关节镜手术与透明质酸钠联合治疗老年膝骨关节炎患者的效果分析

Effect analysis of arthroscopic surgery combined with sodium hyaluronate in the treatment of knee osteoarthritis in the elderly

目的 分析对老年膝骨关节炎患者开展关节镜手术与透明质酸钠联合治疗的可行性,并探究所获取的治疗效果。方法 84例老年膝骨关节炎患者,通过随机抽签的方式分为研究组及参照组,每组42例。研究组患者开展关节镜手术与透明质酸钠联合治疗,参照组患者采用关节镜手术单独治疗。对比两组疗效,治疗前后的炎症指标[白细胞介素-6 (IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)]、代谢指标[软骨寡聚基质蛋白(COMP)、Ⅱ型胶原交联羧基端肽(CTX-Ⅱ)、基质金属蛋白酶(MMP-3)]、各项评分[视觉模拟评分法(VAS)评分、Lyshlom评分],手术和术后指标。结果 研究组治疗总有效率97.62%较参照组的78.57%高,具有统计学差异(P<0.05)。治疗后,研究组患者的TNF-α(1.52±0.99)μg/L、IL-6(87.93±22.54)μg/L、hs-CRP(23.17±11.86)mg/L较参照组的(2.38±1.43)μg/L、(106.48±21.37)μg/L、(34.44±12.75)mg/L低,具有统计学差异(P<0.05)。治疗后,研究组患者的CTX-Ⅱ(419.73±48.40)μg/L、COMP(2.96±0.50)μg/L、MMP-3(2.75±0.53)μg/L较参照组的(507.48±46.74)、(3.82±0.57)、(3.26±0.52)μg/L低,具有统计学差异(P<0.05)。治疗后,研究组的VAS评分(1.44±0.63)分较参照组的(3.77±1.06)分低, Lysholm评分(84.30±8.57)分较参照组的(72.64±8.35)分高,具有统计学差异(P<0.05)。研究组手术用时(56.03±7.25)min长于参照组的(50.13±6.84)min,关节愈合时间(10.34±2.09)周、完全负重功能锻炼时间(12.58±2.37)周、住院天数(8.37±1.26)d短于参照组的(14.17±2.32)周、(16.73±2.52)周、(10.23±1.63)d,具有统计学差异(P<0.05);两组术中出血量对比,无意义(P>0.05)。结论 关节镜手术与透明质酸钠联合治疗老年膝骨关节炎的效果更突出,减轻疼痛程度的同时关节功能、关节功能、炎症指标均得到较大程度的改善,临床应用价值极高,可广泛推行。

Objective To analyze the feasibility of arthroscopic surgery combined with sodium hyaluronate in the treatment of knee osteoarthritis in the elderly,and to explore the therapeutic effect.Methods 84 elderly patients with knee osteoarthritis were divided into a study group and a reference group by random lottery method,with 42 cases in each group.The study group performed arthroscopic surgery combined with sodium hyaluronate.The reference group was treated by arthroscopic surgery alone.Both groups were compared in terms of efficacy,inflammation indicators[interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α)],metabolic indicators[cartilage oligomeric matrix protein(COMP),carboxy-terminal telopeptide of typeⅡcollagen(CTX-Ⅱ),matrix metalloproteinase-3(MMP-3)],various scores[visual analogue scale(VAS)score,Lyshlom score]before and after treatment,surgical and postoperative indicators.Results The total effective rate of 97.62%in the study group was higher than 78.57%in the reference group,and there was statistical difference(P<0.05).After treatment,the study group had TNF-αof(1.52±0.99)μg/L,IL-6 of(87.93±22.54)μg/L and hs-CRP of(23.17±11.86)mg/L,which were lower than(2.38±1.43)μg/L,(106.48±21.37)μg/L and(34.44±12.75)mg/L in the reference group,and there was statistical difference(P<0.05).After treatment,the study group had CTX-Ⅱof(419.73±48.40)μg/L,COMP of(2.96±0.50)μg/L,and MMP-3 of(2.75±0.53)μg/L,which were lower than(507.48±46.74),(3.82±0.57),and(3.26±0.52)μg/L in the reference group,and there was statistical difference(P<0.05).After treatment,the study group had lower VAS score of(1.44±0.63)points than(3.77±1.06)points in the reference group,and higher Lysholm score of(84.30±8.57)points than(72.64±8.35)points in the reference group.There was statistical difference(P<0.05).The operation time of(56.03±7.25)min in the study group was longer than(50.13±6.84)min in the reference group;in the study group,the joint healing time was(10.34±2.09)weeks,the full weight-bearing exercise time was(12.58±2.37)weeks and the hospitalization days was(8.37±1.26)d,which were shorter than(14.17±2.32)weeks,(16.73±2.52)weeks and(10.23±1.63)d in the control group;there was statistical difference(P<0.05).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).Conclusion Arthroscopic surgery combined with sodium hyaluronate in the treatment of knee osteoarthritis in the elderly has a more prominent effect,which can reduce the pain level while improving joint function,joint function and inflammation indicators to a greater extent,which is of high clinical application value and can be widely implemented.