关节腔积液中炎症因子检测与膝关节骨折患者术后关节功能康复的相关性研究

Articular fracture knee surgery in patients with effusions inflammatory cytokines and joint function rehabilitation correlation analysis

目的探讨关节腔积液中炎症因子检测与膝关节骨折患者术后关节功能康复的相关性,对临床康复治疗提供思路方法。方法选取自2012年5月—2015年5月期间因膝关节骨折就诊于我院行手术治疗的患者80例,患者术后均行常规功能康复训练,康复训练之后根据膝关节评分(AKS)将患者分为A、B、C、D组,A组患者14例,B组患者20例,C组患者25例,D组患者21例。比较4组患者康复训练前关节腔积液内的炎症因子TNF-α、IL-6的水平,计算四组患者在康复训练前后的关节活动范围(ROM)变化率、膝关节评分(AKS)变化率,并采用Spearman等级相关和Pearson相关性分析患者关节腔积液内的炎症因子TNF-α、IL-6与ROM及AKS评分变化率的相关性。结果 4组患者康复训练前的膝关节ROM以及AKS评分比较无差异,无统计学意义(P>0.05);但其关节腔积液内的炎症因子TNF-α、IL-6的水平具有明显的差异,均具有统计学意义(P<0.05);经相关性分析,关节腔积液中的TNF-α、IL-6水平与康复治疗前后的ROM及AKS评分变化率、呈显著负相关性(P<0.05)。结论膝关节骨折患者术后的关节腔积液中的炎症因子水平会影响患者的关节功能康复,可在临床治疗中考虑加以抗炎处理来改善患者的预后。

Objective： To explore the relationship between inflammatory cytokines in the articular cavity fluids and the rehabilitation after operation of fractures around the knee joint,and provide ideas for clinical rehabilitation. Methods： The level of tumor necrosis factor-alpha（ TNF-α） and interleukin 6（ IL-6） were quantitatively analyzed by enzyme-linked immunoassay in 80 patients with fractures around knee joints before rehabilitation. The joint＇s ROM was measured and the change rate of ROM was calculated before rehabilitation therapy and 3 months after the operation respectively. With the knee joint clinical manifestations and function evaluated by AKS score80 knee joint were divided into A,B,C,D 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 four groups before rehabilitation therapy. A significant negative correlation was found between the TNF-α/IL-6 and the A,B,C and D grades and the change rate of ROM,as well as the change rate of AKS score（ P〈0. 05）.Conclusion： Fractures in patients after knee joint effusion of inflammatory factors can affect joint function rehabilitation of patients,and anti-inflammatory treatment may be considered to improve the prognosis of patients in clinical therapy.