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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 411 -416. doi: 10.3877/cma.j.issn.1674-134X.2021.04.004

临床论著

关节镜清理术联合超声透药治疗膝骨关节炎的效果
王珩1,†(), 吴琼1, 刘月姣1   
  1. 1. 102600　北京，首都医科大学大兴教学医院全科医学
  • 收稿日期:2020-05-08 出版日期:2021-09-29
  • 通信作者: 王珩
  • 基金资助:
    北京市大兴区人民医院科技项目(4201902260)

Effect of arthroscopic debridement combined with drug penetration by ultrasound on knee osteoarthritis

Heng Wang1,†(), Qiong Wu1, Yuejiao Liu1   

  1. 1. Daxing Teaching Hospital of Capital Medical University, Beijing 102600, China
  • Received:2020-05-08 Published:2021-09-29
  • Corresponding author: Heng Wang
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引用本文：

王珩, 吴琼, 刘月姣. 关节镜清理术联合超声透药治疗膝骨关节炎的效果[J]. 中华关节外科杂志(电子版), 2021, 15(04): 411-416.

Heng Wang, Qiong Wu, Yuejiao Liu. Effect of arthroscopic debridement combined with drug penetration by ultrasound on knee osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(04): 411-416.

目的

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。

方法

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。

结果

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。

结论

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。

关键词: 骨关节炎, 膝, 酶联免疫吸附测定, 血清
Objective

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.

Methods

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.

Results

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.

Conclusion

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.

