中国修复重建外科杂志

中国修复重建外科杂志

胫骨高位截骨术治疗单纯内侧间室膝骨关节炎术后炎性细胞因子水平变化研究

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目的 探讨胫骨高位截骨术(hight tibial osteotomy,HTO)治疗单纯内侧间室膝骨关节炎(osteoarthritis,OA)后患者血浆和关节滑液中 IL-1β、IL-6、IL-17 水平变化。 方法 以 2011 年 1 月—2014 年 6 月因单纯内侧间室膝关节 OA 行 HTO 治疗的 26 例患者作为研究对象(试验组),以 30 例膝关节正常的自愿者作为正常对照(对照组)。两组研究对象性别、年龄、体质量指数比较差异均无统计学意义(P>0.05)。试验组术后复查 X 线片,记录截骨愈合时间,测量股胫角,评估下肢力线;采用膝关节学会评分系统(KSS)评价膝关节功能,疼痛视觉模拟评分(VAS)评价膝关节疼痛程度。术前及术后 6、12、18 个月抽取肘部静脉血以及患侧膝关节滑液,采用 ELISA 检测试剂盒测量血浆及关节滑液 IL-1β、IL-6、IL-17 含量,对照组抽取肘部静脉血进行相应检测并比较。 结果 试验组患者术后切口均Ⅰ期愈合。术后均获随访,随访时间 18~24 个月,平均 21 个月。X 线片复查示,截骨端均达骨性愈合,愈合时间 9~14 周,平均 11.5 周。截骨端愈合后测量股胫角为 165~170°,平均 167.5°;下肢力线矫正满意。术后各时间点 VAS 评分均较术前显著降低,KSS 评分较术前显著增加,比较差异有统计学意义(P<0.05);术后各时间点间比较,差异均无统计学意义(P>0.05)。与对照组比较,试验组术前血浆及关节滑液 IL-1β、IL-6、IL-17 含量均增高,差异均有统计学意义(P<0.05);术后各时间点均较术前显著降低(P<0.05),但均高于对照组(P<0.05)。试验组术后各时间点血浆及关节滑液 IL-1β、IL-6、IL-17 含量均逐渐下降,但比较差异无统计学意义(P>0.05)。 结论 HTO 可显著改善单纯内侧间室膝 OA 患者疼痛症状和关节功能,并在一定程度上降低患者体内 IL-1β、IL-6、IL-17 含量,但尚未恢复至正常水平。

Objective To investigate interleukin-1β (IL-1β), IL-6, and IL-17 levels in both synovial fluid and serum of patients with primary knee medial osteoarthritis (OA) after high tbial osteotomy (HTO). Methods Twenty-six patients with primary knee medial OA undergoing HTO between January 2011 and June 2014 (experimental group) and 30 healthy individuals (control group) were recruited into the study. There was no significant difference in gender, age, and body mass index between 2 groups (P>0.05). The X-ray film was taken to record healing time at osteotomy site, to measure the tibiofemoral angle, and to assess limb alignment after HTO. Visual analogue scale (VAS) pain score and knee society score (KSS) were used to evaluate pain level and function of the knee. The IL-1β, IL-6, and IL-17 concentrations in both plasma and synovial fluid were measured before operation and at 6, 12, and 18 months after operation in the experimental group using ELISA method; the levels in plasma were measured in control group. Results Primary healing of incisions was achieved in patients. All patients were followed up 18-24 months (mean, 21 months). The X-ray film showed osseous healing at osteotomy site at 9-14 weeks (mean, 11.5 weeks). The average tibiofemoral angle was 167.5° (range, 165-170°) after bone healing. Satisfactory limb alignment was obtained in all patients. The postoperative VAS pain score was significantly decreased and KSS score was significantly improved when compared with preoperative scores (P<0.05), but no significant difference was found between different time points after operation (P>0.05). The preoperative plasma and synovial fluid IL-1β, IL-6, and IL-17 concentrations were significantly higher in patients than controls (P<0.05). The postoperative IL-1β, IL-6, and IL-17 concentrations in plasma and synovial fluid were significantly lower than preoperative ones in patients (P<0.05), but the concentrations were significantly higher than those in controls (P<0.05). The postoperative plasma and synovial fluid IL-1β, IL-6, and IL-17 concentrations were significantly declined in patients, but there was no significant difference between different time points after operation (P>0.05). Conclusion HTO can significantly improve the pain symptom and joint function and reduce IL-1β, IL-6, and IL-17 levels in both plasma and synovial fluid of patients with medial compartment knee OA, but these cytokines can not return to normal level.

关键词: 胫骨高位截骨术; 骨关节炎; 膝关节; IL-1β; IL-6; IL-17

Key words: High tibial osteotomy; osteoarthritis; knee; interleukin-1β; interleukin-6; interleukin-17

引用本文: 白玉明, 张海森, 刘畅, 靳胜利, 苏柯, 刘颖, 吕志昌. 胫骨高位截骨术治疗单纯内侧间室膝骨关节炎术后炎性细胞因子水平变化研究. 中国修复重建外科杂志, 2017, 31(4): 422-426. doi: 10.7507/1002-1892.201609123 复制

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