关节镜下清理术联合三联针关节注射对老年骨性关节炎患者膝关节功能及复发的影响

Effect of arthroscopic debridement combined with triple needle joint injection on knee joint function and recurrence of elderly patients with knee osteoarthritis

目的探讨关节镜下清理术联合三联针关节注射对老年膝骨关节炎(KOA)患者关节功能及复发的影响。方法选择黔东南州人民医院2019年4月至2020年4月收治的115例老年KOA患者为研究对象,根据治疗方式将患者分为单纯手术组(n=55)和联合治疗组(n=60);单纯手术组患者给予关节镜下清理术治疗,联合治疗组患者给予关节镜下清理术和三联针关节注射(每周注射1次,共注射2次)治疗。分别于治疗前和治疗后抽取2组患者关节腔内关节液4 mL,采用酶联免疫吸附法检测关节液中肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)水平。分别于治疗前、治疗后4周、治疗后6个月采用视觉模拟评分(VAS)法评估2组患者膝关节疼痛程度,采用Lysholm评分评估2组患者膝关节功能。治疗后评估2组患者的临床疗效,并记录术后并发症及1 a内复发情况。结果治疗前2组患者关节液中TNF-α、IL-1β、IL-6水平比较差异无统计学意义(P>0.05)。2组患者治疗后关节液中TNF-α、IL-1β、IL-6水平显著低于治疗前(P<0.05)。治疗后,联合治疗组患者关节液中TNF-α、IL-1β、IL-6水平显著低于单纯手术组(P<0.05)。治疗前2组患者的VAS、Lysholm评分比较差异无统计学意义(P>0.05)。治疗后4周及治疗后6个月,2组患者的VAS评分均显著低于治疗前,Lysholm评分均显著高于治疗前(P<0.05);2组患者治疗后6个月时的VAS评分显著低于治疗后4周,Lysholm评分显著高于治疗4周(P<0.05)。治疗后4周及治疗后6个月,联合治疗组患者的VAS评分显著低于单纯手术组,Lysholm评分显著高于单纯手术组(P<0.05)。联合治疗组患者的治疗总有效率显著高于单纯手术组(χ^(2)=10.044,P<0.05)。2组患者术后关节肿胀、关节内血肿、患肢静脉炎等并发症发生率比较差异无统计学意义(χ^(2)=20.438、0.259、0.003,P>0.05)。单纯手术组和联合治疗组患者1 a内复发率分别为14.55%(8/55)、1.67%(1/60),联合治疗组患者1 a内复发率显著低于单纯手术组(χ^(2)=6.598,P<0.05)。结论关节镜下清理术联合三联针关节注射治疗老年KOA患者的临床疗效显著,可进一步减轻患者疼痛程度,提高患者膝关节功能,降低关节液中炎症因子水平,且安全性高,复发率低。

Objective To investigate the effect of arthroscopic debridement combined with triple needle joint injection on knee joint function and recurrence of elderly patients with knee osteoarthritis(KOA).Methods A total of 115 elderly patients with KOA admitted to Qiandongnan People′s Hospital from April 2019 to April 2020 were selected as the research objects.The patients were divided into the simple operation group(n=55)and the combined treatment group(n=60)according to the treatment method.The patients in the simple operation group were treated with arthroscopic debridement,the patients in the combined treatment group were treated with arthroscopic debridement and triple needle joint injection(once a week,twice in total).Before and after treatment,4 mL of joint fluid in the joint cavity of patients in the two groups were extracted,and the levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interleukin-6(IL-6)in the joint fluid were detected by enzyme-linked immunosorbent assay.Before treatment and 4 weeks,6 months after treatment,the degree of knee joint pain was assessed by visual analogue scale(VAS),and the knee joint function was assessed by Lysholm score.The clinical efficacy of patients in the two groups was evaluated after treatment and the postoperative complications,the recurrence within 1 year were recorded.Results There was no significant difference in TNF-α,IL-1β,and IL-6 levels in the joint fluid of patients between the two groups before treatment(P>0.05).The levels of TNF-α,IL-1β,and IL-6 in the joint fluid of patients after treatment were significantly lower than those before treatment in the two groups(P<0.05).The levels of TNF-α,IL-1β,and IL-6 in the joint fluid of patients in the combined treatment group were significantly lower than those in the simple operation group after treatment(P<0.05).There was no significant difference in the VAS and Lysholm scores of patients between the two groups before treatment(P>0.05).At 4 weeks and 6 months after treatment,the VAS scores of patients were significantly lower than those before treatment,and the Lysholm scores were significantly higher than those before treatment in the two groups(P<0.05).The VAS scores of patients in the two groups at 6 months after treatment were significantly lower than those at 4 weeks after treatment,and the Lysholm scores were significantly higher than those at 4 weeks after treatment(P<0.05).At 4 weeks and 6 months after treatment,the VAS score of patients in the combined treatment group was significantly lower than that in the simple operation group,and the Lysholm score was significantly higher than that in the simple operation group(P<0.05).The total effective rate of patients in the combined treatment group was significantly higher than that in the simple operation group(χ^(2)=10.044,P<0.05).There was no significant difference in the incidence of complications such as joint swelling,intra-articular hematoma,and phlebitis of the affected limbs of patients between the two groups(χ^(2)=20.438,0.259,0.003;P>0.05).The recurrence rate of patients in the simple operation group and the combined treatment group were 14.55%(8/55)and 1.67%(1/60),respectively within 1 year;the recurrence rate of patients in the combined treatment group was significantly lower than that in the simple operation group(χ^(2)=6.598,P<0.05).Conclusion Arthroscopic debridement combined with triple needle joint injection has a significant therapeutic effect in the treatment of elderly KOA patients,which can further reduce the pain degree of patients,improve the joint function,reduce the level of inflammatory factors in joint fluid of patients,and the safety is higher,the recurrence rate is low.