Key words: Osteoarthritis, knee, Enzyme-linked immunosorbent assay, Plasma
表1 两组基线资料比较
组别 例数 性别 年龄[岁，(±s)] 病程[年，(±s)] 患侧 K-L分级
男 女 左膝 右膝 Ⅱ级 Ⅲ级
观察组 40 11 29 62.5±7.4 3.6±1.2 17 23 32 8
对照组 40 13 27 61.3±6.8 3.3±1.5 19 21 35 5
统计值   χ2＝0.238 t＝0.755 t＝0.988 χ2＝0.202 χ2＝0.827
P值   >0.05 >0.05 >0.05 >0.05 >0.05
表2 两组临床疗效比较(例)
组别 例数 治愈 显效 有效 无效 总有效率[例(%)]
观察组 40 12 14 10 4 36(90.0)
对照组 40 7 11 9 13 27(67.5)
χ2值           6.050
P值           0.014
表3 两组相关量表评分比较[分，(±s)]
组别 例数 LKSS评分 WOMAC评分 疼痛VAS评分
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 40 58.3±11.2 83.3±15.5 68.1±15.0 22.6±6.2 7.5±1.5 2.8±0.7
对照组 40 59.3±9.1 75.2±12.5 69.5±13.7 31.5±8.1 7.4±1.7 3.5±0.8
t值   0.404 2.588 0.426 5.541 0.314 4.140
P值   >0.05 0.012 >0.05 <0.001 >0.05 <0.001
表4 两组血清骨代谢生化指标水平比较(±s)
组别 例数 BGP(g/L) OPG(ng/L) RANKL(ng/L)
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 40 3.5±1.0 7.0±1.4 1.5±0.3 2.6±0.6 46.4±3.6 29.8±2.8
对照组 40 3.6±1.0 5.2±1.0 1.4±0.3 2.0±0.4 47.1±3.2 38.1±3.5
t值   0.447 6.717 0.288 4.840 0.916 12.292
P值   >0.05 <0.001 >0.05 <0.001 >0.05 <0.001
表5 两组血清炎症标志物浓度比较(±s)
组别 例数 IL-1β(ng/L) IL-6(ng/L) TNF-α(ng/L)
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 40 43.1±9.5 17.3±5.1ab 55.3±10.4 18.1±4.3ab 24.2±5.3 6.3±2.6ab
对照组 40 42.9±8.2 26.1±7.5a 54.7±9.5 29.2±6.9a 23.6±6.0 10.4±3.7a
t值   0.111 6.040 0.252 8.744 0.443 5.745
P值   >0.05 <0.001 >0.05 <0.001 >0.05 <0.001
[4]
刘锐，张焕．百合固金汤超声电导仪药物透入对复治肺结核患者血清免疫功能及炎症因子水平影响研究[J]．辽宁中医药大学学报，2018，20(5)：122-125.
[5]
中华医学会骨科学分会关节外科学组．骨关节炎诊疗指南(2018年版)[J]．中华骨科杂志，2018，38(12)：705-715.
[6]
郑筱萸．中药新药临床研究指导原则[M]．北京：中国医药科技出版社，2002：349.
[7]
Moss P, Benson H, Will R, et al. Patients with knee osteoarthritis who score highly on the pain detect questionnaire present with multimodality hyperalgesia, increased pain, and impaired physical function[J]. Clin J Pain, 2018, 34(1): 15-21.
[8]
裴儒，何仁豪，尹识渊，等．关节镜下膝关节清理术联合去神经化对膝骨性关节炎的临床疗效研究[J]．中国临床医生杂志，2020，48(4)：472-475.
[9]
徐仲林，张彪，喻德富．关节镜清理术联合Ilizarov牵伸术治疗老年膝关节骨性节炎的效观察[J]．中国骨与关节损伤杂志，2019，34(12)：1296-1298.
[10]
宋敬锋，柴宏伟，孙晓新，等．关节镜清理术联合药物注射对膝骨关节炎患者疼痛症状、膝关节功能和细胞因子的影响[J]．解放军医药杂志，2018，30(4)：57-60.
[11]
杨勇，赵良虎，黄金．膝关节置换术结合中药疗法对膝关节骨性关节炎的临床疗效研究[J]．中国骨质疏松杂志，2016，22(7)：837-841.
[12]
米智华，董大龙，于大朋，等．经天枢穴超声电导大承气汤对胃癌根治术患者术后早期恢复质量的影响[J]．国际麻醉学与复苏杂志，2019，40(1)：11-15.
[13]
路娜，温晓燕，黄敏娜，等．益气活血汤"药物透入治疗气虚血瘀型奥沙利铂所致外周神经毒性病变的临床研究[J]．天津中医药，2020，37(5)：544-548.
[14]
朱莉，张丽，何婷，等．超声药物透入治疗在肺炎患儿的疗效观察及护理[J]．中国药物与临床，2019，19(6)：1025-1027.
[15]
袁海娟，张小林，刘楠，等．超声电导靶位透入大黄至天枢穴促进胃癌患者术后早期胃肠功能恢复的临床护理研究[J]．实用临床医药杂志，2019，23(2)：112-115.
[16]
曾锦全，柯俊杰．软骨下骨病变在骨关节炎发病机制中的作用[J]．中国细胞生物学学报，2020，42(7)：1255-1262.
[17]
肖壮，唐涛，朱成华，等．破骨细胞在骨关节炎中的增殖变化及意义[J]．重庆医学，2017，46(30)：4181-4184.
[18]
陈瀚宇，徐颖鹏，李鼎鹏，等．RANK/RANKL/OPG系统在骨性关节炎与骨质疏松相关性中的作用机制[J]．中国中医骨伤科杂志，2019，27(1)：86-88.
[19]
吴毅华，罗高斌，黄煜朗，等．关节镜下清理术联合腓骨截骨术治疗膝关节骨性关节炎的疗效及对炎性因子的影响[J]．现代生物医学进展，2019，19(10)：1966-1969, 1977.
[20]
刘建华，赵海勇，温芳，等．炎性细胞因子在膝骨关节炎中的表达及与高敏C反应蛋白和红细胞沉降率的相关性[J]．天津医药，2020，48(1)：55-58.
[1]
Soul J, Dunn SL, Anand S, et al. Stratification of knee osteoarthritis: two major patient subgroups identified by genome-wide expression analysis of articular cartilage[J]. Ann Rheum Dis, 2017, 77(3): 423-430.
[2]
Conaghan PG, Hunter DJ, Cohen SB, et al. Effects of a single Intra-Articular injection of a microsphere formulation of triamcinolone acetonide on knee osteoarthritis pain：a double-blinded，randomized，placebo-controlled，multinational study[J]. J Bone Joint Surg Am, 2018, 100(8): 666-677.
[3]
Siemieniuk RAC, Harris IA, Agoritsas T, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline[J]. Br J Sports Med, 2018, 52(5): 313-320.
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