切换至 "中华医学电子期刊资源库"

中华损伤与修复杂志(电子版) ›› 2022, Vol. 17 ›› Issue (03) : 227 -232. doi: 10.3877/cma.j.issn.1673-9450.2022.03.008

论著

关节镜清理术联合药物注射治疗膝关节骨性关节炎的临床疗效观察
康靖东1, 王明新2,()   
  1. 1. 102413 北京核工业医院骨科
    2. 100037 北京,解放军总医院第三医学中心骨关节科
  • 收稿日期:2022-03-16 出版日期:2022-06-01
  • 通信作者: 王明新
  • 基金资助:
    国家重点研发计划(2018YFF0301101)

Clinical observation of arthroscopic debridement combined with drug injection in the treatment of knee osteoarthritis

Jingdong Kang1, Mingxing Wang2,()   

  1. 1. Department of Orthopedics, Beijing Nuclear Industry Hospital, Beijing 102413, China
    2. Department of Bone and Joint, Third Medical Center, PLA General Hospital, Beijing 100037, China
  • Received:2022-03-16 Published:2022-06-01
  • Corresponding author: Mingxing Wang
引用本文:

康靖东, 王明新. 关节镜清理术联合药物注射治疗膝关节骨性关节炎的临床疗效观察[J/OL]. 中华损伤与修复杂志(电子版), 2022, 17(03): 227-232.

Jingdong Kang, Mingxing Wang. Clinical observation of arthroscopic debridement combined with drug injection in the treatment of knee osteoarthritis[J/OL]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2022, 17(03): 227-232.

目的

探讨关节镜清理术联合关节腔内药物注射治疗膝关节骨性关节炎(KOA)的临床疗效。

方法

回顾性分析2015年10月至2019年10月因KOA于北京核工业医院行关节镜清理手术治疗的60例患者。按治疗方法不同将其分为对照组(n=30)和实验组(n=30)。对照组采用关节镜清理术治疗,在麻醉下采用常规膝前内、外侧入路作长度约5 mm的手术切口并对患膝进行穿刺,穿刺成功后置入关节镜保护套管,注入适量灌注液使关节腔扩张充盈后置入关节镜镜头,视关节内病损情况取出游离体。冲洗关节腔,吸净关节腔内的液体后缝合加压包扎切口。实验组在关节镜清理术(同对照组)的基础上,术后即刻给予2 mL医用几丁糖+1 mL复方倍他米松注射液行关节腔内注射治疗,此后每2周关节腔内注射治疗1次,共连续治疗3次。观察记录2组患者术后6周内关节肿胀与再手术例数;比较2组患者术前、术后6周膝关节疼痛程度与膝关节功能评分,膝关节疼痛程度采用疼痛视觉模拟评分法(VAS)评定,膝关节功能活动情况依据膝关节功能Lysholm评分标准评定。比较2组患者术后6周C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)炎性指标的水平。数据采用独立样本t检验、配对样本t检验及χ2检验。

结果

60例患者手术均获成功。术后6周内,对照组有1例重度、2例中度、2例轻度关节肿胀,实验组有1例中度、2例轻度关节肿胀,2组比较差异无统计学意义(χ2=1.347,P=0.246);术后6周内对照组9例,实验组8例再手术治疗,再手术例数比较差异无统计学意义(χ2=1.405,P=0.263);对照组患者术后6周VAS评分较术前显者降低,而Lysholm评分较术前显著升高,差异均有统计学意义(t=12.385、9.173,P<0.05);实验组患者手术前后VAS评分、Lysholm评分与对照组患者变化趋势相同,差异均有统计学意义(t=13.665、11.196,P<0.05)。术前2组患者VAS评分、Lysholm评分比较,差异均无统计学意义(t=0.174、0.105,P>0.05);术后6周,实验组患者VAS评分[(2.47±1.13)分]低于对照组患者[(3.25±1.37)分],而Lysholm评分[(86.36±11.05)分]高于对照组患者[(73.14±12.08)分],差异均有统计学意义(t=7.301、5.415,P<0.05)。术后6周,实验组患者CRP、IL-6、TNF-α分别为(11.13±3.36) mg/L、(2.03±0.22) ng/L、(4.92±2.56) pg/mL,均较对照组[(14.75±5.32) mg/L、(5.17±1.94) ng/L、(7.18±1.98) pg/mL)]低,差异均有统计学意义(t=3.938、5.125、6.741,P<0.05)。

结论

关节镜清理术联合医用几丁糖及复方倍他米松注射液治疗KOA可有效缓解疼痛,改善膝关节功能活动,疗效满意。

Objective

To investigate the clinical effect of arthroscopic debridement combined with intra-articular drug injection in the treatment of knee osteoarthritis (KOA).

