关节镜下清理术联合截骨术治疗内侧间室膝骨关节炎的疗效研究

Study on the therapeutic effect of arthroscopic debridement combined with osteotomy for medial compartment knee osteoarthritis

目的探讨关节镜下清理术联合截骨术治疗内侧间室膝骨关节炎的临床效果。方法开展前瞻性研究,选取临沂市中医医院2020年2月至2021年8月收治的58例内侧间室膝骨关节炎患者,随机抽签分为观察组和对照组,各29例。观察组男性17例,女性12例,年龄(41.12±5.84)岁;对照组男性19例,女性10例,年龄(40.87±6.02)岁。对照组行关节镜下清理术,观察组在对照组的基础上联合截骨术治疗。比较两组围手术期相关指标、视觉模拟评分法(VAS)评分、美国特种外科医院(HSS)膝关节评分、美国膝关节协会评分(AKSS)、西安大略和麦克马斯特大学(WOMAC)骨关节炎指数、血清及关节滑液白细胞介素(IL)-17、基质金属蛋白酶-3(MMP-3)、MMP-9水平和并发症发生率。采用t检验、χ^(2)检验。结果观察组手术时间及术后VAS评分、HSS评分、AKSS、WOMAC评分分别为(72.68±7.64)min、(2.56±0.52)分、(89.06±10.23)分、(86.24±9.85)分、(16.24±2.86)分,对照组分别为(50.46±6.87)min、(3.12±0.43)分、(78.69±9.93)分、(75.95±7.86)分、(20.57±3.35)分,差异均有统计学意义(t=11.646、4.469、3.917、4.397、5.294,均P<0.001)。观察组术后血清IL-17、MMP-3、MMP-9水平分别为(4.03±1.12)ng/L、(98.97±18.76)μg/L、(29.86±6.47)μg/L,对照组为(4.96±1.09)ng/L、(146.96±19.15)μg/L、(38.87±7.54)μg/L,差异均有统计学意义(t=3.205、9.640、4.884,均P<0.001)。观察组术后关节滑液IL-17、MMP-3、MMP-9水平分别为(5.35±1.21)ng/L、(102.96±17.84)μg/L、(36.08±7.94)μg/L,对照组为(6.98±1.14)ng/L、(162.74±18.23)μg/L、(48.87±8.35)μg/L,差异均有统计学意义(t=5.280、12.621、5.978,均P<0.001)。观察组术后并发症发生率为10.34%(3/29),对照组为3.45%(1/29),差异无统计学意义(χ^(2)=0.269,P=0.604)。结论关节镜下清理术联合截骨术治疗内侧间室膝骨关节炎可获得较好的治疗效果,能够抑制炎症反应,减轻关节疼痛,改善膝关节功能。

Objective To study the therapeutic effect of arthroscopic debridement combined with osteotomy for medial compartment knee osteoarthritis.Methods A prospective study was conducted.Fifty-eight patients with medial compartment knee osteoarthritis admitted to Linyi Traditional Chinese Medical Hospital from February 2020 to August 2021 were randomly divided into an observation group and a control group by drawing lots,with 29 cases in each group.In the observation group,there were 17 males and 12 females,aged(41.12±5.84)years.In the control group,there were 19 males and 10 females,aged(40.87±6.02)years.The control group underwent arthroscopic debridement,and the observation group underwent combined osteotomy on the basis of the control group.The perioperative indexes were compared between the two groups,including the Visual Analogue Scale(VAS)score,Hospital for Special Surgery(HSS)knee score,American Knee Society Score(AKSS),Western Ontario and McMaster University(WOMAC)osteoarthritis index,levels of interleukin(IL)-17,matrix metalloproteinase-3(MMP-3),and MMP-9 in serum and synovial fluid,and incidence of complications.t test andχ^(2) test were used.Results In the observation group,the operation time and postoperative VAS score,HSS score,AKSS score,and WOMAC score were(72.68±7.64)min,(2.56±0.52)points,(89.06±10.23)points,(86.24±9.85)points,and(16.24±2.86)points,and those in the control group were(50.46±6.87)min,(3.12±0.43)points,(78.69±9.93)points,(75.95±7.86)points,(20.57±3.35)points,with statistically significant differences(t=11.646,4.469,3.917,4.397,and 5.294;all P<0.001).The postoperative serum levels of IL-17,MMP-3,and MMP-9 in the observation group were(4.03±1.12)ng/L,(98.97±18.76)μg/L,and(29.86±6.47)μg/L,and those in the control group were(4.96±1.09)ng/L,(146.96±19.15)μg/L,and(38.87±7.54)μg/L,with statistically significant differences(t=3.205,9.640,and 4.884;all P<0.001).The postoperative synovial fluid levels of IL-17,MMP-3,and MMP-9 in the observation group were(5.35±1.21)ng/L,(102.96±17.84)μg/L,and(36.08±7.94)μg/L,and those in the control group were(6.98±1.14)ng/L,(162.74±18.23)μg/L,and(48.87±8.35)μg/L,with statistically significant differences(t=5.280,12.621,and 5.978;all P<0.001).The incidence of postoperative complications was 10.34%(3/29)in the observation group and 3.45%(1/29)in the control group,with no statistically significant difference(χ^(2)=0.269,P=0.604).Conclusion Arthroscopic debridement combined with osteotomy in the treatment of medial compartment knee osteoarthritis can obtain a good therapeutic effect,which can inhibit the inflammatory reaction,reduce the joint pain,and improve the knee joint function.