摘要
目的观察探讨人工全膝关节置换术(TKA)治疗重度膝骨性关节炎患者的作用机制及临床价值。方法回顾性分析2018年1月—2019年1月南京医科大学附属苏州医院收治的74例重度膝关节骨性关节炎患者的临床资料,其中男性34例,女性40例;年龄(58.22±3.24)岁,年龄范围47~75岁。所有患者均接受TKA,对比观察术前3 d、术后3个月、术后6个月手术前后美国特种外科医院膝关节评分(HSS)、麦克马斯特大学(WOMAC)骨关节炎指数以及膝关节液中肿瘤坏死因子α(TNF-α)和白细胞介素1β(IL-1β)含量。采用SPSS20.0软件进行统计学分析,多组数据组间对比采用方差分析或非参数检验。结果患者HSS评分术后3个月、术后6个月均高于于术前,差异均具有统计学意义[(58.30±6.33)分比(31.31±15.92)分、(72.39±6.68)分比(31.31±15.92)分,P均<0.05]。与术前相比,WOMAC评分术后3个月及术后6个月均明显下降,差异均具有统计学意义[(31.07±6.77)分比(67.01±7.70)分、(24.22±5.22)分比(67.01±7.70)分,P均<0.05];膝关节滑液中TNF-α含量术后3个月、术后6个月均明显降低[(56.182±7.056)pg/ml比(85.065±6.666)pg/ml;(30.387±4.194)pg/ml比(85.065±6.666)pg/ml;P均<0.05];IL-1β术后3个月和术后6个月含量均明显降低[(21.411±4.751)pg/ml比(60.305±6.932)pg/ml;(11.578±4.142)pg/ml比(60.305±6.932)pg/ml;P均<0.05]。与术后3个月相比,术后6个月的TNF-α含量、IL-1β含量均明显低于术后3个月,差异有统计学意义[(30.387±4.194)pg/ml比(56.182±7.056)pg/ml、(11.578±4.142)pg/ml比(21.411±4.751)pg/ml,P均<0.05]。结论人工全膝关节置换术能明显改善重度膝关节骨性关节炎患者关节功能及活动,且显著降低膝关节液中TNF-α和IL-1β等炎性因子的含量,减轻患者术后疼痛,加快术后关节功能康复进程。
Objective To observe and evaluate the mechanism and clinical values of Total Knee Arthroplasty in treating the patients with severe knee osteoarthritis.Method To review and analyse 74 patients with severe knee osteoarthritis who were treated in Suzhou Atliliated Hospital of Nanjing Medical College,including 34 male patients and 40 female patients with average aged(58.22±3.24)ranging from 47 to 75.All the patients received TKA.Compared the HSS score,WOMAC and content of TNF-αand IL-1βin knee synovial fluid 3 months before the operation,3 months after the operation and 6 months after the operation.SPSS20.0 software was used for statistical analysis,and ANOVA or nonparametric test was used for comparison among groups of data.Results HSS scores measured at 3 months after the operation[(58.30±6.33)vs(31.31±15.92)]and 6 months after the operation[(72.39±6.68)vs(31.31±15.92)]were better than those measured before the operation,which proved a statistical difference(P<0.05).WOMAC measured 3 months after the operation and 6 months after the operation were better than those measured before the operation[(31.068±6.771)vs(67.014±7.699);(24.216±5.224)vs(67.014±7.699),all P<0.05].TNF-αin knee synovial fluid measured 3 months after the operation and 6 months after the operation were lower than those measured before the operation[(56.182±7.056)pg/ml vs(85.065±6.666)pg/ml;(30.387±4.194)pg/ml vs(85.065±6.666)pg/ml;all P<0.05].IL-1βmeasured at 3 months after the operation and 6 months after the operation were lower than those measured before the operation[(21.411±4.751)pg/ml vs(60.305±6.932)pg/ml;(11.578±4.142)pg/ml vs(60.305±6.932)pg/ml;P<0.05].Compared with the data at 3 months after the operation,the content of TNF-α[(30.387±4.194)pg/ml vs(56.182±7.056)pg/ml]and IL-1β[(11.578±4.142)pg/ml vs(21.411±4.751)pg/ml]were both lower,which proved a statistical difference(P<0.05).Conclusion TKA can imporve the joint functions and activities of the patients with severe knee osteoarthritis and lower the the inflammatory factor like TNF-αand IL-1βin knee synovial fluid to relief the pain of the patiences and accelerate the process of recovery.
作者
郑斌
王文晔
谢孝枫
Zheng Bin;Wang Wenye;Xie Xiaofeng(Department of Orthopaedics,Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215008,China)
出处
《国际外科学杂志》
2019年第12期845-850,共6页
International Journal of Surgery
