关节镜肘关节有限清理及松解治疗类风湿关节炎肘关节僵直的疗效及安全性  

Efficacy and safety of arthroscopic elbow joint limited clearing and arthrolysis for treatment of rheumatoid arthritis elbow stiffness

作　　者：邓代华 李思吟 倪远飘 张羽 李敏 罗家昂 杨静 DENG Daihua;LI Siyin;NI Yuanpiao;ZHANG Yu;LI Min;LUO Jiangang;YANG Jing(Department of Rheumatology,Affiliated Mianyang Hospital,School of Medicine,University of Electronic Science and Technology of China,Mianyang,Sichuan 621000,China)

机构地区：[1]电子科技大学医学院附属绵阳医院/四川省绵阳市中心医院风湿免疫科,621000

出　　处：《重庆医学》2022年第1期80-84,共5页Chongqing medicine

基　　金：四川省科技计划项目(2017SZ0148);四川省卫生健康委员会普及应用项目(19P5114);四川省基层卫生事业发展研究中心资助项目(SWFZ19-Q-14)。

摘　　要：目的观察关节镜肘关节有限清理及松解术治疗类风湿关节炎(RA)肘关节僵直的疗效及安全性。方法选择2017年1月至2020年1月该院风湿免疫科住院治疗的24例出现肘关节僵直的RA患者,采用局部浸润麻醉行关节镜有限清理术,并对挛缩的关节囊和侧副韧带等给予松解,术后2、12、24周随访,记录患者疾病活动评分28 C反应蛋白(DAS28)-CRP)评分、健康评估问卷(HAQ)评分、Mayo肘关节功能评分、ROM屈伸功能等。结果24例患者术后2、12、24周DAS28-CRP评分[分别为(4.172±0.622)、(3.432±0.471)、(2.957±0.556)分]均较术前[(5.262±0.954)分]明显降低,HAQ评分[分别为(5.083±2.412)、(4.500±2.467)、(3.375±2.299)分]均较术前[(7.541±2.519)分]明显改善,Mayo关节功能评分[分别为(30.833±4.815)、(39.583±11.317)、(38.750±8.753)分]均较术前[(20.000±7.223)]明显升高,肘关节屈曲度[分别为(133.166±8.986)°、(135.125±8.189)°、(133.541±8.856)°]均明显优于术前[(130.458±11.931)°],肘关节伸直度[分别为(-12.333±9.229)°、(-6.667±8.971)°、(-8.541±8.587)°]均较术前[(-15.875±10.617)°]明显改善,差异均有统计学意义(P<0.05);24例患者术后12、24周日常活动能力[分别为(22.291±2.544)、(21.041±2.074)分]均较术前[(18.958±2.544)分]明显好转,差异均有统计学意义(P<0.05);关节稳定性较术前改善,但差异无统计学意义(P>0.05);肘关节僵直时间大于或等于12个月的患者术后关节伸屈功能恢复情况较小于12个月的患者效果稍差;24例患者术后均未出现并发症。结论关节镜肘关节有限清理及松解术能缓解RA肘关节僵直的疼痛,改善屈伸活动度及功能,并发症发生率低,安全性高。Objective To observe the efficacy and safety of arthroscopic elbow joint limited clearing and arthrolysis in treating elbow stiffness of rheumatoid arthritis.Methods Twenty-four patients with rheumatoid arthritis(RA)appearing elbow rigidity in the department of rheumatology and immunology department of this hospital from January 2017 to January 2020 adopted the arthroscopic limited debridement under local infiltration anesthesia,and gave release of the contracture joint capsule and collateral ligaments.The follow up was performed in postoperative 2,12,24 weeks.The disease activity score(DAS28)-CRP score,health assessment questionnaire(HAQ)score,Mayo elbow function score and ROM flexion and extension function score were recorded.Results The DAS28-CRP scores at postoperative 2,12,24 weeks in 24 cases were(4.172±0.622),(3.432±0.471),(2.957±0.556)points respectively,which were significantly decreased compared with(5.262±0.954)point before surgery.The HAQ scores were(5.083±2.412),(4.500±2.467),(3.375±2.299)points respectively,which were significantly decreased compared with(7.541±2.519)pointsbefore surgery(P<0.05).The Mayo joint function scores were(30.833±4.815),(39.583±11.317),(38.750±8.753)points,which were significantly increased compared with(20.000±7.223)points before surgery.The elbow joint flexion degrees were(133.166±8.986),(135.125±8.189),(133.541±8.856)°,which were significantly better than(130.458±11.931)°before operation.The elbow joint stiffnesses were(-12.333±9.229),(-6.667±8.971),(-8.541±8.587)°respectively,which were significantly improved compared with(-15.875±10.617)°before operation,and the difference was statistically significant(P<0.05);the daily activities at postoperative 12,24 weeks in 24 cases were(22.291±2.544)points and(21.041±2.074)points respectively,which were significantly improved compared with(18.958±2.544)points before operation,and the differences were statistically significant(P<0.05).The joint stability was significantly improved compared with before ope

关 键 词：类风湿关节炎 肘关节僵直 关节镜 

分 类 号：R593.22[医药卫生—内科学]