加速康复外科联合胫骨高位截骨对内侧间室膝骨关节炎围术期炎症因子影响及疗效观察

Observation on perioperative inflammatory factors and therapeutic effect of enhanced recovery after surgery combined with high tibial osteotomy on medial compartment knee osteoarthritis

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)在胫骨高位截骨对内侧间室膝关节骨关节炎(knee osteoarthritis,KOA)围术期炎症因子影响及临床疗效。方法选取2017年1月至2019年6月于我院行胫骨高位截骨治疗内侧间室KOA患者120例,采用随机数字表法分为两组,每组60例。治疗组患者在围术期使用ERAS指导患者康复,对照组患者予以常规康复治疗。观察记录两组患者术后住院天数、手术时间以及并发症发生率;观察患者术前12 h、术后24 h、48 h、72 h、1周、2周血清中白介素-6(interleukin-6,IL-6)、IL-1β的表达变化;观察术前、术后12 h、24 h、48 h、72 h的疼痛视觉模拟评分(visual analogue scale,VAS)变化以及术前、术后1个月、3个月、6个月及12个月WOMAC功能评分变化。结果两组患者术后伤口均愈合良好,无感染、血管损伤、内固定松动或断裂等并发症发生。两组手术时间差异无统计学意义(P>0.05);治疗组在术后1周、2周时可以更早地降低血清中IL-6、IL-1β的表达水平(P<0.05);治疗组术后住院时间以及术后12 h、24 h、48 h及72 h VAS评分均显著优于对照组(P<0.05);治疗组术后1个月和3个月的膝关节WOAMC评分优于对照组(P<0.05),但在术后6个月和12个月时,两组差异无统计学意义(P>0.05);治疗组并发症发生率(3.33%)显著低于对照组(8.33%)。结论ERAS在胫骨内侧高位截骨术治疗内侧间室KOA围术期应用可以有效缩短患者住院时间,降低患者术后疼痛,早期降低血清中炎症因子表达,促进患者早期进行功能康复,恢复患膝功能。

Objective To observe the clinical effect and perioperative inflammatory factors of enhanced recovery after surgery(ERAS)combined with high tibial osteotomy(HTO)in the treatment of medial compartment knee osteoarthritis(KOA).Methods A total of 120 patients with medial compartment KOA who underwent HTO in our hospital from January 2017 to June 2019 were selected.They were randomly divided into two groups with 60 cases in each group.ERAS was applied in one group to guide the recovery of patients perioperatively(treatment group),while conventional rehabilitation therapy in the other group(control group).Hospital stay,operation time and complication rate of the two groups after surgery were recorded;Expressions of interleukin-6(IL-6)and IL-1β12 h before operation,24 h,48 h,72 h,1 week,2 weeks after operation were observed;changes of VAS before operation and 12 h,24 h,48 h,72 h after operation were assessed;changes of WOMAC scores before operation and 1,3,6,12 months after operation were evaluated.Results All wounds healed well after the operation without infection,vascular injury,loosening or rupture of internal fixation.No significant differences in operation time were noted between the treatment group and control group(P>0.05);expression levels of IL-6 and IL-1βin the the treatment group were reduced earlier at 1 and 2 weeks after surgery(P<0.05);postoperative hospital stay and VAS at 12,24,48 and 72 hours after surgery of the treatment group were significantly superior than that of the control group(P<0.05);WOAMC of the treatment group at 1 and 3 months after surgery was superior than that of the control group(P<0.05),while not at 6 and 12 months after surgery(P>0.05);complication rate of the treatment group(3.33%)was significantly lower than that of the control group(8.33%).Conclusions ERAS combined with high tibial osteotomy will effectively shorten the hospital stay,reduce postoperative pain,promote early functional rehabilitation,and restore knee function in the treatment of medial compartment knee osteoarthritis.