[1]宗华,王凡,邹嵩.关节镜下清理术联合三联针关节注射对老年骨性关节炎患者膝关节功能及复发的影响[J].新乡医学院学报,2023,40(5):453-457.[doi:10.7683/xxyxyxb.2023.05.010]
　ZONG Hua,WANG Fan,ZOU Song.Effect of arthroscopic debridement combined with triple needle joint injection on knee joint function and recurrence of elderly patients with knee osteoarthritis[J].Journal of Xinxiang Medical University,2023,40(5):453-457.[doi:10.7683/xxyxyxb.2023.05.010]
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关节镜下清理术联合三联针关节注射对老年骨性关节炎患者膝关节功能及复发的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
40卷
期数:
2023年5
页码:
453-457
栏目:
临床研究
出版日期:
2023-05-05

文章信息/Info

Title:
Effect of arthroscopic debridement combined with triple needle joint injection on knee joint function and recurrence of elderly patients with knee osteoarthritis
作者:
宗华; 王凡; 邹嵩
（黔东南州人民医院骨一科,贵州　凯里　556000）
Author(s):
ZONG Hua; WANG Fan; ZOU Song
（Department of Orthopedics,Qiandongnan People′s Hospital,Kaili 556000,Guizhou Province，China）
关键词:
关节镜下清理术; 透明质酸钠; 利多卡因; 醋酸曲安奈德; 骨性关节炎
Keywords:
arthroscopic debridement; sodium hyaluronate; lidocaine; triamcinolone acetate; osteoarthritis
分类号:
R684.3
DOI:
10.7683/xxyxyxb.2023.05.010
文献标志码:
A
摘要:
目的　探讨关节镜下清理术联合三联针关节注射对老年膝骨关节炎（KOA）患者关节功能及复发的影响。
方法　选择黔东南州人民医院2019年4月至2020年4月收治的115例老年KOA患者为研究对象，根据治疗方式将患者分为单纯手术组（n=55）和联合治疗组（n=60）；单纯手术组患者给予关节镜下清理术治疗，联合治疗组患者给予关节镜下清理术和三联针关节注射（每周注射1次，共注射2次）治疗。分别于治疗前和治疗后抽取2组患者关节腔内关节液4 mL，采用酶联免疫吸附法检测关节液中肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）水平。分别于治疗前、治疗后4周、治疗后6个月采用视觉模拟评分（VAS）法评估2组患者膝关节疼痛程度，采用Lysholm评分评估2组患者膝关节功能。治疗后评估2组患者的临床疗效，并记录术后并发症及1 a内复发情况。
结果　治疗前2组患者关节液中TNF-α、IL-1β、IL-6水平比较差异无统计学意义（P>0.05）。2组患者治疗后关节液中TNF-α、IL-1β、IL-6水平显著低于治疗前（P<0.05）。治疗后，联合治疗组患者关节液中TNF-α、IL-1β、IL-6水平显著低于单纯手术组（P<0.05）。治疗前2组患者的VAS、Lysholm评分比较差异无统计学意义（P>0.05）。治疗后4周及治疗后6个月，2组患者的VAS评分均显著低于治疗前，Lysholm评分均显著高于治疗前（P<0.05）；2组患者治疗后6个月时的VAS评分显著低于治疗后4周，Lysholm评分显著高于治疗4周（P<0.05）。治疗后4周及治疗后6个月，联合治疗组患者的VAS评分显著低于单纯手术组，Lysholm评分显著高于单纯手术组（P<0.05）。联合治疗组患者的治疗总有效率显著高于单纯手术组（χ2=10.044,P<0.05）。2组患者术后关节肿胀、关节内血肿、患肢静脉炎等并发症发生率比较差异无统计学意义（χ2=20.438、0.259、0.003，P>0.05）。单纯手术组和联合治疗组患者1 a内复发率分别为14.55%（8/55）、1.67%（1/60），联合治疗组患者1 a内复发率显著低于单纯手术组（χ2=6.598，P<"0.05）。
结论　关节镜下清理术联合三联针关节注射治疗老年KOA患者的临床疗效显著，可进一步减轻患者疼痛程度，提高患者膝关节功能，降低关节液中炎症因子水平，且安全性高，复发率低。
Abstract:
Objective　To investigate the effect of arthroscopic debridement combined with triple needle joint injection on knee joint function and recurrence of elderly patients with knee osteoarthritis（KOA）.
Methods　A total of 115 elderly patients with KOA admitted to Qiandongnan People′s Hospital from April 2019 to April 2020 were selected as the research objects.The patients were divided into the simple operation group (n="55) and the combined treatment group (n=60) according to the treatment method.The patients in the simple operation group were treated with arthroscopic debridement,the patients in the combined treatment group were treated with arthroscopic debridement and triple needle joint injection(once a week,twice in total).Before and after treatment,4 