富血小板血浆联合深层肌肉刺激对早期膝骨关节炎患者平衡功能及炎症水平的影响

Effects of platelet-rich plasma combined with deep muscle stimulation on balance function and inflammation level in patients with early knee osteoarthritis

目的观察富血小板血浆联合深层肌肉刺激对早期膝骨关节炎患者平衡功能及炎症水平的影响。方法前瞻性选取2021年10月至2022年10月忻州市人民医院收治的60例早期膝骨关节炎患者为研究对象,采用奇偶数分组法将患者分为两组:肌肉刺激组28例和联合组32例。两组均进行常规康复治疗,肌肉刺激组给予深层肌肉刺激干预,联合组在肌肉刺激组基础上联合富血小板血浆治疗。比较两组患肢平均肌电值(AEMG)、Berg评分、西大略和麦克马斯特大学骨关节炎指数(WOMAC)评分及炎症因子[红细胞沉降率(ESR)、超敏C反应蛋白(hs-CRP)、白细胞介素(IL)-6、IL-1β]水平差异,计算两组足底不同部位最大压力差值。结果治疗后,两组ESR、hs-CRP、IL-6、IL-1β水平均较治疗前明显下降,且联合组ESR、hs-CRP、IL-6、IL-1β水平分别为(13.11±2.08)mm/h、(3.65±0.57)mg/L、(58.25±9.22)pg/mL、(38.89±4.77)ng/L,均低于肌肉刺激组[(16.58±3.22)mm/h、(5.52±1.04)mg/L、(79.05±11.33)pg/mL、(44.52±5.85)ng/L],差异均有统计学意义(P<0.05)。治疗后,两组患肢股外侧肌(VL)、股直肌(RF)、股内侧肌(VMO)及股二头肌(BF)的AEMG均明显较治疗前升高,且联合组分别为(62.47±13.05)、(79.66±10.17)、(70.21±13.65)、(70.66±13.65)mV,均高于肌肉刺激组[(51.02±10.33)、(68.47±9.85)、(62.98±14.17)、(64.25±15.02)mV],差异均有统计学意义(P<0.05)。治疗后,两组Berg评分较治疗前均明显升高,WOMAC评分较治疗前均明显下降,且联合组Berg评分为(53.31±4.03)分,高于肌肉刺激组[(49.95±3.67)分],WOMAC评分为(10.77±1.68)分,低于肌肉刺激组[(14.23±2.11)分],差异均有统计学意义(P<0.05)。治疗后,联合组足底不同部位最大压力差值均小于肌肉刺激组,差异均有统计学意义(P<0.05)。结论富血小板血浆联合深层肌肉刺激可改善早期膝骨关节炎患者平衡功能,促进膝关节功能的恢复,可能与调节血清因子的表达有关。

Objective To observe the effects of platelet-rich plasma combined with deep muscle stimulation on balance function and inflammation level in patients with early knee osteoarthritis.Methods Sixty patients with early knee osteoarthritis admitted to Xinzhou People's Hospital from October 2021 to October 2022 were retrospectively selected as subjects and divided into two groups by odd-even grouping method:28 cases in the muscle stimulation group and 32 cases in the combination group.Both groups received routine rehabilitation treatment,the muscle stimulation group was given deep muscle stimulation intervention,and the combination group was combined with platelet-rich plasma therapy on the basis of the muscle stimulation group.The averaged electromyography(AEMG),Berg score,Western Ontario and McMaster University Osteoarthritis Index(WOMAC)score and the levels of inflammatory factors[erythrocyte sedimentation rate(ESR),hypersensitive C-reactive protein(hs-CRP),interleukin(IL)-6 and IL-1β]were compared between the two groups,and the maximum pressure difference in different parts of the plantar between the two groups was calculated.Results After treatment,the levels of ESR,hs CRP,IL-6,IL-1βof the two groups were significantly lower than those before treatment,and those in the combination group were(13.11±2.08)mm/h,(3.65±0.57)mg/L,(58.25±9.22)pg/mL,and(38.89±4.77)ng/L,respectively,which were lower than those in the muscle stimulation group[(16.58±3.22)mm/h,(5.52±1.04)mg/L,(79.05±11.33)pg/mL,and(44.52±5.85)ng/L],the differences were statistically significant(P<0.05).After treatment,the AEMG of the lateral thigh muscle(VL),rectus femoris muscle(RF),vastus medialis(VMO)and biceps femoris muscle(BF)of the affected limbs in both groups were significantly higher than those before treatment,and the AEMG of the combination group were(62.47±13.05),(79.66±10.17),(70.21±13.65),(70.66±13.65)mV respectively,which were higher than those of the muscle stimulation group[(51.02±10.33),(68.47±9.85),(62.98±14.17),(64.25±15.02)mV],the differences were statistically significant(P<0.05).After treatment,the Berg score of the two groups were significantly higher than those before treatment,while the WOMAC score were significantly lower than thoset before treatment,the Berg score of the combination group was(53.31±4.03)points,which was higher than that of the muscle stimulation group[(49.95±3.67)points],while the WOMAC score was(10.77±1.68)points,which was lower than that of the muscle stimulation group[(14.23±2.11)points],and the differences were statistically significant(P<0.05).The maximum pressure differences of different parts of plantar in combination group were lower than those in muscle stimulation group,and the differences were statistically significant(P<0.05).Conclusion Platelet rich plasma combined with deep muscle stimulation can improve the balance function and promote the recovery of knee function in patients with early knee osteoarthritis,which may be related to regulating the expression of serum factors.