6.284,q3=5.061,P<0.05),关节镜组MCP-1和NO水平与治疗前比较,差异无统计学意义(P>0.05)。治疗后12个月,联合组MCP-1和NO水平仍低于治疗前,SOD水平高于治疗前,冲击波及关节镜组与治疗前比较,差异无统计学意义(P>0.05);联合组MCP-1和NO水平低于冲击波及关节镜组,SOD水平高于冲击波及关节镜组,冲击波及关节镜组两组间MCP-1、NO和SOD水平比较,差异无统计学意义(P>0.05)。

结论

体外冲击波联合关节镜手术能有效缓解膝关节骨关节炎关节疼痛症状,改善关节功能,有效降低关节液中炎性介质MCP-1和NO水平,提高SOD水平,其近期和远期疗效均显著优于单纯应用体外冲击波或关节镜手术治疗。

Objective

To observe the clinical effect of extracorporeal shock wave combined with arthroscopy in the treatment of osteoarthritis of knee joint in early and middle stage, and to observe the effect of extracorporeal shock wave combined with arthroscopy on the levels of monocyte chemoattractant protein-1 (MCP-1), superoxide dismutase (SOD) and nitric oxide (NO) in articular fluid.

Methods

According to the principle of random control, 285 patients with knee osteoarthritis were divided into three groups: extracorporeal shock wave combined with arthroscopic surgery group (combining group), extracorporeal shock wave group (shock wave group) and arthroscopic surgery group (arthroscopic group). Lysholm score and visual analogue scale (VAS) score were measured before treatment and three, six, 24 months after the treatment. The levels of MCP-1, SOD and NO in articular fluid of the groups were measured. The scores of Lysholm and VAS were statistically analyzed by repetitive measure analysis of variance, SNK-q test or chi-square test.

Results

Three months after the treatment, the Lysholm and VAS scores in the three groups were significantly better than those before treatment, and the scores in the combining group were significantly better than those in the shock wave group and the arthroscopic group (q1=4.091, q2=5.562, P<0.05). The scores of the three groups six months after the treatment compared to the data three months after the treatment showed statistically significant differences. The scores of the combining group and shock wave group were still better than before the treatment (q1=6.194, q2=6.064, P<0.05), while the arthroscopic group was not significantly different compared to the scores before treatment (P>0.05). At 12 months after treatment, the scores of Lysholm and VAS in the combining group were still better than those before treatment, and the scores in the combining group were significantly better than the other two groups. There was no significant difference in the score of shock wave and arthroscopy group compared with that before treatment (P>0.05). Three months after treatment, the levels of MCP-1 and NO in the three groups were significantly lower than those before treatment, and SOD was higher than that before treatment. There was significant difference between the combining group and the shock and arthroscopy group (q1=4.065, q2=5.046, q3=5.556, P<0.05). At six months after treatment, the levels of MCP-1 and NO in the three groups were higher than those in three month after treatment, and the levels of SOD in the combining group were significantly lower than those in the shock wave and arthroscopy group, the levels of MCP-1 and NO in the combining group were significantly lower than those in the shock wave and arthroscopy group, and the SOD level was higher than that in the shock wave group and arthroscopy group (q1 =4.929, q2 =6.284, q3=5.061, P<0.05). The levels of MCP-1 and NO in arthroscopy group were not significantly different from those before treatment (P>0.05). Twelve months after treatment, the levels of MCP-1 and NO in the combined group were still lower than those before treatment, the level of SOD was higher than that before treatment, the levels of MCP-1 and NO in the combined group were lower than those in the shock wave and arthroscopy group, and the level of SOD was higher than that of shock wave and arthroscopy. The levels of MCP-1, NO and SOD in shock wave and arthroscopy group were not significantly different from those before treatment (P>0.05).

Conclusions

Extracorporeal shock wave combined with arthroscopy can effectively relieve the joint pain, improve joint function, reduce the levels of inflammatory mediators MCP-1 and NO, and increase the level of SOD in articular fluid. The short-term and long-term results of combining the two methods are better than that of extracorporeal shock wave or arthroscopy alone.

