关节镜下清理术与透明质酸钠关节内注射治疗膝骨关节炎

目的：探讨关节镜下清理术（arthroscopic debridement， AS）和透明质酸钠关节内注射(intra-articular sodium hyaluronate injection，SHI)治疗膝骨关节炎(KOA)的临床疗效，以及治疗前后血清和关节液中IL-1和NO水平的变化。方法：将轻、中度KOA患者69例，随机采用AS组32例（41膝）和SHI组37例（48膝）治疗，并收集治疗前后血清和膝关节液测定IL-1和NO。膝关节功能用Lysholm评分。IL-1测定为常规ELSIA法，NO测定用硝酸还原酶法。结果：AS和SHI治疗后随访1年，每组Lysholm评分与治疗前比较均有提高，差异均有显著性（P<0.05），AS治疗组的优良率（78.0%）显著高于SHI治疗组（58.3%）；每组治疗后关节液和血清中IL-1、NO水平均较治疗前降低，两组比较差异亦有显著性（P<0.05）。结论：AS和SHI均能使患膝Lysholm的功能评分较治疗前提高，均能降低关节液和血清中炎性介质浓度，都是KOA的有效治疗方法；但在KOA功能改善方面AS更优于SHI。

Treatment of knee osteoarthritis with arthroscopic debridement and intra-articular sodium hyaluronate injection

Objective To study the curative effect of arthroscopic debridement(AS) and intra-articular sodiumhyaluronate injection for patients suffering fromknee osteoarthritis(KOA) and explore their influences onthe levelsof interleukin-1(IL-1) and nitric oxide(NO) in serumand synovial fluid.Methods 69 patients with grade Ⅰtograde Ⅲ KOA were randomly divided into AS group(n=32) and SHI group(n=37).All of the cases wereesti mated by Lyshol mscoring scale pre-intervetion and 1 year post-intervetion,and then serum and synovial fluidwere collected to detect the levels of IL-1 and NObefore and after therapy,respectively,with Nitrate reductase andenzyme-linked i mmuneoabsordent assay(ELISA).Results Lyshol m scores in the two groups were significantlydifferent between pre-operation and post-operation(P<0.05),and the rate of satisfaction one year post-operationin AS group was 78.0 %,superior to 58.3 %in SHI group.In addition,before therapy,levels of IL-1 and NOinsynovial fluid were obviously higher than those in serum in KOA patients(P<0.05).There were significantdifferences of levels of IL-1 and NO in serum and synovial fluid between pre-operation and post-operation(P<0.05).Conclusion Both AS and SHI canincrease the Lyshol mscore in KOA patlents,decrease the levels of IL-1and NOin serumand synovial fluid.ASis superior to SHI in functional i mprovement.