腕关节镜下滑膜切除术治疗类风湿性腕关节炎  

The arthroscopic synovectomy in treating rheumatoid arthritis of wrist

作　　者：沈云东[1] 徐文东 冯俊涛[1] 蒋苏[1] 郑谋雄 徐建光[1] 顾玉东[1] 

机构地区：[1]复旦大学附属华山医院手外科、上海市周围神经显微外科重点实验室、卫生部手功能重建重点实验室,上海200040 [2]医学神经生物学国家重点实验室,上海

出　　处：《中华手外科杂志》2015年第2期85-88,共4页Chinese Journal of Hand Surgery

基　　金：卫生部国家临床重点专科建设项目（2010）;上海市周围神经显微外科重点实验室资助项目（08DZ2270600）

摘　　要：目的探讨腕关节镜下滑膜切除术治疗类风湿性腕关节炎的短期疗效。方法对20例类风湿性腕关节炎患者在腕关节镜下行滑膜切除术，其中男4例，女16例；年龄19～41岁，平均31岁。术中彻底清除桡腕关节、腕中关节、桡尺远侧关节内增生滑膜，冲洗关节腔。分别于术前、术后6周及术后12个月对患者腕关节疼痛情况应用疼痛视觉模拟评分（VAS）评估疼痛水平，术前及术后12个月测量腕关节屈伸活动度，对其进行比较。结果术中见腕关节中大量增生红色软组织血管翳，进行清除并冲洗关节腔。患者术后制动2d即早期活动，无明显腕关节僵硬发生。术后随访时间平均12个月（9～15个月）。术前患者VAS评分平均为6分（4～8分）；术后6周患者疼痛有所缓解，VAS评分平均为4分（3～7分）；术后12个月时疼痛缓解明显，VAS评分平均为2分（1～4分）。腕关节活动度明显增加，由术前平均65°增大到术后12个月时平均95°。结论腕关节镜下治疗类风湿性腕关节炎效果良好，有效缓解疼痛，增加腕关节活动度，患者对手术效果满意。具有推广应用前景。Objective To evaluate the short-term effect of the arthroscopic synovectomy in treating rheumatoid arthritis of wrist. Methods Twenty rheumatoid patients including 4 men and 16 women aged 19 to 41 （mean, 31） years old underwent the arthroscopic synovectomy of the radiocarpal joint, the midcarpal joint and the distal radioulnar joint. The visual analogue scale was used to evaluate the pain of the patients before surgery, 6 weeks and 12 months after the surgery. The wrist flexion-extension arc was evaluated before and 12 months after surgery. Results Hypertrophy of the synovia and synovial pannus in the wrist was seen and reseeted during the surgery, and the articular cavity lavage was performed at the same time. The affected limb was immobilized for 2 days and started rehabilitation exercise. No ankylosis was seen in all 20 patients. The median duration of follow- up was 12 months, ranging from 9 to 15 months. 6 weeks after the surgery the pain was relieved from VAS 6 paints （range, 4 to 8） to 4 points （range, 3 to 7） on average, and 12 months after the surgery the VAS decreased to 2 points （range, 1 to 4）. The flexion-extension are increased from 65° to 95° on average. Conclusion The arthroscopic synovectomy can obtain a satisfying outcome for rheumatoid arthritis patients, especially in relieving pain and increasing the wrist motion. The surgery is well accepted by patients and has a promising future in clinical treatment.

关 键 词：腕 关节镜 关节炎 类风湿 

分 类 号：R593.22[医药卫生—内科学]