膝关节周围骨折术后关节腔液中炎性细胞因子水平对膝关节康复的影响

Influence of inflammatory cytokines in the articular cavity fluids on the rehabilitation after the operation of fractures around the knee joint

目的:探讨膝关节周围骨折术后关节腔液中炎性细胞因子水平对膝关节康复的影响。方法:86例膝关节周围骨折患者(共97个患膝),酶联免疫分析法检测患膝康复前关节腔液中白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,康复治疗前及术后6个月测量关节活动范围(ROM),计算康复治疗前后ROM变化率;按照膝关节评分标准(AKS)进行膝关节临床表现和功能评分,计算康复治疗前后AKS评分变化率。结果:康复治疗前ROM与AKS评分差异无统计学意义(P>0.05),优、良、中、差组的患者康复治疗前关节腔液中IL-6与TNF-α水平差异有统计学意义(P<0.05)。关节腔液中IL-6、TNF-α水平与康复的等级、康复治疗前后ROM变化率、AKS评分变化率呈显著负相关性(P<0.05)。结论:关节腔液中IL-6、TNF-α与膝关节周围骨折术后膝关节僵直潜在相关,IL-6、TNF-α表达水平与康复治疗效果负相关。

Objective： To explore the relationship between inflammatory cytokines in the articular cavity fluids and the rehabilitation after operation of fractures around the knee joint. Methods： The level of tumor necrosis factoralpha（ TNF-α） and interleukin 6（ IL-6） were quantitatively analyzed by enzyme-linked immunoassay in 97 knees of86 patients with fractures around knee joints before rehabilitation. The joint＇s range of motion（ ROM） was measured and the change rate of ROM was calculated before rehabilitation therapy and 6 months after the operation respectively. With the knee joint clinical manifestations and function evaluated by the American Knee Society（ AKS） score,97 knee joint were divided into excellent,good,medium,poor grade group. The change rate of AKS score were calculated before and after rehabilitation therapy. The relationship between the improvement of ROM（ or AKS score） and the inflammatory cktokines was evaluated. Results： ROM and AKS score had no significant differences before and after rehabilitation therapy（ P〉0. 05）,while the accumulation of TNF-α and IL-6 in articular cavity fluids had significant differences（ P〈0. 05） in excellent groups,good groups,moderate groups and poor groups before rehabilitation therapy. A significant negative correlation was found between the TNF-α / IL-6 and the excellent,good,moderate,poor grade,and the change rate of ROM,as well as the change rate of AKS score（ P〈0. 05）. Conclusion： Inflammatory cytokine level in the articular cavity fluids is potentially associated with the rigidity of knee joint after operation of fractures around the knee. Increased TNF-α and IL-6 in the articular cavity fluids indicates an negative effect on the rehabilitation therapy.