关节镜下微骨折术对膝骨关节炎并发下肢深静脉血栓形成患者疗效与膝关节功能的影响  

Effect of arthroscopic microfracture on knee osteoarthritis complicated with lower extremity deep vein thrombosis patients and its effect on knee joint function

作　　者：冉庆林 林浩[1] 武治铭[2] 李东[3] Ran Qinglin;Lin Hao;Wu Zhiming;Li Dong(Department of Orthopaedics,Beijing Hepingli Hospital,Beijing 100010,China;Department of General Surgery,Beijing Hepingli Hospital,Beijing 100010,China;Department of Orthopeadic Surgery,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China)

机构地区：[1]北京市和平里医院骨科,北京100010 [2]北京市和平里医院普外科,北京100010 [3]首都医科大学附属北京友谊医院骨外科,北京100050

出　　处：《血管与腔内血管外科杂志》2022年第2期210-214,225,共6页Journal of Vascular and Endovascular Surgery

摘　　要：目的 探讨关节镜下微骨折术对膝骨关节炎(KOA)并发下肢深静脉血栓形成(DVT)患者疗效与膝关节功能的影响。方法 收集2018年1月至2021年6月北京市和平里医院收治的84例KOA并发下肢DVT患者的临床资料。根据治疗方式不同将患者分为两组,将其中采用开放式胫骨高位截骨术治疗的42例患者作为开放组,将采用关节镜下微骨折术治疗的42例患者作为微骨折组。比较两组患者的手术时间与住院时间,术前、术后3 d血清炎性因子[C反应蛋白(CRP)、白细胞介素(IL)-6、IL-1α]水平,术后3个月的临床疗效,手术前后关节功能指标[关节活动度、髋膝踝角(HKA)、美国特种外科医院(HSS)膝关节功能评分、Lysholm膝关节功能评分]。采用西大略湖麦克马斯特大学(WOMAC)量表评价膝关节的结构和功能。观察并比较两组患者术后DVT复发率、切口感染率及关节感染率。结果 微骨折组患者的手术时间、住院时间均短于开放组患者,差异均有统计学意义(P<0.01)。术后3 d,微骨折组患者的血清CRP、IL-6、IL-1α水平均明显低于开放组患者,差异均有统计学意义(P<0.01)。术后3个月,微骨折组患者的临床疗效优于开放组患者,关节活动度、HKA、HSS膝关节功能评分、Lysholm膝关节功能评分均高于开放组患者(P<0.05)。术后3个月,微骨折组患者WOMAC量表中疼痛、僵硬、日常活动难度维度的评分及总分均低于开放组患者(P<0.01)。结论 关节镜下微骨折术治疗KOA并发下肢DVT的疗效较好,能够进一步改善患者膝关节功能,减轻KOA严重程度及术后炎性应激反应程度,从而降低术后下肢DVT复发率与感染率。Objective To investigate the effect of arthroscopic microfracture on knee osteoarthritis(KOA)complicated with lower extremity deep vein thrombosis(DVT) patients and its effect on knee joint function. Method The clinical data of 84 patients with KOA complicated with lower extremity DVT treated in Beijing Hepingli Hospital from January 2018 to June 2021 were collected. According to different treatment methods, the patients were divided into two groups. A total of 42 patients treated with open high tibial osteotomy were used as the open group, and 42patients treated with arthroscopic microfracture were used as the microfracture group. The operation time and hospital stay, serum inflammatory factor of the two groups were compared. The serum inflammatory factors [C-reactive protein(CRP), interleukin(IL)-6 and IL-1α] level before and after operation were compared between the two groups, and the joint function indexes [joint range of motion, hip knee ankle angle(HKA), American Hospital for Special Surgery(HSS) knee function score and Lysholm knee function score] of the two groups were compared. Clinical efficacy 3months after operation of the two groups were compared. The structure and function of knee joint were evaluated by the Western Ontario and McMaster Universities(WOMAC) scale. The recurrence rate of DVT, incision infection rate and joint infection rate were observed and compared between the two groups. Result The operation time of the microfracture group was significantly longer than that of the open group, and the hospitalization time was significantly shorter than that of the open group, with statistical significance(P<0.01). On the 3rd day after operation, serum CRP,IL-6 and IL-1α in the microfracture group was significantly lower than that in the open group, and the differences were statistically significant(P<0.01). Three months after operation, the clinical efficacy of patients in the microfracture group was better than that in the open group, the joint range of motion, HKA, HSS knee function score and L

关 键 词：膝骨关节炎 关节镜 微骨折术 下肢 深静脉血栓形成 膝关节功能 

分 类 号：R543[医药卫生—心血管疾病]