表1 两组一般资料比较
表2 各组VAS评分比较[分,(±s)]
表3 各组Lysholm膝关节评分比较[分,(±s)]
表4 各组MCP-1比较[μg/L,(±s)]
表5 各组SOD比较[μU/L,(±s)]
表6 各组NO比较[μmol/L,(±s)]
[1]
Zhang JF, Song LH, Wei JN, et al. Prevalence of and risk factors for the occurrence of symptomatic osteoarthritis in rural regions of Shanxi Province, China[J]. Int J Rheum Dis, 2014, 19(8): 781-789.
[2]
赵学千,贾育松,孙旗,等.关节镜清理联合术后针刺与鸡尾酒疗法治疗膝骨关节炎[J/CD].中华关节外科杂志(电子版),2018,12(5):681-686
[3]
Zhao BX, Yu YB, Liu WQ, et al. Efficacy of arthroscopic loose body removal for knee osteoarthritis[J]. Exp Ther Med, 2018, 15(2): 1666-1671.
[4]
Teunis T, Beekhuizen M, Van Osch GV, et al. Soluble mediators in posttraumatic wrist and primary knee osteoarthritis[J]. Arch Bone Jt Surg, 2014, 2(3): 146-150.
[5]
Yu L, Liu S, Zhao Z, et al. Extracorporeal shock wave rebuilt subchondral bone in vivo and activated Wnt5a/Ca2+ Signaling In Vitro[J/OL]. Biomed Res Int, 2017:1404650. doi: 10.1155/2017/1404650.
[6]
席立成,李宏宇,赵子星,等.体外冲击波治疗早中期膝关节骨性关节炎效果观察及其机制[J].山东医药杂志,2016,56(48):60-62.
[7]
邱贵兴.骨关节炎诊治指南[J].中华骨科杂志,2007,27(10):793-796.
[8]
张立智,刘兰兰.早期膝骨关节炎的划分[J/CD]. 中华关节外科杂志(电子版),2018,12(5):700-706.
[9]
Trueba Vasavilbaso C, Rosas Bello CD, Medina López E, et al. Benefits of different postoperative treatments in patients undergoing knee arthroscopic debridement[J]. Open Access Rheumatol, 2017, 9:171-179. doi:10.2147/OARRR.S138353.
[10]
熊志宏,熊翔.关节镜下有限清理术结合玻璃酸钠治疗高龄膝骨性关节炎[J].实用医学杂志,2012,28(18):3057-3059.
[11]
Su X, Li C, Liao W, et al. Comparison of arthroscopic and conservative treatments for knee osteoarthritis:a 5-year retrospective comparative study[J]. Arthroscopy, 2018, 34(3): 652-659.
[12]
Zhao Z, Ji H, Jing R, et al. Extracorporeal shock-wave therapy reduces progression of knee osteoarthritis in rabbits by reducing nitric oxide level and chondrocyte apoptosis[J]. Arch Orthop Trauma Surg, 2012, 132(11): 1547-1553.
[13]
黄艺林,刘洪柏,张鸣生.低能量体外冲击波对兔膝骨关节炎软骨细胞修复和重塑能力的影响[J].生物医学工程与临床,2016,20(6):557-561.
[14]
Wang CJ, Sun YC, Wong T, et al. Extracorporeal shockwave therapy shows time-dependent chondroprotective effects in osteoarthritis of the knee in rats[J]. J Surg Res, 2012, 178(1): 196-205.
[15]
Kawcak CE, Frisbie DD, Mcllwraith CW. Effects of extracorporeal shock wave therapy and polysulfated glycosaminoglycan treatment on subchondral bone, serum biomarkers, and synovial fluid biomarkers in horses with induced osteoarthritis[J]. Am J Vet Res, 2011, 72(6): 772-779.
[16]
Gollwitzer H, Saxena A, Didomenico LA, et al. Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study[J]. J Bone Joint Surg Am, 2015, 97(9): 701-708.
[17]
Lyon R, Liu XC, Kubin M, et al. Does extracorporeal shock wave therapy enhance healing of osteochondritis dissecans of the rabbit knee? A pilot study[J]. Clin Orthop Relat Res, 2013, 471(4): 1159-1165.
