目的：通过观察关节镜清理术配合术后口服补肾活血中药治疗膝骨关节炎，评估其临床疗效及对血清CTX-Ⅱ、COMP的影响。方法：将符合诊断标准的患者随机分成治疗组和对照组，各30例。先行关节有限清理术，观察并记录关节内关节软骨退变程度、滑膜增生及炎性程度，术前采集静脉血，用ELISA法测定血清CTX-Ⅱ和COMP含量，术后治疗组行手术治疗+术后口服补肾活血中药，对照组行手术治疗+口服塞来昔布胶囊治疗。分别于治疗前及治疗后4周，采用WOMAC膝关节功能评分及临床疗效评定，并测定术后血清CTX-Ⅱ和COMP含量。结果：治疗组有效率高于对照组（P<0.05）；治疗组WOMAC评分在疼痛、僵直、活动难度评分及总评分与对照组比较有显著差别（P<0.05）；两组治疗前后，及治疗组与对照组治疗后血清CTX-Ⅱ、COMP差异均有统计学意义（P<0.05）；血清CTX-Ⅱ和COMP与软骨的退变及滑膜增生呈正相关，差异均有统计学意义（P<0.05）。结论：关节镜下有限清理配合补肾活血法治疗膝骨关节炎有协同治疗作用，可有效缓解临床症状，改善膝关节功能，血清CTX-Ⅱ、COMP含量较前降低明显；膝骨关节炎关节镜下软骨退变、滑膜增生与细胞因子CTX-Ⅱ和COMP有内在密切的联系；细胞因子CTX-Ⅱ和COMP水平对软骨退变、滑膜增生程度的估计及预后有重要参考价值。

By observing the arthroscopy cleaning technique with postoperative oral administration with reinforcing kidney and activating blood Chinese herbal medicine in the treatment of knee osteoarthritis (KOA), this article was aimed to evaluate the clinical curative effect and its influence on serum C endⅡ collagen type (CTX-Ⅱ) and cartilage oligomeric matrix protein (COMP). Patients who met the diagnostic criteria were randomly divided into the treatment group and control group, with 30 cases in each group. Joint limited debridement was firstly applied. And the degree of articular cartilage degeneration, synovial hyperplasia and inflammatory degree were observed and recorded. Preoperative venous blood was collected. The contents of CTX-Ⅱ and COMP were detected with ELISA method. After surgery, in the treatment group, surgery plus postoperative oral administration with reinforcing kidney and activating blood Chinese herbal medicine was given. In the control group, surgery plus oral administration with celecoxib capsules was given. Four weeks before and after the treatment, the WOMAC knee function score was used in the evaluation of clinical curative effect. The contents of postoperative serum CTX-Ⅱ and COMP were determined. The results showed that the effectiveness of the treatment group was higher than that of the control group (P < 0.05). In the treatment group, the WOMAC score in pain, rigidity, difficulty of activity and total score had significant differences compared with the control group (P < 0.05). There were statistical significances on serum CTX-Ⅱ and COMP in the treatment group before and after the treatment, as well as the comparison between the treatment and control group both before and after the treatment (P < 0.05). Serum CTX-Ⅱ and COMP had positive correlation with the degeneration of cartilage and synovial hyperplasia with statistical significances (P < 0.05). It was concluded that joint limited debridement under arthroscopy combined with reinforcing kidney and activating blood method had synergistic effect in the treatment of KOA. It can effectively relieve the clinical symptoms and improve the knee joint function. It can also obviously reduce the contents of serum CTX-Ⅱ and COMP. There was internal close relation between the articular cartilage degeneration, synovial hyperplasia under the arthroscopy in KOA and cytokines of CTX-Ⅱ and COMP. The cytokines of CTX-Ⅱ and COMP provided important references for the estimation of articular cartilage degeneration and synovial hyperplasia.

广东省科技厅科技计划项目（K3050010）：补肾方对肾虚大鼠膝骨关节炎软骨病变基因表达谱的影响，负责人：韩清民。