探讨关节镜清理术后联合内外膝眼穴超声透药治疗膝关节骨关节炎(KOA)的临床疗效及其对患者血清骨代谢生化指标及炎症标志物水平的影响。

选择首都医科大学大兴教学医院骨科2018年1月至2019年11月收治的Kellgren & Lawrence分级Ⅱ~Ⅲ级、单侧发病并排除膝关节严重强直或畸形、合并其他影响下肢功能疾患的KOA病人80例，利用简单随机数字表法分成观察组(n＝40)与对照组(n＝40)。所有对象均行关节镜清理术治疗，术后对照组给予常规处理，观察组则在对照组基础上于术后联合内外膝眼穴超声透药治疗。两组均于关节镜清理术后第4周进行临床疗效评估。治疗前、关节镜清理术后第4周对两组患者进行Lysholm膝关节评分系统(LKSS)、西安大略和麦克马斯特大学(WOMAC)骨关节炎指数、疼痛视觉模拟量表(VAS)评分，使用酶联免疫法检测血清骨代谢生化指标如骨钙素(BGP)、骨保护素(OPG)和核因子κB受体活化因子配基(RANKL)及炎症标志物：白介素(IL)-1β、IL-6、肿瘤坏死因子(TNF)-α水平。最后汇总两组术后并发症和药物副作用的发生情况。组间比较计数资料采用卡方检验，计量资料采用t检验。

观察组总有效率90.0%(36/40)与对照组67.5%(27/40)相比显著上升(χ²＝6.050，P<0.05)。治疗后，两组LKSS评分均较本组治疗前升高，WOMAC、VAS评分均较本组治疗前降低，但以观察组的改善更显著(t＝2.588、5.541、4.140，均为P<0.05)。治疗后，两组血清BGP、OPG含量均较本组治疗前增高，血清RANKL浓度则均较本组治疗前下降，观察组血清BGP、OPG水平均显著高于对照组同期(t＝6.717、4.840，均为P<0.05)，而血清RANKL含量显著更低(t＝12.292，P<0.05)。治疗后，两组血清IL-1β、IL-6及TNF-α水平均低于本组治疗前，观察组治疗后上述炎症标志物的血清含量较对照组同期均显著更低(t＝6.040、8.744、5.745，均为P<0.05)。两组术后均无明显的并发症及药物副作用产生。

关节镜清理术后联合内外膝眼穴超声透药治疗KOA的整体疗效显著，可明显缓解病人患膝关节疼痛、肿胀等症状，改善膝关节功能。

To investigate the clinical effect of knee osteoarthritis (KOA) treated by arthroscopic debridement combined with drug penetrationby internal and external knee point ultrasound and its effect on serum biochemical markers of bone metabolism and inflammatory markers.

Eighty patients with unilateral KOA of Kellgren& Lawrence grade Ⅱ to Ⅲ, from January 2018 to November 2019 in orthopedics department of Daxing Teaching Hospital of Capital Medical University were selected and the patients of severe knee joint stiffness or deformity and other diseases affecting lower limb function were excluded. The enrolled patients were divided into the observation group (n=40) and the control group (n=40) by simple random number table method. All the patients were treated with arthroscopic debridement, and the control group were treated with routine treatment, while the observation group were treated with the combination of internal and external knee point ultrasound and drug penetration besides the same routine treatment. The clinical effects of the two groups were evaluated after four weeks of continuous treatment. Before and after the treatment, the two groups were assessed by Lysholm knee joint scoring system, osteoarthritis index of Western Ontario and McMaster University (WOMAC) and visual analogue scale (VAS). The biochemical indexes of serum bone metabolism, including bone Gla protein (BGP), osteoprotegerin (OPG), receptor activator of neuclear factor-κB ligand (RANKL), inflammation markers levels such as interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α were detected by enzyme-linked immunosorbent assay. Finally, the complications and side effects of the two groups were summarized. Counting data between groups were analyzed by chi-square test and measurement data were analyzed by t test.

The total effective rate of the observation group [90.0% (36/40)] was significantly higher than that of the control group [67.5% (27/40)] (χ²=6.050, P<0.05). After the treatment, Lysholm score of the two groups was significantly higher than that of the group before treatment, while WOMAC score and pain VAS score were significantly lower than that of the group before treatment, but the improvement of the observation group was more significant (t =2.588, 5.541, 4.140, all P<0.05). After the treatment, the levels of BGP and OPG in serum of the two groups were significantly higher than those before treatment, while the levels of RANKL in serum of the two groups were significantly lower than those before treatment. The levels of BGP and OPG in serum of the observation group were significantly higher than those of the control group at the same time (t=6.717, 4.840, both P<0.05), while the levels of RANKL in serum were significantly lower (t=12.292, P<0.05). After treatment, the serum levels of IL-1β, IL-6 and TNF -α in the two groups were significantly lower than those before treatment, but the serum levels of the above inflammatory markers in the observation group were significantly lower than those in the control group at the same time (t=6.040, 8.744, 5.745, all P<0.05). There was no obvious complication or side effect in neither of the two groups after the operation.

After arthroscopic debridement combined with internal and external knee point ultrasound and drug penetration therapy, the overall effect of KOA is significant, which can significantly alleviate the pain, swelling and other symptoms of patients with knee joint, improve knee joint function.