mL of joint fluid in the joint cavity of patients in the two groups were extracted,and the levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interleukin-6(IL-6) in the joint fluid were detected by enzyme-linked immunosorbent assay.Before treatment and 4 weeks,6 months after treatment,the degree of knee joint pain was assessed by visual analogue scale (VAS),and the knee joint function was assessed by Lysholm score.The clinical efficacy of patients in the two groups was evaluated after treatment and the postoperative complications,the recurrence within 1 year were recorded.
Results　There was no significant difference in TNF-α,IL-1β,and IL-6 levels in the joint fluid of patients between the two groups before treatment(P>0.05) .The levels of TNF-α,IL-1β,and IL-6 in the joint fluid of patients after treatment were significantly lower than those before treatment in the two groups(P<0.05).The levels of TNF-α,IL-1β,and IL-6 in the joint fluid of patients in the combined treatment group were significantly lower than those in the simple operation group after treatment(P<0.05).There was no significant difference in the VAS and Lysholm scores of patients between the two groups before treatment (P>0.05).At 4 weeks and 6 months after treatment,the VAS scores of patients were significantly lower than those before treatment,and the Lysholm scores were significantly higher than those before treatment in the two groups (P<0.05).The VAS scores of patients in the two groups at 6 months after treatment were significantly lower than those at 4 weeks after treatment,and the Lysholm scores were significantly higher than those at 4 weeks after treatment (P<0.05).At 4 weeks and 6 months after treatment,the VAS score of patients in the combined treatment group was significantly lower than that in the simple operation group,and the Lysholm score was significantly higher than that in the simple operation group (P<0.05).The total effective rate of patients in the combined treatment group was significantly higher than that in the simple operation group (χ2=10.044,P<0.05).There was no significant difference in the incidence of complications such as joint swelling,intra-articular hematoma,and phlebitis of the affected limbs of patients between the two groups (χ2=20.438,0.259,0.003;P>0.05).The recurrence rate of patients in the simple operation group and the combined treatment group were 14.55% (8/55) and 1.67% (1/60),respectively within 1 year;the recurrence rate of patients in the combined treatment group was significantly lower than that in the simple operation group (χ2=6.598,P<0.05).
Conclusion　Arthroscopic debridement combined with triple needle joint injection has a significant therapeutic effect in the treatment of elderly KOA patients,which can further reduce the pain degree of patients,improve the joint function,reduce the level of inflammatory factors in joint fluid of patients,and the safety is higher,the recurrence rate is low.

