胫骨上端高位截骨与单髁置换治疗膝关节单侧骨性关节炎的疗效及对患者血清HA、NO和MMP-9水平的影响  

Efficacy of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of unilateral knee osteoarthritis and its influence on serum hyaluronic acid,nitric oxide,and matrix metalloproteinase-9 levels of patients

作　　者：李星 段冰 黄敬文 LI Xing;DUAN Bing;HUANG Jing-wen(Department of Orthopedics,Baoji Central Hospital,Baoji 721000,Shaanxi,CHINA)

机构地区：[1]宝鸡市中心医院骨科,陕西宝鸡721000

出　　处：《海南医学》2023年第10期1406-1411,共6页Hainan Medical Journal

基　　金：陕西省宝鸡市卫生和计划生育局科研项目(编号:2017-17)。

摘　　要：目的 比较胫骨上端高位截骨术(HTO)与单髁置换术(UKA)治疗膝关节单侧骨性关节炎的疗效及对患者血清一氧化氮(NO)、透明质酸(HA)和基质金属蛋白酶-9 (MMP-9)的影响。方法 回顾性分析2019年1月至2021年6月宝鸡市中心医院骨科收治的257例膝关节单侧骨性关节炎患者的临床资料,根据患者的手术方式将其分为HTO组(n=105)和UKA组(n=152),比较两组患者的术中指标(手术时间、术中出血量、呼吸频率、心率等)、术后指标(术后引流量、下地时间、切口长度、住院时间、疼痛程度等)、术前至术后6个月期间内膝关节功能[膝关节活动度(ROM)、胫骨角(FTA)、美国纽约特种外科医院(HSS)评分、Lysholm膝关节评分等]、术前与术后7 d血清学指标[NO、HA、MMP-9、肿瘤坏死因子(TNF-α)、白细胞介素-6 (IL-6)]和并发症发生情况。结果 HTO组患者的术中出血量、手术时间分别为(120.28±35.26) m L、(103.05±11.81) min,明显少(短)于UKA组的(131.30±38.89) mL、(106.73±15.12) min,差异均有统计学意义(P<0.05),但两组患者的呼吸、心率比较差异均无统计学意义(P>0.05);HTO组患者的手术切口长度为(9.41±2.02) cm,明显短于UKA组的(10.05±2.11) cm,差异有统计学意义(P<0.05),而术后引流量、下地时间、住院时间及术后疼痛程度等指标比较差异均无统计学意义(P>0.05);两组患者术前至术后6个月期间内的ROM、FTA、HSS评分、Lysholm膝关节评分交互、组间比较差异均无统计学意义(P>0.05),但时间点比较差异有统计学意义(P<0.05);术前两组患者的NO、HA、MMP-9、TNF-α、IL-6等指标比较差异均无统计学意义(P>0.05),术后7 d两组患者的NO、MMP-9、TNF-α、IL-6等指标水平均降低,HA水平均升高,差异均有统计学意义(P<0.05),但两组患者的上述各项血清指标术后比较差异均无统计学意义(P>0.05);HTO组和UKA组患者术后并发症发生率分别为4.76%、3.95%,差异无统计学意义(PObjective To compare the efficacy of high tibial osteotomy(HTO)and unicompartmental knee ar-throplasty(UKA)in the treatment of unilateral knee osteoarthritis and its influence on serum nitric oxide(NO),hyaluron-ic acid(HA),and matrix metalloproteinase-9(MMP-9)of patients.Methods The clinical data of 257 patients with unilateral knee osteoarthritis admitted to Department of Orthopedics,Baoji Central Hospital from January 2019 and June 2021 were retrospectively analyzed.All patients were divided into HTO group(n=105)and UKA group(n=152)accord-ing to the surgical methods of patients.The intraoperative indicators(surgical time,intraoperative blood loss,respiratory rate,heart rate),postoperative indicators(postoperative drainage volume,ambulation time,incision length,length of hos-pital stay,pain degree),knee function[knee range of motion(ROM),femoral tibial angle(FTA),Hospital for Special Surgery(HSS)score,Lysholm knee score]before and 6 months after surgery,serological indicators[NO,HA,MMP-9,tumor necrosis factor(TNF-α),interleukin-6(IL-6)]before and 7 days after surgery were compared between the two groups.Results The intraoperative blood loss and surgical time in the HTO group were(120.28±35.26)mL and(103.05±11.81)min,which were significantly less or shorter than(131.30±38.89)mL and(106.73±15.12)min in the UKA group(P<0.05);but there were no statistically significant differences in respiratory rate and heart rate between the two groups(P>0.05).The surgical incision length in the HTO group was(9.41±2.02)cm,which was significantly shorter than(10.05±2.11)cm in the UKA group(P<0.05);however,there was no significant difference in postoperative drainage volume,ambulation time,length of hospital stay and postoperative pain degree(P>0.05).There were no statistically sig-nificant differences in interaction effect and between-group effect of ROM,FTA,HSS score,and Lysholm knee score be-tween the two groups before and 6 months after surgery(P>0.05),but there was significant difference among difference time points(P<0.

关 键 词：胫骨上端高位截骨术 单髁置换术 膝关节单侧骨性关节炎 疗效 一氧化氮 透明质酸 基质金属蛋白酶-9 

分 类 号：R687.3[医药卫生—骨科学]