摘要
目的探讨抗骨质疏松治疗对膝关节骨性关节炎(KOA)患者行全膝关节置换术(TKA)后临床疗效的影响。方法选择2017年12月至2018年12月在新乡市中心医院行单侧TKA的46例KOA患者为研究对象。根据患者手术前后是否行抗骨质疏松治疗将其分为观察组(n=23)与对照组(n=23),观察组患者术前7 d给予抗骨质疏松药物治疗,连续用药12个月,对照组患者不予以抗骨质疏松药物干预。比较2组患者的临床疗效;分别于术前及术后12个月,采用视觉模拟评分法(VAS)评估患者膝关节疼痛程度,美国西部Ontario和McMaster大学骨关节炎指数(WOMAC)评分评估关节炎症反应,Barthel评分评估患者日常生活能力,Fugl-Meyer评分评估患者膝关节运动功能;应用骨密度仪检测2组患者术前及术后12个月腰椎、胫骨近端、股骨远端骨密度;应用酶联免疫吸附法检测2组患者术前及术后12个月关节液中白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-3(MMP-3)、骨钙素水平。结果观察组和对照组患者的总显效率分别为82.61%(19/23)、52.17%(12/23),观察组患者总显效率显著高于对照组(P<0.05)。术前2组患者VAS、WOMAC、Barthel、Fugl-Meyer评分比较差异均无统计学意义(P>0.05);2组患者术后12个月VAS、WOMAC评分低于术前,Barthel、Fugl-Meyer评分高于术前(P<0.05);术后12个月,观察组患者VAS、WOMAC评分显著低于对照组(P<0.05),Barthel、Fugl-Meyer评分显著高于对照组(P<0.05)。术前2组患者腰椎、胫骨近端、股骨远端骨密度比较差异无统计学意义(P>0.05);术后12个月,观察组患者腰椎、胫骨近端、股骨远端骨密度高于术前(P<0.05),对照组患者股骨远端、胫骨近端、腰椎骨密度低于术前(P<0.05);术后12个月,观察组患者股骨远端、胫骨近端、腰椎骨密度显著高于对照组(P<0.05)。术前2组患者关节液中IL-1β、TNF-α、MMP-3、骨钙素水平比较差异无统计学意义(P>0.05);术后12个月,2组患者关节液中骨钙素水平高于术前(P<0.05),IL-1β、TNF-α、MMP-3水平低于术前(P<0.05);术后12个月,观察组患者关节液中骨钙素水平显著高于对照组(P<0.05),IL-1β、TNF-α、MMP-3水平显著低于对照组(P<0.05)。结论行TKA的KOA患者术前、术后应用抗骨质疏松药物治疗可显著增加患者骨密度,减轻术后疼痛及软骨炎症损伤,促进膝关节功能恢复。
Objective To investigate the effect of anti-osteoporosis treatment on clinical efficacy of total knee arthroplasty(TKA)in patients with knee osteoarthritis(KOA).Methods Forty patients with KOA who underwent unilateral TKA in Xinxiang Central Hospital from December 2017 to December 2018 were selected as study objects.They were divided into observation group(n=23)and control group(n=23)according to whether they received anti-osteoporosis treatment before and after operation.The patients in the observation group were treated with anti-osteoporosis drugs for 12 months,and the patients in the control group were not given anti-osteoporosis drugs.The curative effect of patients were compared between the two groups.The degree of knee joint pain was evaluated by visual analogue scale(VAS),the inflammatory response of joint was evaluated by western Ontario and McMaster universities osteoarthritis index(WOMAC)score,the ability of daily living of patients was evaluated by Barthel score and the motor function of knee joint was evaluated by Fugl-Meyer score before operation and 12 months after operation.The bone mineral density of lumbar vertebrae,proximal tibia and distal femur was measured by bone densitometer before operation and 12 months after operation.The levels of interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),matrix metalloproteinase 3(MMP-3)and osteocalcin in synovial fluid of patients in the two groups were measured by enzyme linked immunosorbent assay method.Results The total effective rate of patients in the observation group and the control group was 82.61%(19/23),52.17%(12/23),respectively;the total effective rate of patients in the observation group was significantly higher than that in the control group(P<0.05).There was no significant difference in the VAS,WOMAC,Barthel and Fugl Meyer scores between the two groups before operation(P>0.05);the VAS,WOMAC scores of patients at 12 months after operation were significanlty lower than those before operation,and the Barthel,Fugl Meyer scores were significanlty higher than those before operation in the two groups(P<0.05);the VAS,WOMAC scores of patients in the observation group were significanlty lower than those in the control group,and the Barthel,Fugl Meyer scores were significanlty higher than those in the control group at 12 months after operation(P<0.05).There was no significant difference in the bone mineral density of lumbar vertebrae,proximal tibia and distal femur of patients between the two groups before operation(P>0.05);the bone mineral density of lumbar vertebrae,proximal tibia and distal femur of patients in the observation group at 12 months after operation was significanlty higher than that before operation(P<0.05);the bone mineral density of lumbar vertebrae,proximal tibia and distal femur of patients in the control group at 12 months after operation was significanlty lower than that before operation(P<0.05);the bone mineral density of lumbar vertebrae,proximal tibia and distal femur of patients in the observation group was significanlty higher than that in the control group at 12 months after operation(P<0.05).There was no significant difference in the levels of IL-1β,TNF-α,MMP-3 and osteocalcin in synovial fluid of patients between the two groups before operation(P>0.05);at 12 months after operation,the osteocalcin level in synovial fluid of patients was significanlty higher than that before operation in the two groups,and the IL-1β,TNF-α,MMP-3 levels in synovial fluid of patients were lower than those before operation in the two groups(P<0.05);at 12 months after operation,the osteocalcin level in synovial fluid of patients in the observation group was significanlty higher than that in the control group,and the IL-1β,TNF-α,MMP-3 levels were significanlty lower than those in the control group(P<0.05).Conclusion The application of the preoperative anti-osteoporosis drugs can increase bone density,reduce postoperative pain and cartilage inflammation,promote knee function recovery of KOA patients undergoing TKA.
作者
杨卫可
贾瑞平
王明晶
贠霄
郭新军
YANG Weike;JIA Ruiping;WANG Mingjing;YUN Xiao;GUO Xinjun(Department of Orthopaedics,Xinxiang Central Hospital,Xinxiang 453000,Henan Province,China)
出处
《新乡医学院学报》
CAS
2020年第12期1147-1151,共5页
Journal of Xinxiang Medical University
基金
河南省卫生健康委员会资助项目(编号:KHGJ20191326)。
