关节镜下关节清理术联合腓骨近端截骨对膝关节骨性关节炎患者关节功能及炎性因子的影响

简蔚泓 丁健 冯捷 廖学勤

[摘要] 目的 探讨关节镜下关节清理术联合腓骨近端截骨对膝关节骨性关节炎患者关节功能及炎性因子的影响。方法 采用便利抽样法，选取我院2016年1月～2019年1月收治的60例膝关节骨性关节炎患者作为研究对象，按照随机数字表法分为研究组与对照组，各30例。对照组患者采用膝关节镜下关节清理术治疗，研究组采用膝关节镜下关节清理术联合腓骨近端截骨治疗。比较两组患者治疗前、治疗后6个月的膝关节功能评分及炎性因子IL-1β、IL-6、TNF-α水平，统计两组的并发症发生率。 结果 两组治疗前的HSS评分比较，差异无统计学意义（P>0.05）;两组治疗后的HSS评分高于治疗前，差异有统计学意义（P<0.05）;研究组治疗后的HSS评分高于对照组，差异有统计学意义（P<0.05）。两组治疗前的IL-1β、IL-6、TNF-α水平比较，差异无统计学意义（P>0.05）;两组治疗后的IL-1β、IL-6、TNF-α水平低于治疗前，差异有统计学意义（P<0.05）;研究组治疗后的IL-1β、IL-6、TNF-α水平低于对照组，差异有统计学意义（P<0.05）。两组的并发症发生率比較，差异无统计学意义（P>0.05）。 结论 关节镜下关节清理术联合腓骨近端截骨能够改善膝关节骨性关节炎患者的关节功能及炎性因子水平，值得临床应用。

[关键词] 膝关节骨性关节炎;关节镜下关节清理术;腓骨近端截骨;关节功能;炎性因子

[中图分类号] R687.3          [文献标识码] B          [文章编号] 1673-9701（2019）33-0075-04

[Abstract] Objective To investigate the effects of arthroscopic joint debridement combined with proximal humerus osteotomy on joint function and inflammatory factors in patients with knee osteoarthritis. Methods Sixty patients with knee osteoarthritis admitted to our hospital from January 2016 to January 2019 were enrolled in the study by convenient sampling method. The patients were divided into study group and control group， with 30 cases in each group according to the random number table method. The patients in the control group underwent arthroscopic joint debridement. The study group underwent arthroscopic joint debridement combined with proximal humerus osteotomy. The knee function scores and inflammatory factors IL-1β， IL-6 and TNF-α were compared before treatment and 6 months after treatment. The incidence of complications was statistically analyzed. Results There was no significant difference in HSS scores between the two groups before treatment （P>0.05）. The HSS scores of the two groups after treatment were higher than those before treatment， and the difference was statistically significant （P<0.05）. The HSS scores of the study group after treatment were higher than those of the control group， and the difference was statistically significant（P<0.05）. There was no significant difference in the levels of IL-1β， IL-6 and TNF-α between the two groups before treatment（P>0.05）. The levels of IL-1β， IL-6 and TNF-α in the two groups were lower than those before treatment， and the difference was statistically significant （P<0.05）. The levels of IL-1β， IL-6 and TNF-α in the study group were significantly lower than those in the control group after treatmetn（P<0.05）. There was no significant difference in the incidence of complications between the two groups （P>0.05）. Conclusion Arthroscopic joint debridement combined with proximal humerus osteotomy can improve the joint function and inflammatory factor levels in patients with knee osteoarthritis， which is worthy of clinical application.

3讨论

膝关节骨性关节炎是由衰老、外伤、肥胖、遗传、炎症、代谢等多种原因引起的关节软骨损伤、软骨下骨质变及囊腔变、关节边缘骨赘形成，可伴随滑膜增生，关节囊及周围韧带蜕变、纤维化、萎缩，最终可致关节面被完全破坏、变形。膝关节骨性关节炎的主要病理改变是软骨损伤，且具有不可逆性，给患者的日常生活及工作带来严重影响，导致患者的生活质量下降，并给患者带来了严重的经济及社会负担。