标题：关节镜清理联合自体骨髓间充质干细胞移植对膝骨关节炎患者疼痛程度、炎症介质及膝关节功能的影响

      作者：白朝奇 1，封鹏 1，张雪艳 1，党华 1，陈振 2    1.铜川市人民医院骨科，陕西 铜川 727000；2.商洛市中心医院骨科，陕西 商洛 726000

      卷次： 2020年31卷17期

      【摘要】 目的 探讨膝骨关节炎(KOA)应用关节镜清理术联合自体骨髓间充质干细胞(ABMSCs)移植术治疗的临床效果。方法 选取铜川市人民医院骨科2016年3月至2018年1月收治的114例KOA患者为研究对象，采用随机数表法将其随机分为观察组和对照组，每组57例。两组患者均行关节镜清理术治疗，观察组患者在此基础上联合ABMSCs移植术治疗。比较两组患者的临床疗效，治疗前后疼痛程度[视觉模拟评分法(VAS)评分]和患侧膝关节液内炎症介质[白介素(IL)-1β、肿瘤坏死因子(TNF-α)、前列腺素(PG) E2]水平，以及膝关节功能[Lysholm膝关节评分量表(LKSS)评分]变化。结果 观察组患者的治疗总有效率为96.49%，明显高于对照组的80.70%，差异有统计学意义(P<0.05)；两组患者术前、术后3个月和6个月时的疼痛VAS评分均逐渐降低，术前、术后3个月和6个月时患侧LKSS评分均逐渐升高，且观察组术后3、6个月时疼痛VAS评分较对照组同期均显著更低，患侧LKSS评分则均显著更高，差异均有统计学意义(P<0.05)；两组患者术后 3、6个月时患侧膝关节液内各项炎性介质(IL-1β、TNF-α、PGE2)水平均逐渐降低，且观察组降低较对照组同期更明显，差异均有统计学意义(P<0.05)。结论 关节镜清理术联合ABMSCs移植术治疗KOA能显著减轻患者疼痛程度，下调患侧膝关节液内炎症介质的释放，改善患侧膝关节功能，疗效确切。
      【关键词】 关节镜清理术；自体骨髓间充质干细胞移植；膝骨关节炎；疼痛；炎症介质；膝关节功能
      【中图分类号】 R684.3 【文献标识码】 A 【文章编号】 1003—6350（2020）17—2203—04

Effect of arthroscopic debridement combined with autologous bone marrow mesenchymal stem cellstransplantation on the pain level and inflammatory mediators and knee function in patients with kneeosteoarthritis.
BAI Chao-qi 1, FENG Peng 1, ZHANG Xue-yan 1, DANG Hua 1, CHEN Zhen 2. 1. Department of Orthopedics,Tongchuan People's Hospital, Tongchuan 727000, Shaanxi, CHINA; 2. Department of Orthopaedics, Shangluo CentralHospital, Shangluo 726000, Shaanxi, CHINA
【Abstract】 Objective To investigate the clinical effect of arthroscopic debridement combined with autologousbone marrow mesenchymal stem cells (ABMSCs) transplantation for knee osteoarthritis (KOA). Methods A total of114 patients with KOA admitted to the Department of Orthopaedics, Tongchuan People's Hospital from March 2016 toJanuary 2018 were enrolled in the study. They were randomly divided into observation group and control group, with 57patients in each group. Patients in the control group were treated with arthroscopic debridement, and patients in the obser-vation group were treated with ABMSCs transplantation on this basis of control group. The clinical efficacy of patientsin the two groups was compared, including the degree of pain (VAS score) before and after treatment, the inflammatorymediators (interleukin-1β [IL-1β], tumor necrosis factor α [TNF-α], prostaglandin [PG] E2) in the knee fluid of the af-fected side, and the changes in knee function (Lysholm knee score scale [LKSS] score). Results The overall effectiverate of the observation group was 96.49%, which was significantly higher than 80.70% of the control group (P<0.05).The pain VAS scores of the two groups were gradually decreased before operation, 3 months and 6 months after opera-tion, and the LKSS scores of the affected side were gradually increased. The pain VAS scores of the observation group at3 and 6 months after operation were significantly lower than those of the control group, and the LKSS scores of the af-fected group were significantly higher (P<0.05). The levels of inflammatory mediators (IL-1β ,TNF-α, PGE2 ) in the af-fected knee joint fluid gradually decreased at 3 and 6 months after operation in both groups, and the decrease in the ob-servation group was more significant than that in the control group over the same period (P<0.05). Conclusion Ar-throscopic debridement combined with ABMSCs transplantation for the treatment of KOA can significantly reduce thedegree of pain in patients, down-regulate the release of inflammatory mediators in the knee joint fluid, and improve theknee joint function of the affected side.
      【Key words】 Arthroscopic debridement; Autologous bone marrow mesenchymal stem cell transplantation; Kneeosteoarthritis; Pain; Inflammatory mediator; Knee joint function