关节镜下清理术联合富血小板血浆治疗中重度膝骨性关节炎的效果研究

doi:10.3969/j.issn.1007-3205.2022.04.007

摘要/Abstract

摘要：

目的探讨关节镜下清理术联合富血小板血浆（platelet rich plasma，PRP）对中重度膝骨性关节炎（knee osteoarthritis，KOA）患者的临床疗效以及对关节腔炎症和氧化应激反应的影响和相关性。

方法选取中重度KOA患者64例为研究对象，按治疗方法分为观察组和对照组各32例。观察组采用关节镜下清理术联合富血小板血浆治疗。对照组采用关节镜下清理术。分别于术前及术后3、12个月采用视觉模拟评分法(visual analogue scale，VAS)评价患者疼痛情况、西安大略和麦克马斯特大学骨关节炎指数（Western Ontario and McMaster Universities Osteoarthritis Index，WOMAC）评估膝关节功能，术前、术后12个月抽取患者关节腔液以观察肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）、白细胞介素8（interleukin-8，IL-8）、超氧化物歧化酶（superoxide dismutase，SOD）、一氧化氮（nitric oxide，NO）水平，记录2组并发症情况。

结果 64例患者随访时间12~14个月，平均（13.0±0.82）个月。2组术前、术后3个月和12个月的组间、时点间、组间与时点间交互作用差异均有统计学意义（P＜0.05）。2组术前、术后3和12个月WOMAC评分组间、时点间、组间与时点间交互作用差异均有统计学意义（P＜0.05）。术后12个月，观察组TNF-α、IL-6、NO水平低于对照组，SOD高于对照组，观察组TNF-α、IL-6、NO水平低于术前，SOD高于术前，差异均有统计学意义（P＜0.05）；对照组与术前比较差异无统计学意义（P＞0.05）。观察组下肢肿胀1例，切口感染1例，对照组下肢肿胀2例，切口感染1例，血栓栓塞1例，经相应治疗后症状及体征均消失。2组并发症发生率比较差异无统计学意义（χ2=0.136，P＞0.05）。

结论关节镜下清理术联合PRP较关节镜下清理术治疗中重度膝骨性关节炎在缓解患膝疼痛、改善功能方面效果更好，并发症发生率较低，这与关节镜下清理术联合PRP可减轻关节腔内的炎症和氧化应激反应有关。

关键词: 骨关节炎, 膝；关节镜下清理术；富血小板血浆

Abstract:

Objective To investigate the therapeutic effect and safety of debridement under arthroscopy combined with platelet-rich plasma(PRP) in patients with moderate to severe knee osteoarthritis(KOA), their impact on joint inflammation and oxidative stress and their correlation.

Methods A total of 64 patients with moderate and severe KOA were selected as the research subjects. According to the treatment methods, they were divided into observation group and control group, with 32 cases in each group. The observation group was treated with arthroscopic debridement combined with PRP. The control group was treated with arthroscopic debridement. Visual analogue scale(VAS) score was used to evaluate the pain relief before operation, and at 3 months and 12 months after operation. Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) was used to evaluate the function of knee joint. The changes of tumor necrosis factor-α(TNF-α), interleukin-8(IL-8), superoxide dismutase(SOD) and nitric oxide(NO) were observed before and at 12 months after operation. The complications of the two groups were recorded.

Results All 64 patients were followed up for 12-14 months, with a mean of(13.0±0.82) months. There were significant differences of interaction between groups, time points, time points between groups before operation, and at 3 months and 12 months after operation(P＜0.05). There were significant differences of interaction between groups, time points, and time points between groups with respect to WOMAC scores before operation, and at 3 and 12 months after operation(P＜0.05). At 12 months after operation, the levels of TNF-α, IL-8 and NO in the observation group were lower than those in the control group, while SOD was higher than that in the control group. In the observation group, the levels of TNF-α, IL-8 and NO were lower than those before operation, and SOD was higher than that before operation, with significant difference(P＜0.05). There was no significant difference before and after operation in the control group(P＞0.05). There was 1 case of lower limb swelling, and 1 case of incision infection in the observation group, as well as 2 cases of lower limb swelling, 1 case of incision infection and 1 case of thromboembolism in the control group. After corresponding treatment, the symptoms and signs disappeared. There was no significant difference in the incidence of complications between the two groups(χ2=0.136, P＞0.05).

Conclusion Compared with arthroscopic debridement, arthroscopic debridement combined with PRP in the treatment of moderate to severe KOA is more effective in relieving knee joint pain and improving knee function, and the incidence of complications is also lower. This may be related to the fact that arthroscopic debridement combined with PRP can reduce inflammation and oxidative stress in the joint cavity.

Key words: osteoarthritis, knee, debridement under arthroscopy, platelet-rich plasma

辜伟. 关节镜下清理术联合富血小板血浆治疗中重度膝骨性关节炎的效果研究[J]. 河北医科大学学报, 2022, 43(4): 402-406，411.

GU Wei. Study on the effect of debridement under arthroscopy combined with platelet-rich plasma in the treatment of moderate to severe knee osteoarthritis[J]. Journal of Hebei Medical University, 2022, 43(4): 402-406，411.

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关节镜下清理术联合富血小板血浆治疗中重度膝骨性关节炎的效果研究

Study on the effect of debridement under arthroscopy combined with platelet-rich plasma in the treatment of moderate to severe knee osteoarthritis

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