关节镜清理术联合药物注射治疗膝关节骨性关节炎的临床疗效观察

目的探讨关节镜清理术联合关节腔内药物注射治疗膝关节骨性关节炎(KOA)的临床疗效。 方法回顾性分析2015年10月至2019年10月因KOA于北京核工业医院行关节镜清理手术治疗的60例患者。按治疗方法不同将其分为对照组(n＝30)和实验组(n＝30)。对照组采用关节镜清理术治疗，在麻醉下采用常规膝前内、外侧入路作长度约5 mm的手术切口并对患膝进行穿刺，穿刺成功后置入关节镜保护套管，注入适量灌注液使关节腔扩张充盈后置入关节镜镜头，视关节内病损情况取出游离体。冲洗关节腔，吸净关节腔内的液体后缝合加压包扎切口。实验组在关节镜清理术(同对照组)的基础上，术后即刻给予2 mL医用几丁糖+1 mL复方倍他米松注射液行关节腔内注射治疗，此后每2周关节腔内注射治疗1次，共连续治疗3次。观察记录2组患者术后6周内关节肿胀与再手术例数；比较2组患者术前、术后6周膝关节疼痛程度与膝关节功能评分，膝关节疼痛程度采用疼痛视觉模拟评分法(VAS)评定，膝关节功能活动情况依据膝关节功能Lysholm评分标准评定。比较2组患者术后6周C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)炎性指标的水平。数据采用独立样本t检验、配对样本t检验及χ²检验。 结果60例患者手术均获成功。术后6周内，对照组有1例重度、2例中度、2例轻度关节肿胀，实验组有1例中度、2例轻度关节肿胀，2组比较差异无统计学意义(χ²＝1.347，P＝0.246)；术后6周内对照组9例，实验组8例再手术治疗，再手术例数比较差异无统计学意义(χ²＝1.405，P＝0.263)；对照组患者术后6周VAS评分较术前显者降低，而Lysholm评分较术前显著升高，差异均有统计学意义(t＝12.385、9.173，P<0.05)；实验组患者手术前后VAS评分、Lysholm评分与对照组患者变化趋势相同，差异均有统计学意义(t＝13.665、11.196，P<0.05)。术前2组患者VAS评分、Lysholm评分比较，差异均无统计学意义(t＝0.174、0.105，P>0.05)；术后6周，实验组患者VAS评分[(2.47±1.13)分]低于对照组患者[(3.25±1.37)分]，而Lysholm评分[(86.36±11.05)分]高于对照组患者[(73.14±12.08)分]，差异均有统计学意义(t＝7.301、5.415，P<0.05)。术后6周，实验组患者CRP、IL-6、TNF-α分别为(11.13±3.36) mg/L、(2.03±0.22) ng/L、(4.92±2.56) pg/mL，均较对照组[(14.75±5.32) mg/L、(5.17±1.94) ng/L、(7.18±1.98) pg/mL)]低，差异均有统计学意义(t＝3.938、5.125、6.741，P<0.05)。 结论关节镜清理术联合医用几丁糖及复方倍他米松注射液治疗KOA可有效缓解疼痛，改善膝关节功能活动，疗效满意。

Clinical observation of arthroscopic debridement combined with drug injection in the treatment of knee osteoarthritis

ObjectiveTo investigate the clinical effect of arthroscopic debridement combined with intra-articular drug injection in the treatment of knee osteoarthritis (KOA). MethodsSixty patients who underwent arthroscopic debridement in Beijing Nuclear Industry Hospital due to KOA from October 2015 to October 2019 were analyzed retrospectively. According to different treatment methods, they were divided into the control group (n=30) and the experimental group (n=30). The control group was treated with arthroscopic debridement. Under the corresponding anesthesia, the conventional anterior medial and lateral approaches of the knee were used to make a surgical incision with a length of about 5 mm, and the affected knee was punctured. After the puncture was successful, the arthroscopic protective sleeve was placed, an appropriate amount of perfusion fluid was injected to expand and fill the joint cavity, and then the arthroscopic lens was placed to observe the situation. According to the condition of intra-articular lesions, and the loose body was taken out. The joint cavity was rinsed, the fluid in the joint cavity was vacuumed, and then the compression dressing incision was sutured. On the basis of arthroscopic debridement (the same as the control group), the experimental group was given 2 mL medical chitosan+ 1 mL compound betamethasone injection for intra-articular injection immediately after operation. After that, it was injected once every 2 weeks for a total of 3 consecutive times. The cases of joint swelling and reoperation in the two groups within 6 weeks after operation were observed and recorded. The degree of knee pain and knee function score were compared between the two groups before and 6 weeks after operation. The degree of knee pain was evaluated by visual analogue scale (VAS), and the knee function activity was evaluated according to Lysholm score standard. The levels of C-reactive protein (CRP), interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α) inflammatory indexes were compared between the two groups at 6 weeks after operation. Data were processed with independent sample t test, paired sample t test and chi-square test. ResultsThe operation was successful in 60 patients. Within 6 weeks after operation, there were 1 case severe, 2 cases moderate and 2 cases mild joint swelling in the control group, and 1 case moderate and 2 cases mild joint swelling in the experimental group, but there was no statistically significant difference (χ²=1.347, P=0.246). Within 6 weeks after operation, 9 cases in the control group and 8 cases in the experimental group were reoperated. There was no statistically significant difference in the number of reoperated cases (χ²=1.405, P=0.263). The VAS score of the control group was significantly lower than that before operation, while the Lysholm score was significantly higher than that before operation (t=12.385, 9.173; P<0.05). The change trend of VAS score and Lysholm score in the experimental group before and after operation were the same as those in the control group (t=13.665, 11.196; P<0.05). There were no statistically significant differences in VAS score and Lysholm score between the two groups before operation (t=0.174, 0.105; P>0.05). Six weeks after operation, the VAS score [(2.47±1.13) points] in the experimental group was lower than that in the control group [(3.25±1.37) points], while the Lysholm score [(86.36 ± 11.05) points] was higher than that in the control group [(73.14 ±12.08) points], and the differences were statistically significant (t=7.301, 5.415; P<0.05). Six weeks after operation, CRP, IL-6 and TNF-α in the experimental group were (11.13±3.36) mg/L, (2.03±0.22) ng/L and (4.92 ± 2.56) pg/mL respectively, which were lower than those in the control group [(14.75 ± 5.32) mg/L, (5.17±1.94) ng/L and (7.18±1.98) pg/mL], the differences were statistically significant (t=3.938, 5.125, 6.741; P<0.05). ConclusionArthroscopic debridement combined with medical chitosan and compound betamethasone injection in the treatment of KOA can effectively alleviate pain and improve knee function and activity, and the curative effect is satisfactory.