全膝关节置换术和关节镜清理术治疗重症膝关节骨关节炎的效果比较

Comparison of therapeutic effect of total knee arthroplasty and arthroscopic debridement on severe knee osteoarthritis

目的比较全膝关节置换术(TKA)和关节镜清理术(AKD)治疗膝关节骨关节炎(KOA)重症患者的临床效果。方法抽取2021年3月至2022年2月开封市中心医院收治的KOA患者106例,按随机数字表法分为AKD组和TKA组,每组53例。AKD组采用AKD治疗,TKA组采用TKA治疗。对比两组治疗效果,围术期指标,血清骨钙素(BGP)、白细胞介素-8(IL-8)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX),视觉模拟评分法(VAS)评分,膝关节功能[膝关节评分(HSS)、美国膝关节协会评分(KSS)]及并发症发生情况。结果TKA组总有效率(94.34%,50/53)高于AKD组(77.36%,41/53),P<0.05;TKA组术中出血量[(207.41±20.14)mL]多于AKD组[(136.98±12.69)mL],住院时间[(7.45±0.74)d]短于AKD组[(10.36±1.06)d],P<0.05;TKA组术后6个月BGP水平[(6.42±0.68)ng/mL]高于AKD组[(5.75±0.56)ng/mL],IL-8水平[(28.79±2.74)pg/mL]、β-CTX水平[(0.42±0.06)ng/mL]低于AKD组[(35.94±3.57)pg/mL]、[(0.58±0.08)ng/mL],P<0.05;术后1、3、6个月,TKA组VAS评分低于AKD组(P<0.05);术后6个月,TKA组HSS、KSS高于AKD组(P<0.05);TKA组并发症发生率与AKD组比较差异未见统计学意义(P>0.05)。结论KOA重症患者应用TKA治疗效果较好,能缩短住院天数,有效减轻机体疼痛,降低IL-8、β-CTX水平,增加BGP含量,改善患者膝关节功能,且术后并发症少。

Objective To compare the treatment effect of total knee arthroplasty(TKA)and arthroscopic debridement(AKD)on patients with severe knee osteoarthritis(KOA).Methods A total of 106 patients with KOA in Kaifeng Central Hospital from March 2021 to February 2022 were selected,and they were divided into AKD group and TKA group according to random number table method,with 53 cases in each group.The AKD group was treated by AKD,while the TKA group was treated by TKA.The therapeutic effect,perioperative indexes,serum osteocalcin(BGP),interleukin-8(IL-8),type Ⅰ collagen carboxyl-terminal peptideβspecial sequence(β-CTX),visual analogue scale(VAS)score,knee function assessed by hospital for special surgery knee score(HSS)and American Knee Society score(KSS),and complications were compared between the two groups.Results The total effective rate of the TKA group(94.34%,50/53)was higher than that of the AKD group(77.36%,41/53),P<0.05.The amount of intraoperative blood loss in the TKA group was(207.41±20.14)mL,higher than the(136.98±12.69)mL in the AKD group(P<0.05);moreover,the length of hospital stay in the TKA group was(7.45±0.74)d,shorter than the(10.36±1.06)d in the AKD group(P<0.05).The level of BGP in the TKA group was(6.42±0.68)ng/mL,higher than the(5.75±0.56)ng/mL in the AKD group 6 months after operation(P<0.05).The levels of IL-8l andβ-CTX in the TKA group were(28.79±2.74)pg/mL and(0.42±0.06)ng/mL,respectively,lower than the(35.94±3.57)pg/mL and(0.58±0.08)ng/mL in the AKD group,correspondingly(P<0.05).Compared with the AKD group,the VAS scores of the TKA group were lower 1,3 and 6 months after surgery(P<0.05).The HSS score and KSS score of the TKA group were higher than those of the AKD group 6 months after operation(P<0.05).There was no significant difference in the incidence of complications between the TKA group and the AKD group(P>0.05).Conclusions TKA can shorten the length of hospital stay,effectively relieve body pain,reduce levels of IL-8 andβ-CTX,increase BGP content,improve knee joint function,and reduce postoperative complications in severe KOA patients.