体外冲击波联合关节镜术治疗膝关节骨性关节炎

Extracorporeal shock wave combined with arthroscopy for knee osteoarthritis

[目的]探讨体外冲击波联合关节镜清理术治疗膝关节骨性关节炎的疗效。[方法]将360例膝骨性关节炎患者随机分为三组,120例采用单纯体外冲击波治疗(冲击波组),120例采用单纯关节镜清理术治疗(关节镜组),120例采用体外冲击波联合关节镜手术治疗(联合组)。采用VAS疼痛评分、Lysholm评分和关节活动度(ROM)评价临床效果,检测关节滑液NO、SOD、IL-1β、TNF-α、MMP-3等含量。[结果]360例患者均完成相应治疗并获得24周以上随访,无严重并发症。治疗后,三组患者的VAS评分显著降低,而Lysholm评分和ROM显著增加,不同时间点间差异有统计学意义(P<0.05)。治疗后联合组在VAS和Lysholm评分以及ROM方面均优于冲击波组和关节镜组。治疗后,三组患者的SOD含量均显著增加,NO、IL-1β、TNF-α、MMP-3含量降低,不同时间点间差异有统计学意义(P<0.05)。治疗后,联合组在SOD、NO IL-1β、TNF-α、MMP-3含量方面均优于冲击波组和关节镜组。[结论]体外冲击波联合关节镜术治疗膝关节骨性关节炎的效果优于单纯一种治疗方式。

[Objective]To evaluate the efficacy of extracorporeal shock wave(ESW)combined with arthroscopic debridement for treatment of knee osteoarthritis.[Methods]A total of 360 patients with knee ostearthritis were randomly divided into 3 groups.Of them,120 patients received ESW therapy only,120 patients underwent arthroscopic debridement only,while the remaining 120 patients were treated by ESW combined with arthroscopic debridement.The visual analogue scale(VAS)for pain,Lysholm score and knee extension-flexion range of motion(ROM)were used for evaluation of the clinical consequences,additionally laboratory assessing of superoxide dismutase(SOD),nitric oxide(NO),IL-1β,TNF-αand MMP-3 were conducted.[Results]All the 360 patients received corresponding therapy smoothly without obvious adverse reaction,and followed up for more than 24 weeks.After treatment the VAS score significantly decreased,whereas the Lysholm score and ROM significantly increased in all the 3 group with statistically significant differences among time points(P<0.05).The combined group proved superior to the ESW group and arthroscopic group with respect to VAS,Lysholm scores and ROM.Regarding to laboratory assay,the SOD significantly increased,while the NO,IL-1β,TNF-αand MMP-3 significantly decreased after treatment in all the 3 groups with statistically significantly differences among time points(P<0.05).The combined group was superior to the ESW group and arthroscopic group regarding aforesaid laboratory measurements.[Conclusion]This combination of ESW and arthroscopic debridement does achieve superior clinical outcomes to any therapy only for knee osteoarthritis.