他克莫司预防老年髋关节置换术后瘢痕粘连的效果观察

目的： 探讨他克莫司联合医用交联高分子透明质酸钠凝胶预防老年髋关节置换术后瘢痕粘连的效果。方法： 选取2018年1月至2020年12月某院收治的84例全髋关节置换术治疗者为对象，随机分为2组，各42例。对照组给予医用交联高分子透明质酸钠凝胶，观察组在对照组基础上给予局部应用他克莫司。比较2组患者术后髋关节功能、疼痛评分及血清白细胞介素-4（IL-4）及转化生长因子-β（TGF-β）水平，观察2组治疗期间不良反应发生情况。结果： 2组患者手术相关指标比较差异均无显著性（P>0.05）。术后7 d、术后1个月、术后6个月观察组患者Harris评分均较对照组升高（75.88±5.53）/（73.25±5.86）、（89.21±6.03）/（83.08±4.69）、（90.22±6.25）/（85.46±5.16）]分，差异均具有显著性（P<0.05）。术后1个月、术后6个月观察组患者VAS评分均高于对照组（3.76±1.02）/（4.25±1.09）、（2.14±0.62）/（3.21±0.87）]分，差异均具有显著（P<0.05）。术后7 d、术后1个月观察组患者血清IL-4、TGF-β均低于对照组（P<0.01）；对照组不良反应发生率为4.76%，观察组为7.14%，2组不良反应发生率比较差异无统计学意义（P=0.645）。结论： 全髋关节置换术中他克莫司联合医用交联高分子透明质酸钠凝胶的关节腔局部应用能改善患者术后关节活动度，起到预防术后瘢痕粘连形成的作用，可改善术后疼痛程度，其机制可能与下调IL-4、TGF-β水平有关。

Effect of tacrolimus combined with medical crosslinked polymer sodium hyaluronate gel on prevention of scar adhesion after hip replacement in elderly patients

OBJECTIVE To study the effect of tacrolimus combined with medical crosslinked polymer sodium hyaluronate gel on prevention of scar adhesion after hip replacement in elderly patients.METHODS 84 patients with total hip replacement in our hospital from January 2018 to December 2020 were randomly divided into two groups, 42 cases in each group.The control group was treated with medical crosslinked polymer sodium hyaluronate gel, and the observation group was given topical tacrolimus on the basis of the control group.The hip function, pain score, serum interleukin-4(IL-4) and transforming growth factor were compared between the two groups- β(TGF- β) level.The incidence of adverse reactions in the two groups were observed.RESULTS There was no significant difference in operation related indexes between the two groups(P>0.05).7 days, 1 month and 6 months after operation, the score of Harris was higher in the observation group than that of the control group(75.88±5.53)/(73.25±5.86), (89.21±6.03)/(83.08±4.69), (90.22±6.25)/(85.46±5.16)], There were significant differences(all P<0.05).One month and six months after operation, the score of VAS score was higher in the observation group than that of the control group(3.76±1.02)/(4.25±1.09), (2.14±0.62)/(3.21±0.87)], the differences were significant(all P<0.05).7 days and 1 month after operation, the serum levels of IL-4 and TGF- β in the observation group were higher than those in the control group They were lower than those in the control group(P<0.01); The incidence of adverse reactions was 4.76% in the control group and 7.14% in the observation group.There was no significant difference between the two groups(P=0.645).CONCLUSION Intraarticular application of tacrolimus combined with medical crosslinked polymer sodium hyaluronate gel in total hip arthroplasty can improve postoperative joint mobility and prevent postoperative scar adhesion formation, and improve postoperative pain level.The mechanism may be related to down regulation of IL-4 and TGF- β It's related to the level.