| Objective:To explore the feasibility of arthroscopy combined with sodium hyaluronate in the treatment of osteoarthritis of the knee in order to increase the level of knowledge,diagnosis and treatment of osteoarthritis of the knee,and to find the best treatment plan.Methods:180 patients who were hospitalized in our department of orthopaedics during June 2016 to June 2018 were selected.Patients who met the diagnostic criteria for osteoarthritis of the knee(KOA)were selected as the study subjects.Randomly sampled random number table method was used.They were divided into sodium hyaluronate group,arthroscopic group,and combined group,60 cases in each group.The sodium hyaluronate group was randomly divided into sodium hyaluronate group A and sodium hyaluronate group B,with 30 cases in each group.Sodium hyaluronate group A used 900,000 units of low molecular weight sodium hyaluronate(Alchine)joints.Intracavernous injection was used for treatment.Sodium hyaluronate group B was treated with intra-articular injection of 1.8 million units of high molecular weight sodium hyaluronate.The arthroscopic group underwent arthroscopic debridement.The combination group was randomly divided into group A and group B,with 30 cases in each group.Arthroscopically combined with 900,000 units of low-molecular-weight sodium hyaluronate(Alzheimer's disease)in combination with group A was combined with group B to perform arthroscopic surgery.Million units of high molecular weight sodium hyaluronate(Speite)treatment.Arthroscopic surgery and joint cavity puncture in all patients were performed by the same group of senior orthopedic surgeons.The levels of IL-6 and IL-8 were measured by enzyme-linked immunosorbent assay(ELISA)before and after treatment.The clinical efficacy was evaluated by the internationally accepted WOMAC questionnaire and visual analogue scale(VAS).The occurrence of adverse reactions.Results:(1)The contents of IL-6 and IL-8 in the synovial fluid of the sodium hyaluronate group,the arthroscopic group,and the combined group were significantly lower than before treatment(P<0.05);IL-6 and IL in the synovial fluid of the combined group The content of-8 in the hyaluronic acid group and arthroscopic group was significantly lower than that in the hyaluronic acid group and the arthroscope group(P<0.05).There was no significant difference in the content of IL-6 and IL-8 in the synovial fluid between the hyaluronic acid group and the arthroscopic group(P>0.05)..The levels of IL-6 and IL-8 in the synovial fluid after treatment of sodium hyaluronate group A,sodium hyaluronate group B,combined group A,and group B were significantly lower than before treatment(P<0.05);sodium hyaluronate The contents of IL-6 and IL-8 in the synovial fluid of group A,sodium hyaluronate group B,combined group A,and group B had significant differences(P<0.05);and sodium hyaluronate group B and joints There was no significant difference in the content of IL-6 and IL-8 in the synovial fluid after lens treatment(P>0.05).(2)The WOMAC scores after treatment in the sodium hyaluronate group,arthroscopic group,and combination group were significantly lower than before treatment(P<0.05);after 6 months and 1 year after treatment,the WOMAC score in the combined group was significantly lower than that of hyaluronic acid.In sodium group and arthroscope group(P<0.05),there was no significant difference in the WOMAC score between the sodium hyaluronate group and arthroscopic group at each time period(P>0.05).In the sodium hyaluronate A group,sodium hyaluronate B group,combination A group,and B group,the WOMAC scores after treatment were significantly lower than before treatment(P<0.05);6 months and 1 year after treatment,sodium hyaluronate A There were significant differences in WOMAC scores between group B,sodium hyaluronate group B,combined group A and group B(P<0.05),and 3 months,6 months and 1 year after treatment with sodium hyaluronate in group B and arthroscopic group.There were no significant differences in WOMAC scores(P>0.05).(3)The VAS scores of the sodium hyaluronate group,arthroscopic group and combination group were significantly lower than those before treatment(P<0.05).The VAS scores of the combination group after 6 months and 1 year were significantly lower than hyaluronic acid.The sodium group and the arthroscopy group(P<0.05);there was no significant difference in the VAS score between the sodium hyaluronate group and the arthroscopy group(P>0.05).The VAS scores of sodium hyaluronate group A,sodium hyaluronate group B,combined group A and group B were significantly lower than those before treatment(P<0.05).6 months and 1 year after treatment,sodium hyaluronate A The VAS scores of group,sodium hyaluronate group B,combined group A and group B were significantly different(P<0.05),while sodium hyaluronate group B and arthroscopy group were treated for 3 months,6 months,1 year.There were no significant differences in VAS scores(P>0.05).(4)One year follow-up,the clinical efficacy of each group was evaluated according to the WOMAC score.The total effective rate was 73.33%in the sodium hyaluronate group;the total effective rate was 71.67%in the arthroscopic group;the total effective rate was 88.33%in the combined group;The total effective rate was significantly higher than sodium hyaluronate group and arthroscopic group(P<0.05),but there was no significant difference in the total effective rate between sodium hyaluronate group and arthroscopic group(P>0.05).In the sodium hyaluronate group,the total effective rate of sodium hyaluronate A group was 76.67%;the total effective rate of sodium hyaluronate group B was 70.00%.In the combination group,the total effective rate in combination with group A was 93.33%;the total effective rate in group B combined was 83.33%.The total effective rate in each group was significantly different(P<0.05).There was no significant difference in the total effective rate between sodium hyaluronate group B and the arthroscopic group(P>0.05).(5)There were no obvious abnormalities in the three routine and liver and kidney tests performed before and after treatment in each group.There was one case of sodium hyaluronate in group A and group B,and one patient in group B had a brief increase in pain within 24 to 48 hours after intra-articular injection.There was knee soreness discomfort,but both Relieve soon.There was no obvious adverse reaction in any of Yu.Conclusions:(1)Sodium hyaluronate injection,arthroscopic debridement,and arthroscopic debridement combined with sodium hyaluronate injection have a good clinical effect on knee osteoarthritis and can reduce synovial fluid Inflammatory cytokines relieve joint pain and stiffness,improve daily activities,and have no obvious adverse reactions.The three treatments have similar efficacy in the near future,but the long-term efficacy of arthroscopic debridement combined with sodium hyaluronate injection is better,and it is worth further promotion in clinical practice.(2)The small molecular weight sodium hyaluronate has a better therapeutic effect on knee osteoarthritis,and the clinical treatment of small molecular weight sodium hyaluronate is preferred. |
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