关节镜下膝关节滑膜切除术联合药物治疗膝关节类风湿关节炎疗效观察  

Arthroscopic synovectomy treating rheumatoid arthritis of knee joint cartilage

作　　者：晋松[1] 郑红梅[1] 林俊[1] 马莎[1] 李芹[1] 

机构地区：[1]云南省第一人民医院风湿免疫科,昆明650032

出　　处：《中国医药》2015年第1期106-110,共5页China Medicine

摘　　要：目的 探讨关节镜下膝关节滑膜切除术联合抗类风湿药治疗类风湿关节炎（RA）的疗效.方法 选择膝关节损伤的RA患者143例,根据患者关节损伤程度及关节功能将其分为对照组（74例）和联合治疗组（69例）.对照组仅给予常规的抗类风湿药甲氨蝶呤7.5 mg/周,顿服,来氟米特20 mg 1次/d口服治疗;联合治疗组69例共73个关节,依据1987年美国风湿病学学会RA分类标准,将患者依X线检查分成3期,其中一期17例患者共17个关节,二期38例患者共41个关节,三期14例患者共15个关节,除给予常规的抗类风湿药治疗外,行关节镜下膝关节滑膜切除术治疗.2组患者于术后第6、12个月进行随访,行关节功能评估及膝关节磁共振成像（MRI）检查,随访内容包括健康评估问卷（HAQ）评分和关节炎影响测量量表（AIMS）评分,关节功能评价采用Ishikawa疗效评分,MRI检查膝关节软骨损伤采用Recht标准评分.结果 联合治疗组患者治疗后6、12个月的HAQ评分和AIMS评分均明显低于对照组,差异有统计学意义[治疗后6个月：HAQ评分（7±6）分比（13±11）分,AIMS评分（10±5）分比（18±10）分;治疗后12个月：HAQ评分（6±5）分比（14±11）分,AIMS评分（8±6）分比（18±10）分,P＜0.05].治疗后6、12个月联合治疗组Recht标准评分明显低于对照组,差异有统计学意义[治疗后6个月：（2.8±0.7）分比（3.4±0.8）分;治疗后12个月：（2.7±0.6）分比（3.5±0.9）分,P＜0.05].联合治疗组患者于术后6、12个月进行膝关节功能Ishikawa疗效评分比较,结果显示一、二期患者关节功能优良率均明显高于三期患者,差异均有统计学意义[治疗后6个月：100.0％ （17/17）、90.2％ （37/41）比80.0％ （12/15）;治疗后12个月：94.1％ （16/17）、92.4％（38/41）比73.3％（11/15）,均P＜0.05].结论 对RA患者进行关节镜下膝关节滑膜切除术可明显延缓关节软骨的破坏,较单独使用�Objective To investigate the effect of arthroscopic synovectomy treating rheumatoid arthritis of knee joint cartilage.Methods One hundred and fourty three patients were divided into two groups：the control group （74 cases） and the treatment group （69 cases）.The control group was only given conventional antirheumatoid drug therapy; treatment group （69 cases） were given surgical therapy for knee joint synovium resection under arthroscopy.Health assessment survey questions （HAQ scores）,arthritis affecting measurement scale （AIMS scores）,Joint function Ishikawa efficacy score and MRI of the knee joint cartilage injury Recht standard score were analyzed.Results The HAQ and AIMS scores of the treatment group after treatment of 6,12 months were significantly lower than those of the control group[after 6 months of treatment：HAQ scores （7 ± 6） vs （13 ± 11）,AIMS scores（10 ±5） vs （18 ± 10） ;after 12 months of treatment：HAQ scores （6 ±5） vs （14 ± 11）,AIMS scores （8 ± 6） vs （18 ± 10）,P ＜ 0.05] ; the difference was statistically significant.The Recht scores of the treatment group after 6,12 months of treatment were significantly lower than those in the control group,the difference had statistical significance[after 6 months of treatment：（2.8 ± 0.7） vs （3.4 ± 0.8） ; after 12 months of treatment：（2.7 ± 0.6） vs （3.5 ± 0.9）,P ＜ 0.05].The patients in the treatment group were evaluated by knee function after treatment of 6,12 months,the results showed that the excellent and good rate of first and second stage patients were significantly higher than those of the third stage patients,the difference had statistical significance [after treatment of 6 months：100.0％ （17/17）,90.2％ （37/41） vs 80.0％ （12/15） ;after treatment of 12 months：94.1％ （16/17）,92.4％（38/41） vs 73.3％ （11/15）,P＜0.05].Conclusion The effect of arthroscopic synovectomy treating rheumatoid arthritis of knee joint cartilage is optimistic,it ca

关 键 词：类风湿关节炎 膝关节 关节镜 抗类风湿药 

分 类 号：R684.3[医药卫生—骨科学]