Methods

Sixty patients who underwent arthroscopic debridement in Beijing Nuclear Industry Hospital due to KOA from October 2015 to October 2019 were analyzed retrospectively. According to different treatment methods, they were divided into the control group (n=30) and the experimental group (n=30). The control group was treated with arthroscopic debridement. Under the corresponding anesthesia, the conventional anterior medial and lateral approaches of the knee were used to make a surgical incision with a length of about 5 mm, and the affected knee was punctured. After the puncture was successful, the arthroscopic protective sleeve was placed, an appropriate amount of perfusion fluid was injected to expand and fill the joint cavity, and then the arthroscopic lens was placed to observe the situation. According to the condition of intra-articular lesions, and the loose body was taken out. The joint cavity was rinsed, the fluid in the joint cavity was vacuumed, and then the compression dressing incision was sutured. On the basis of arthroscopic debridement (the same as the control group), the experimental group was given 2 mL medical chitosan+ 1 mL compound betamethasone injection for intra-articular injection immediately after operation. After that, it was injected once every 2 weeks for a total of 3 consecutive times. The cases of joint swelling and reoperation in the two groups within 6 weeks after operation were observed and recorded. The degree of knee pain and knee function score were compared between the two groups before and 6 weeks after operation. The degree of knee pain was evaluated by visual analogue scale (VAS), and the knee function activity was evaluated according to Lysholm score standard. The levels of C-reactive protein (CRP), interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α) inflammatory indexes were compared between the two groups at 6 weeks after operation. Data were processed with independent sample t test, paired sample t test and chi-square test.

Results

The operation was successful in 60 patients. Within 6 weeks after operation, there were 1 case severe, 2 cases moderate and 2 cases mild joint swelling in the control group, and 1 case moderate and 2 cases mild joint swelling in the experimental group, but there was no statistically significant difference (χ2=1.347, P=0.246). Within 6 weeks after operation, 9 cases in the control group and 8 cases in the experimental group were reoperated. There was no statistically significant difference in the number of reoperated cases (χ2=1.405, P=0.263). The VAS score of the control group was significantly lower than that before operation, while the Lysholm score was significantly higher than that before operation (t=12.385, 9.173; P<0.05). The change trend of VAS score and Lysholm score in the experimental group before and after operation were the same as those in the control group (t=13.665, 11.196; P<0.05). There were no statistically significant differences in VAS score and Lysholm score between the two groups before operation (t=0.174, 0.105; P>0.05). Six weeks after operation, the VAS score [(2.47±1.13) points] in the experimental group was lower than that in the control group [(3.25±1.37) points], while the Lysholm score [(86.36 ± 11.05) points] was higher than that in the control group [(73.14 ±12.08) points], and the differences were statistically significant (t=7.301, 5.415; P<0.05). Six weeks after operation, CRP, IL-6 and TNF-α in the experimental group were (11.13±3.36) mg/L, (2.03±0.22) ng/L and (4.92 ± 2.56) pg/mL respectively, which were lower than those in the control group [(14.75 ± 5.32) mg/L, (5.17±1.94) ng/L and (7.18±1.98) pg/mL], the differences were statistically significant (t=3.938, 5.125, 6.741; P<0.05).

Conclusion

Arthroscopic debridement combined with medical chitosan and compound betamethasone injection in the treatment of KOA can effectively alleviate pain and improve knee function and activity, and the curative effect is satisfactory.

