关节镜下联合玻璃酸钠注射对半月板损伤患者血清骨性标志物水平的影响

Effect of combined sodium hyaluronate injection under arthroscopy on serum bone markers in patients with meniscus injury

目的研究关节镜下联合玻璃酸钠注射对半月板损伤患者血清骨性标志物水平的影响。方法前瞻性选取2019年4月至2021年4月河北中石油中心医院收治的90例半月板损伤患者纳入研究,采用随机数字表法将患者分为观察组与对照组,每组各45例。对照组行关节镜下手术,观察组在对照组基础上加用玻璃酸钠注射液,5周1个疗程,连续注射1个疗程。比较两组临床疗效及并发症发生率(关节水肿、术后感染、发热、关节黏连),比较两组治疗前后膝关节功能情况及视觉模拟评分法(VAS)评分、血清骨性标志物水平[骨钙素、Ⅰ型前胶原羧基端肽(PICP)、骨碱性磷酸酶(BALP)及降钙素]。结果观察组患者治疗总有效率为95.56%,显著高于对照组(82.22%),差异有统计学意义(P<0.05)。治疗前,两组膝关节功能评分、膝关节活动度、VAS评分比较,差异无统计学意义(P>0.05);治疗后6个月,观察组膝关节功能评分、膝关节活动度分别为(91.18±6.88)分、(105.88±14.07)°,显著高于对照组[(80.01±10.178)分、(88.33±8.47)°],VAS评分为(1.01±0.47)分,显著低于对照组[(2.33±0.68)分],差异均有统计学意义(P<0.05)。治疗前,两组骨钙素、PICP、BALP、降钙素水平比较,差异无统计学意义(P>0.05);治疗后6个月,观察组骨钙素、PICP、BALP、降钙素水平为(4.57±0.63)μg/L、(153.68±19.58)μg/L、(317.55±40.38)U/L、(69.44±9.74)μg/L,显著高于对照组[(3.87±0.44)μg/L、(137.18±16.55)μg/L、(229.74±27.55)U/L、(53.47±9.17)μg/L],差异均有统计学意义(P<0.05)。观察组与对照组的并发症发生率比较(4.44%vs.11.11%),差异无统计学意义(P>0.05)。结论关节镜下联合玻璃酸钠用于半月板损伤疗效较好,可调节患者血清骨性标志物水平,临床效果确切,值得应用。

Objective To study the effect of arthroscopic combined with sodium hyaluronate injection on serum bone markers in patients with meniscus injury.Methods A total of 90 patients with meniscus injury admitted from April 2019 to April 2021 were prospectively selected and randomly divided into observation group and control group,with 45 cases in each group.The control group was treated with arthroscopic surgery,and the observation group was treated with sodium hyaluronate injection on the basis of the control group.One course of treatment was 5 weeks,and continuous injection was 1 course of treatment.The clinical efficacy and incidence of complications(joint edema,postoperative infection,fever,joint adhesion)were compared between the two groups.The knee function,visual analogue scale(VAS)score and serum bone markers[osteocalcin,type I procollagen carboxy-terminal peptide(PICP),bone alkaline phosphatase(BALP)and calcitonin]were compared between the two groups before and after treatment.Results The total effective rate of patients in the observation group was 95.56%,which was significantly higher than that in the control group(82.22%),and the difference was statistically significant(P<0.05).There were no significant differences in knee function score,knee range of motion and VAS score between the two groups before treatment(P>0.05).Six months after treatment,knee function score and knee motion in the observation group were(91.18±6.88)points,(105.88±14.07)°,which were significantly higher than those in the control group[(80.01±10.178)points,(88.33±8.47)°],and the VAS score was(1.01±0.47)points,which were significantly lower than those in the control group[(2.33±0.68)points],and the differences were statistically significant(P<0.05).There were no significant differences in the levels of osteocalcin,PICP,BALP and calcitonin between the two groups before treatment(P>0.05).The levels of osteocalcin,PICP,BALP and calcitonin in observation group were(4.57±0.63)μg/L,(153.68±19.58)μg/L,(317.55±40.38)U/L,(69.44±9.74)μg/L,which were significantly higher than those in the control group[(3.87±0.44)μg/L,(137.18±16.55)μg/L,(229.74±27.55)U/L,(53.47±9.17)μg/L],and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between the observation group and the control group(4.44%vs.11.11%)(P>0.05).Conclusion Arthroscopy combined with sodium hyaluronate has a good effect on meniscus injury,which can adjust the level of serum bone markers in patients with definite clinical effect and is worthy of application.