[18]
El Mansouri FE, Chabane N, Zayed N, et al. Contribution of H3K4 methylation by SET-1A to interleukin-1-induced cyclooxygenase 2 and inducible nitric oxide synthase expression in human osteoarthritis chondrocytes[J]. Arthritis Rheum, 2011, 63(1): 168-179.
[19]
Tao R, Wang S, Xia X, et al. Pyrroloquinoline quinone slows down the progression of osteoarthritis by inhibiting nitric oxide production and metalloproteinase synthesis[J]. Inflammation, 2015, 38(4): 1546-1555.
[20]
Wu M, Feng K, Li Q, et al. Glutaraldehyde-polymerized hemoglobin and tempol(polyHb-tempol)has superoxide dismutase activity that can attenuate oxidative stress on endothelial cells induced by superoxide anion[J]. Artif Cells Nanomed Biotechnol, 2018, 46(1): 47-55.
[21]
Morrison NA, Day CJ, Nicholson GC. Dominant negative MCP-1 blocks human osteoclast differentiation [J]. J Cell Biochem, 2014, 115(2): 303-312.
[1] 纪小孟, 刘璠, 唐晓波, 卞为伟, 董佩龙, 刘振鲁. 两种手术方式治疗肩袖撕裂合并粘连性肩关节囊炎[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 561-567.
[2] 许银峰, 盛璞义, 余世明, 张阳春. 偏心性髋臼旋转截骨术治疗发育性髋关节发育不良[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 568-574.
[3] 马桥桥, 张传开, 郭开今, 蒋涛, 王子豪, 刘勇, 郝亮. 可降解止血粉减少初次全膝关节置换术失血量的研究[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 585-589.
[4] 刘鹏, 罗天, 许珂媛, 邓红美, 李瑄, 唐翠萍. 八段锦对膝关节炎疗效的初步步态分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 590-595.
[5] 李焕玺, 何淳诺, 田志敏, 周胜虎, 吴昊越, 张浩强. 全膝关节置换术后股骨远端假体周围骨折治疗现状[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 630-637.
[6] 王相迎, 杨长生, 曲铁兵. 固定平台单髁置换假体合适位置的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 638-645.
[7] 苏介茂, 齐岩松, 王永祥, 魏宝刚, 马秉贤, 张鹏飞, 魏兴华, 徐永胜. 关节镜手术在早中期膝骨关节炎治疗的应用进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 646-652.
[8] 谢佳乐, 李琦, 芦升升, 姜劲松. 内侧膝骨关节炎伴胫股关节冠状半脱位的手术治疗[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 653-657.
[9] 郭艳波, 马亮, 李刚, 阎伟, 骆帝, 岳亮, 吴伟山. 全膝关节置换术后胫股关节脱位的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 658-671.
[10] 王振宇, 张洪美, 荆琳, 何名江, 闫奇. 膝骨关节炎相关炎症因子与血浆代谢物间的因果关系及中介效应[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 467-473.
[11] 王典, 刘双赫, 曾峥. 肩关节镜术后肌肉功能改变对颈椎形态及矢状面参数影响的自身前后对照队列研究[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(05): 371-378.
[12] 李鑫, 邓相奎, 林昌永, 郭勇. 心脏起搏器/心律转复除颤器与体外冲击波碎石相关指南文献解读[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 313-317.
[13] 宋庆成, 郑占乐, 王天瑞, 王宇钏, 张凯旋, 纳静, 蔚佳昊, 杨思繁, 宋九宏, 张英泽. “人老膝不老”:膝关节健康管理的全方位探索与实践[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 321-324.
[14] 郑占乐, 王宇钏, 蔚佳昊, 宋庆成, 张凯旋, 纳静, 王天瑞, 宋九宏, 张英泽, 王娟. 保膝须“开膝”——“开膝”在膝骨关节炎中的临床应用价值[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 325-330.
[15] 高广涵, 张耀南, 石磊, 王林, 王飞, 郑子天, 王鸿禹, 郭民政, 薛庆云. 膝骨关节炎患者前交叉韧带功能影像学影响因素分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 301-307.
阅读次数
全文


摘要