关节镜清理术联合曲安奈德、透明质酸钠关节腔内注射对膝骨性关节炎血清骨代谢相关指标的影响  

Influence of arthroscopic debridement combined with intra-articular injection of triamcinolone acetonide and sodium hyaluronate on serum bone metabolism indexes in patients with knee osteoarthritis

作　　者：吕科 雷文黎 马建军 刘刚 孙栋 姜猛 Lyu Ke;Lei Wenli;Ma Jianjun;Liu Gang;Sun Dong;Jiang Meng(Department of Orthopaedics,The First People＇s Hospital of Xianyang,Xianyang 712000,China)

机构地区：[1]陕西省咸阳市第一人民医院骨三科,咸阳71200

出　　处：《广西医科大学学报》2018年第10期1392-1396,共5页Journal of Guangxi Medical University

摘　　要：目的:探讨关节镜清理术联合曲安奈德、透明质酸钠关节腔内注射对膝骨性关节炎(KOA)血清骨代谢相关指标的影响。方法:选取2015年1月至2017年1月在咸阳市第一人民医院就诊且拟行关节镜清理术的KOA患者104例,按随机数字表法分为观察组(n=48)与对照组(n=49),对照组关节镜下行关节清理术,观察组关节镜清理术后3d向关节腔内注射曲安奈德及透明质酸钠。比较两组临床疗效,采用西安大略和麦克马斯特大学骨关节炎调查量表(WOMAC)评价KOA关节功能,测定血清白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、环氧合酶(COX-2)、胰岛素样生长因子-1(IGF-1)、骨保护素(OPG)、核因子κB受体活化因子配基(RANKL)及β胶原降解产物(β-CTX)水平。结果:观察组治疗总有效率显著高于对照组(93.75%vs.77.55%,P<0.05);术后3个月、6个月,观察组的WOMAC评分显著低于对照组(P<0.05);术后6个月,观察组患者血清IL-1β、TNF-α、COX-2、β-CTX、RANKL水平均显著低于对照组(均P<0.05),OPG、IGF-1显著高于对照组(P<0.05)。结论:关节镜清理术联合曲安奈德、透明质酸钠关节腔内注射治疗KOA疗效确切,其机制可能与控制炎症反应和调节骨代谢紊乱有关。Objective：To investigate the influence of arthroscopic debridement combined with intra-articular injection of triamcinolone acetonide and sodium hyaluronate on serum bone metabolism indexes in patients with knee osteoarthritis（KOA）.Methods：A total of 97 KOA patients were randomly divided into an observation group（n=48）and a control group（n=49）.The patients in the control group received arthroscopic debridement,and those in the observation group received intra-articular injection with triamcinolone acetonide and sodium hyaluronate after 3 days of arthroscopic debridement.The clinical efficacy was compared.The serum levels of interleukin 1β（IL-1β）,tumor necrosis factor-α（TNF-α）,cyclooxygenase（COX-2）,osteocalcin（BGP）,insulin-like growth factor-1（IGF-1）,osteoprotegerin（OPG）,nuclear factor-κB receptor activator ligand（RANKL）andβ-type I collagen degradation product（β-CTX）were detected.The Western Ontario and McMaster University Osteoarthritis（WOMAC）survey scale was used to evaluate the joint function of KOA patients.Results：The total effective rate in the observation group was significantly higher than that in the control group（93.75%vs.77.55%,P〈0.05）.At 3 and 6 months after the operation,the WOMAC scores in the observation group were significantly lower than those in the control group（P〈0.05）.At 6 months post-operation,the serum levels of IL-1β,TNF-α,COX-2,β-CTX and RANKL in the observation group were significantly lower than those in the control group,while the OPG and IGF-1 were significantly higher（P〈0.05）.Conclusion：Arthroscopic debridement combined with intraarticular injection of triamcinolone acetonide and sodium hyaluronate was effective in the treatment of KOA,and the mechanism might be related to the attenuation of inflammation and regulation of bone metabolic disorders.

关 键 词：膝骨性关节炎 关节镜清理术 曲安奈德 透明质酸钠 骨代谢 

分 类 号：R684.3[医药卫生—骨科学]