膝关节腔脉冲射频治疗膝骨关节炎的临床观察

The clinical observation of pulsed radiofrequency in paients with knee osteoarthritis and the discussion of mechanism

摘要:

目的：观察膝关节腔脉冲射频治疗膝骨关节炎的临床疗效及炎症指标变化，探讨其治疗机制。方法：纳入膝骨关节炎患者63例，依随机数字表分为对照组，灌洗组和射频组，于治疗前后评价三组患者疼痛视觉模拟评分 (visual ana- logue scale, VAS) 、西安大略和麦克马斯特大学指数 (western ontario and mcmaster universities osteoarthritis index, WOMAC) ，及膝关节液中P物质、IL-1β、TNF-α变化。结果：治疗后1周，灌洗组、射频组各项指标较对照组降低，治疗后4周，灌洗组、射频组各项指标较对照组降低，射频组较灌洗组各项指标降低，治疗后12、24周，射频组较对照组、灌洗组指标降低。结论：脉冲射频术可有效改善膝关节骨关节炎的临床症状和炎性指标，可能通过抑制P物质、TNF-α 和 IL-1β的释放，改善关节腔内环境，调节关节软骨细胞代谢。

Abstract:

Objective:To observe the clinical efficacy of pulsed radiofrequency of knee cavity in the treatment of knee osteoarthritis,and detect the changes of substance P,IL-1βand TNF-α in knee fluid before and after treatment,and discuss its mechanism of treatment.Methods:Patients with knee osteoarthritis were randomized to control group,irrigation group and pulsed radiofrequency group.VAS,WOMAC of the patients were evaluated and substance P,IL-1βand TNF-α in knee fluid were detected before treatment and 1,4,12,24 weeks after.Results:1 week after treatmennt,the indicators of the irrigation group and the pulsed radiofrequency group were decreased than the control group（P＜0.05）. 4 weeks after treatmennt,the indicators of the irrigation group and the pulsed radiofrequency group were decreased than the control group（P＜0.05）. The indicators of the pulsed radiofrequency group were decreased than the irrigation group.12 and 24 weeks after treatment,the indicators of the pulsed radiofrequency group were decreased than the control group and the irrigation group（P＜0.05）.Conclusions:Pulsed radiofrequency could effectively improve the clinical symptoms of knee osteoarthritis, it maight inhibit the release of substance P,IL-1βand TNF-α, to improve the joint cavity environment and regulate metabolism of articular cartilage cells.