关节镜清理联合透明质酸钠治疗膝骨关节炎的短期疗效

目的探究关节镜下清理术联合透明质酸钠腔内注射治疗早中期膝关节骨关节炎的短期临床效果及血清相关指标的变化。 方法回顾性分析广州中医药大学附属佛山市中医院骨科2017年7月至2019年5月收治的膝关节骨关节炎患者。共有108例纳入本研究，采用随机数字表法分为对照组(n＝54)和观察组(n＝54)。两组患者均接受关节镜下膝关节清理术，对照组术后给予安慰剂关节腔内注射，观察组术后给予透明质酸钠关节腔内注射，治疗时间4周，治疗后随访6个月。比较两组治疗前后的疼痛视觉模拟评分(VAS)、日常生活活动量表(ADL)及Lysholm膝关节评分、血清基质金属蛋白酶(MMP-1)、软骨寡聚基质蛋白(COMP)、白介素-1(IL-1)、一氧化氮(NO)和血沉(ESR)的水平，采用t检验比较两组之间的差异。记录两组并发症情况，采用卡方检验评估两组间差异。 结果治疗6个月后，两组ADL及Lysholm评分较治疗前显著升高，治疗后观察组高于对照组(t＝8.390、11.690，P<0.05)。治疗4周后，两组血清MMP-1、COMP、IL-1、NO、ESR水平和VAS评分较治疗前显著降低，治疗后观察组低于对照组(t＝26.284、4.293、5.023、10.508、5.351、8.701, P<0.05)。治疗4周后，观察组并发症发生率为5.56%，与对照组(16.67%)相比，差异无统计学意义(χ²＝2.352，P>0.05)。 结论关节镜下清理术联合透明质酸钠腔内注射治疗早中期膝关节骨关节炎，能在短期内缓解膝关节疼痛、促进关节功能恢复、减轻炎症反应、改善软骨代谢，但远期效果尚需进一步探索和验证。

Short-term effect of arthroscopic debridement combined with sodium hyaluronate on knee osteoarthritis

ObjectiveTo investigate the short-term clinical effect of arthroscopic debridement combined with sodium hyaluronate injection in the treatment of the early and medium stages of the knee osteoarthritis and the changes of serum related indexes. MethodsRetrospective analysis of knee osteoarthritis patients admitted from July 2017 to May 2019 in Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine, affiliated to Guangzhou University of Traditional Chinese Medicine. A total of 108 cases were included, and were divided into the control group (n=54) and the observation group (n=54) by random number table method. Both groups received arthroscopic knee joint debridement, the control group received placebo intra-articular injection after operation, and the observation group received sodium hyaluronate intra-articular injection after operation for four weeks and followed up for six months after treatment. The pain visual analogue scale (VAS), activity of daily living scale (ADL), Lysholm knee joint score, serum matrix metalloproteinase (MMP-1), cartilage oligomeric matrix protein (COMP), interleukin-1(IL-1), nitric oxide (NO) and ESR levels before and after treatment were compared between the two groups by t test. The complications of the two groups were recorded and chi-square test was used to analyze the difference. ResultsAfter six months of treatment, ADL and Lysholm scores of the two groups were significantly higher than before treatment, and the observation group was higher than the control group after treatment (t=8.390, 11.690, P<0.05). After four weeks of treatment, the levels of serum MMP-1, COMP, IL-1, NO, ESR and VAS scores in the two groups were significantly lower than those before treatment, and the observation group was lower than the control group after treatment (t=26.284, 4.293, 5.023, 10.508, 5.351, 8.701, P<0.05). The incidence of complications in the observation group was 5.56%, while the control group was 16.67% (χ²=2.352, P>0.05). ConclusionArthroscopic debridement combined with intraarticular sodium hyaluronate injections in the treatment of early and mid stages of the knee osteoarthritis can relieve pain, improve joint function, reduce inflammation and improve cartilage metabolism, but the long-term effect needs further study.