参考文献/References:

［1］　PERLMAN A,FOGERITE S G,GLASS O,et al.Efficacy and safety of massage for osteoarthritis of the knee:a randomized clinical trial［J］.J Gen Intern Med,2019,34(3):379-386.
［2］　WANG Z,JONES G,WINZENBERG T,et al.Effectiveness of curcuma longa extract for the treatment of symptoms and effusion-synovitis of knee osteoarthritis:a randomized trial［J］.Ann Intern Med,2020,173(11):861-869.
［3］　TU J F,YANG J W,SHI G X,et al.Efficacy of intensive acupuncture versus sham acupuncture in knee osteoarthritis:a randomized controlled trial［J］.Arthritis Rheumatol,2021,73(3):448-458.
［4］　LV B,HUANG K,CHEN J,et al.Medium-term efficacy of arthroscopic debridement vs conservative treatment for knee osteoarthritis of Kellgren-Lawrence grades I-III［J］.World J Clin Cases,2021,9(19):5102-5111.
［5］　YANG X,LIANG W,LI J,et al.A meta-analysis and systematic review of the therapeutic effects of arthroscopy combined with intraa-rticular injection of sodium hyaluronate in the treatment of knee osteoarthritis［J］.Ann Palliat Med,2021,10(9):9859-9869.
［6］　中华医学会骨科学分会.骨关节炎诊治指南(2007年版)［J］.中华关节外科杂志（电子版）,2007,1(4):280-283.
CHINESE ORTHOPAEDIC ASSOCIATION.Guidelines for diagnosis and treatment of osteoarthritis (2007 edition) ［J］.Chin J Joint Surg(Electr Ver),2007,1(4):280-283.
［7］　王玉冰,田媛,黄薇,等.膝关节镜联合腓骨近端截骨术治疗老年膝关节骨性关节炎的疗效及对血清炎症因子的影响［J］.中国老年学杂志,2019,39(13):3170-3173.
WANG Y B,TIAN Y,HUANG W,et al.Therapeutic effect of knee arthroscopy combined with proximal fibular osteotomy in the treatment of senile knee osteoarthritis and its influence on serum inflammatory factors［J］.Chin J Gerontology,2019,39(13):3170-3173.
［8］　胡艳昭,崔丽红,刘长利,等.关节镜下关节清理术联合红花化瘀汤熏蒸对膝关节骨关节炎患者的近远期疗效及血液流变学的影响［J］.中国内镜杂志,2020,26(3):7-12.
HU Y Z,CUI L H,LIU C L,et al.Effect of arthroscopic joint debridement combined with Honghua Huayu Decoction on short-term and long-term efficacy and hemorheology in patients with osteoarthritis of knee joint［J］.China J Endosc,2020,26(3):7-12.
［9］　JI L,LI W,QIAN W,et al.The role of nanoparticles-mediated ligustrazine in the treatment of knee osteoarthritis and its effect on matrix metalloproteinases and upstream NF-κB signaling pathway in knee osteoarthritis［J］.J Nanosci Nanotechnol,2021,21(2):1372-1377.
［10］　TIAN J,WANG Z,AN J,et al.Arthroscopic debridement combined with proximal fibular osteotomy in medial tibial articular genu osteoarthritis treatment:systematic review and meta-analysis［J］.Ann Palliat Med,2021,10(7):7894-7904.
［11］　OLIVIERO F,RAMONDA R,HOXHA A,et al.Effect of an oral preparation containing hyaluronic acid,chondroitin sulfate,hydrolyzed collagen type Ⅱ and hydrolyzed keratin on synovial fluid features and clinical indices in knee osteoarthritis.A pilot study ［J］.Reumatismo,2020,72(3):125-130.
［12］　MATAS J,ORREGO M,AMENABAR D,et al.Umbilical cord-derived mesenchymal stromal cells (mscs) for knee osteoarthritis:repeated msc dosing is superior to a single msc dose and to hyaluronic acid in a controlled randomized phase I/II trial［J］.Stem Cells Transl Med,2019,8(3):215-224.
［13］　MALAHIAS M A,ROUMELIOTIS L,NIKOLAOU V S,et al.Platelet-rich plasma versus corticosteroid intra-articular injections for the treatment of trapeziometacarpal arthritis:a prospective randomized controlled clinical trial［J］.Cartilage,2021,12(1):51-61.
［14］　吕科,雷文黎,马建军,等.关节镜清理术联合曲安奈德、透明质酸钠关节腔内注射对膝骨性关节炎血清骨代谢相关指标的影响［J］.广西医科大学学报,2018,35(10):1392-1396.
LYU K,LEI W L,MA J J,et al.Influence of arthroscopic debridement combined with intra-articular injection of triamcinolone acetonide and sodium hyaluronate on serum bone metabolism indexes in patients with knee osteoarthritis［J］.J Guangxi Med Univ,2018,35(10):1392-1396.
［15］　ORELLANA C,CALVET J,BERENGUER-LLERGO A,et al.Synovial adiponectin was more associated with clinical severity than synovial leptin in women with knee osteoarthritis［J］.Cartilage,2021,13(1):1675-1683.
［16］　SCHIEKER M,CONAGHAN P G,MINDEHOLM L,et al.Effects of interleukin-1β inhibition on incident hip and knee replacement:exploratory analyses from a randomized,double-blind,placebo-controlled trial［J］.Ann Intern Med,2020,173(7):509-515.
［17］　MUN C J,LETZEN J E,NANCE S,et al.Sex differences in interleukin-6 responses over time following laboratory pain testing among patients with knee osteoarthritis［J］.J Pain,2020,21(5):731-741.

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更新日期/Last Update: 2023-05-05