关节镜下微骨折术后早期CPM对膝关节软骨损伤修复效果的影响研究  

Repair Effects of Early CPM on Knee Cartilage Injury After Arthroscopic Microfracture Surgery

作　　者：刘军 吴凯[1] 刘宝应 LIU Jun;WU Kai;LIU Bao-ying(Department of Orthopedics,903 Hospital,Jiangyou,Sichuan 621700,China)

机构地区：[1]九〇三医院骨二科

出　　处：《临床误诊误治》2020年第1期79-83,共5页Clinical Misdiagnosis & Mistherapy

基　　金：四川省卫生计划委员会课题项目(16PJ154)

摘　　要：目的探究关节镜下微骨折术后早期持续被动活动(continuous passive motion,CPM)对膝关节软骨损伤修复效果的影响。方法选取我院2013年6月—2017年6月收治的行关节镜下微骨折术治疗的61例膝关节软骨损伤患者,根据术后开始CPM时间的不同分为观察组32例(术后6 h开始CPM)和对照组29例(术后24 h开始CPM)。比较两组术前及术后2周时膝关节液指标[白细胞介素1β(IL-1β)、肿瘤坏死因子α(TNF-α)、基质金属蛋白酶13(MMP-13)、Ⅱ型胶原C-端肽(CTX-Ⅱ)]差异,术前及术后24周时膝关节功能、生活满意度差异,并记录两组治疗期间并发症发生情况。结果术后2周时,两组膝关节液IL-1β、TNF-α、MMP13、CTX-Ⅱ水平均较术前降低,且观察组上述指标均低于对照组,差异均有统计学意义(P<0.05或P<0.01)。术后24周时,两组中文版牛津膝关节评分、Tegner运动功能评分、膝关节曲度及生活满意度量表评分均较术前升高,且观察组上述指标均高于对照组,差异均有统计学意义(P<0.05或P<0.01)。两组均未出现明显并发症。结论关节镜下微骨折术后早期CPM对膝关节软骨损伤患者治疗效果有显著促进作用,可降低术后关节腔内炎性反应程度,减少软骨组织降解,促进关节软骨修复及膝关节功能恢复,改善患者生活满意度,且安全性良好。Objective To explore the effects of early continuous passive motion(CPM)exercise after arthroscopic microfracture surgery on repairing knee cartilage injury.Methods Sixty-one patients with knee cartilage injury undergoing arthroscopic microfracture surgery in our hospital from June 2013 to June 2017 were divided into control group(n=29,CPM exercise was given at 24 h after operation)and observation group(n=32,CPM exercise was given at 6 h after operation)according to different time when CPM exercise was initiated after surgery.The knee joint fluid indexes[interleukin-1β(IL-1β),tumor necrosis factorα(TNF-α),matrix metalloproteinase-13(MMP-13),typeⅡcollagen C-terminal peptide(CTX-Ⅱ)]before operation and at 2 week after operation,and the knee joint function and life satisfaction before operation and at 24 week after operation were compared between the two groups,and the occurrence of adverse reactions was recorded in the two groups.Results At 2 week after operation,the levels of knee joint fluid IL-1β,TNF-α,MMP-13,and CTX-Ⅱwere lower than those before operation,and the levels in observation group were lower than those in control group(P<0.05 or P<0.01).At 24 week after operation,Oxford Knee Score(Chinese version),Tegner motor function score,knee curvature,and satisfaction with life scale score in the two groups were significantly higher than those before operation,and the above indexes in observation group were higher than those in control group(P<0.05 or P<0.01).There was no occurrence of complications between the two groups.Conclusion Early CPM exercise after arthroscopic microfracture surgery has significant therapeutic effects in the treatment of patients with knee cartilage injury,which can not only reduce inflammatory reactions and degradation of cartilage tissues,promote articular cartilage repair and knee joint function recovery,but also improve the life satisfaction of patients,with good safety.

关 键 词：膝损伤 关节成形术 软骨下 运动疗法 持续被动性 肿瘤坏死因子α 基质金属蛋白酶13 生活质量 不良反应 

分 类 号：R684.76[医药卫生—骨科学]