膝关节十分区法及其在类风湿关节炎关节镜下滑膜全切除除术中的应用  

Ten-Zone Divisional Method of the Knee Joint and Its Application to Arthroscopic Total Synovectomy for Rheumatoid Arthritis

作　　者：赵立恒[1] 余家阔[1] 罗浩[1] 

机构地区：[1]北京大学第三医院运动医学研究所,北京100191

出　　处：《中国微创外科杂志》2009年第4期327-331,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：北京大学二期985工程资助项目

摘　　要：目的探讨膝关节十分区法及其在类风湿关节炎(rheumatoid arthritis,RA)关节镜下滑膜切除术中的应用和临床效果。方法解剖22个新鲜冷冻膝关节,了解膝关节纵隔的解剖特点,在此基础上提出膝关节滑膜分布的十分区法。对接受关节镜下滑膜全切除术的37例RA(40个膝关节)进行随访观察,术后随访10～72个月。其中25个膝关节按常规方法进行滑膜全切除术,15个膝关节按十分区法进行滑膜全切除术。随访内容包括Lysholm评分、Lequesne指数评分以及Larsen分期。结果膝关节存在一个从前至后的纵隔结构,其前方与脂肪垫、翼状皱襞或黏膜韧带相连,中间位于前后交叉韧带之间,后方形成膝关节的后纵隔。借助对膝关节纵隔的解剖结果可以将膝关节的滑膜分布区分成10个区。按十分区法进行关节镜下滑膜全切除术的RA患者的优良率为100%(15/15),而且无一例复发。按常规关节镜下滑膜全切除法进行手术的25个膝关节中,17个为优良,8个膝关节复发,优良率为68%(17/25)(Fisher精确检验,P=0.016)。结论关节镜下滑膜全切除术治疗早期RA效果良好;以膝关节纵隔结构为基础的膝关节十分区法对提高滑膜全切除术的手术效果有一定的意义。Objective To establish a ten-zone divisional method of the knee joint and investigate its clinical application to arthroscopic total synovectomy for rheumatoid arthritis （RA）. Methods A total of 22 fresh frozen specimens of adult knee joints were prepared for anatomical study on the sagittal septum of the knee to establish ten-zone divisional method of the knee joint. A retrospective study was carried out on 37 patients with early-stage RA （40 knees） undergone arthroscopic total synovectomy. Among the cases,15 knees were operated according to ten-zone divisional method, and the other 25 were treated with the routine method. The patients were followed up for 10-72 months to evaluate their Lysholm score,Lequesne Index,and Larsen stage classification. Results There was a sagittal septum in the knees,connecting anteriorly to the fat pad,alar fold,or mucous ligament. The middle part of the sagittal septum lied between the anterior and posterior cruciate ligaments,and its posterior part formed the posterior septum of the knee. Considering the anatomy of the sagittal septum,the synovium of the knee could be divided into 10 zones. All of the patients underwent total synovectomy by ten-zone divisional method achieved excellent or good outcomes （100%,15/15）,none of them recurred during follow-up. Among the 25 knees that received total synovectomy by routine arthroscopic method,17 achieved excellent or good outcomes （68%,17/25）,and 8 had recurrence （Fisher＇s exact test,P=0.016）. Conclusions Arthroscopic total synovectomy was one of the effective treatments for early-stage RA. The ten-zone divisional method for total synovectomy according to the structure of the knee sagittal septum could improve the clinical results of total synovectomy for rheumatoid arthritis.

关 键 词：类风湿关节炎 滑膜切除术 关节镜 膝关节纵隔 

分 类 号：R687.2[医药卫生—骨科学]