表1 2组行膝关节镜清理手术治疗的KOA患者一般资料的比较
表2 2组行膝关节镜清理手术治疗的KOA患者术前、术后6周VAS评分、Lysholm评分比较(分,±s)
表3 2组行膝关节镜清理手术治疗的KOA患者术后6周CRP、IL-6及TNF-α水平比较(±s)
[2]
杨彦飞,周新,周静,等. 透明质酸联合糖皮质激素关节腔注射治疗膝关节骨关节炎的短期疗效[J]. 中化骨科杂志 2020, 40(10): 644-652.
[3]
石晓兵,支晓丞,吴小建,等. 医用几丁糖分期治疗膝骨性关节炎的临床研究[J]. 中国中医骨伤科杂志 2018, 26(6): 48-50, 55.
[4]
中华医学会风湿病学分会. 骨关节炎诊断及治疗指南[J]. 中华风湿病学杂志 2010, 14(6): 416-419.
[5]
Rousing R, Hansen KL, Andersen MO, et al. Twelve-months follow-up in forty-nine patients with acute/semiacute osteoporotic vertebral fractures treated conservatively or with percutaneous vertrbroplasty:a clinical randomized study[J]. Spine(Phila Pa 1976), 2010, 35(5): 478-482.
[6]
岳梦甜,孟银芝,刘静. 基于5E康复模式的护理干预对预防下肢骨折患者下肢深静脉血栓形成的应用效果分析[J]. 黑龙江医学 2022, 46(6): 753-755.
[7]
张宏,王旭昀,郑伟康,等. 药物治疗膝骨关节炎的研究进展[J]. 中国医药导报 2018, 15(27): 38-41.
[8]
刘峰. 硫酸氨基葡萄糖胶囊治疗膝骨关节炎的疗效观察[J]. 中国医药指南 2017, 15(31): 100-101.
[9]
蒋彦彦. 中药熏洗配合手法按摩治疗膝骨性关节炎临床观察[J]. 光明中医 2021, 36(2): 243-245.
[10]
宣懂,肖启贤,李江文,等. 关节镜下有限与广泛膝关节清理术治疗膝关节骨性关节炎的疗效对比[J]. 当代医药论丛 2022, 20(4): 42-45.
[11]
倪磊,昌厚山,陈坚. 膝关节镜术后再手术原因分析[J]. 中华骨科杂志 2004, 24(3): 150-153.
[12]
何玉祥,冯文涛,李松伦,等. 复方倍他米松联合塞来昔布治疗膝关节骨性关节炎的临床研究[J]. 现代药物与临床 2019, 34(6): 1839-1842.
[13]
范连彬,李飞. 针刺结合玻璃酸钠关节腔内注射治疗血瘀型膝骨性关节炎[J]. 吉林中医药 2017, 37(12): 1264-1266.
[1]
李智,代合炎,李煜. 关节腔内注射复方倍他米联合医用几丁糖治疗膝关节骨性关节炎的临床效果探讨[J]. 医药前沿 2021, 11(12): 43-44.
[1] 纪小孟, 刘璠, 唐晓波, 卞为伟, 董佩龙, 刘振鲁. 两种手术方式治疗肩袖撕裂合并粘连性肩关节囊炎[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 561-567.
[2] 许银峰, 盛璞义, 余世明, 张阳春. 偏心性髋臼旋转截骨术治疗发育性髋关节发育不良[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 568-574.
[3] 刘鹏, 罗天, 许珂媛, 邓红美, 李瑄, 唐翠萍. 八段锦对膝关节炎疗效的初步步态分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 590-595.
[4] 苏介茂, 齐岩松, 王永祥, 魏宝刚, 马秉贤, 张鹏飞, 魏兴华, 徐永胜. 关节镜手术在早中期膝骨关节炎治疗的应用进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 646-652.
[5] 谢佳乐, 李琦, 芦升升, 姜劲松. 内侧膝骨关节炎伴胫股关节冠状半脱位的手术治疗[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 653-657.
[6] 杨滢甄, 黄子荣, 梁家敏, 黄晓芳, 胡艳, 朱伟民. 膝关节前交叉韧带重建术前康复治疗的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 538-544.
[7] 庄若语, 杭明辉, 李文华, 张霆, 侯炜. 膝骨关节炎半定量磁共振评分研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 545-552.
[8] 王振宇, 张洪美, 荆琳, 何名江, 闫奇. 膝骨关节炎相关炎症因子与血浆代谢物间的因果关系及中介效应[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 467-473.
[9] 王典, 刘双赫, 曾峥. 肩关节镜术后肌肉功能改变对颈椎形态及矢状面参数影响的自身前后对照队列研究[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(05): 371-378.
[10] 曲洋, 蒋浩然, 邢博涵, 张蒙, 张培训. 肩袖损伤的治疗进展[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 289-291.
[11] 宋庆成, 郑占乐, 王天瑞, 王宇钏, 张凯旋, 纳静, 蔚佳昊, 杨思繁, 宋九宏, 张英泽. “人老膝不老”:膝关节健康管理的全方位探索与实践[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 321-324.
[12] 郑占乐, 王宇钏, 蔚佳昊, 宋庆成, 张凯旋, 纳静, 王天瑞, 宋九宏, 张英泽, 王娟. 保膝须“开膝”——“开膝”在膝骨关节炎中的临床应用价值[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 325-330.
[13] 高广涵, 张耀南, 石磊, 王林, 王飞, 郑子天, 王鸿禹, 郭民政, 薛庆云. 膝骨关节炎患者前交叉韧带功能影像学影响因素分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 301-307.
[14] 王浩汀, 尚运涛, 曹光, 张延祠, 李军勇. 胫骨高位截骨联合关节镜与单髁置换治疗单间室膝关节骨性关节炎的临床疗效比较[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(04): 229-236.
[15] 于晓光, 秦永辉, 李佳, 贾国兴, 李军, 赵振栓, 刘国彬. 人工单髁置换术治疗膝关节内侧间室骨关节炎合并前交叉韧带功能不良的近期疗效[J/OL]. 中华临床医师杂志(电子版), 2024, 18(04): 337-342.
阅读次数
全文


摘要