腕关节镜下滑膜切除术治疗累及腕关节的未分化关节炎的疗效分析  

The clinical efficacy analys is of arthroscopic synovectomy for the treatment of undifferentiated arthritis involving the wrist

作　　者：尹善青[1] 袁芳芳 黄耀鹏[1] 潘佳栋[1] 王欣[1] Yin Shanqing;Yuan Fangfang;Huang Yaopeng;Pan Jiadong;Wang Xin(Department of Hand Surgery,Ningbo No.6 Hospital,Ningbo 315000,China)

机构地区：[1]宁波市第六医院手外科,宁波315000

出　　处：《中华手外科杂志》2023年第2期150-153,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨腕关节镜下滑膜切除术治疗累及腕关节的未分化关节炎的疗效。方法自2016年1月至2021年1月,我们对15例累及腕关节的未分化腕关节炎患者在腕关节镜下行滑膜切除术。术后记录滑膜的病理结果及腕关节滑膜炎的缓解情况,对患者腕关节疼痛情况应用视觉模拟评分(visualanaloguescale,VAS)进行评估,腕关节功能应用Mayo评分系统进行评估,根据Larsen分级记录腕关节影像学变化,记录术前术后实验室指标,包括C反应蛋白、红细胞沉降率,以及腕关节屈伸活动度。结果术后随访时间为10~30个月,平均14.5个月,有6例患者在未服用抗风湿药物的情况下症状完全缓解,8例患者在服用抗风湿药物的情况下完全缓解,1例患者在服用抗风湿药物的情况下滑膜炎未得到控制。术后的病理结果均显示为淋巴细胞及浆细胞弥漫性浸润。术后患者的VAS评分从(6.5±3.2)分降至(1.4±2.1)分,Mayo评分从(47.2±10.4)分增加到(78.3±11.8)分,Larsen分级显示术前和术后腕关节在影像学上没有变化。C反应蛋白术前为(32.2±5.2)mg/L,术后为(14.3±3.2)mg/L;红细胞沉降率术前为(51.3±3.8)mm/1h,术后为(24.7±3.6)mm/1h。腕关节屈伸活动度术前为(71.3±16.8)°,末次随访为(124.7±19.6)°。各项指标与术前比较差异均有统计学意义(P<0.05)。结论腕关节镜下滑膜切除术治疗累及腕关节的未分化关节炎能够辅助确定诊断,在早期能够有效缓解腕关节疼痛,增加腕关节活动度,延缓疾病的进展,具有良好的应用价值。Objective To investigate the clinical efficacy of synovectomy under wrist arthroscope in the treatment of undifferentiated arthritis involving wrist joint.Methods From January 2016 to January 2021,15 cases of undifferentiated wrist arthritis involving the wrist were treated by synovectomy under wrist arthroscope.The pathological results of synovium and the relief of synovitis of wrist joint were recorded after surgery.The pain of wrist joint was evaluated with visual analogue scale(VAS).The wrist function was evaluated with Mayo scoring system.The imaging changes of wrist joint were recorded according to Larsen grading.The laboratory indexes before and after surgery,including C-reactive protein,erythrocyte sedimentation rate,and wrist flexion and extension activity,were recorded.Results The follow-up time was 10 to 30 months,with an average of 14.5 months.6 patients had complete remission without taking anti-rheumatic drugs,8 patients had complete remission with anti-rheumatic drugs,and 1 patient had uncontrollable synovitis with anti-rheumatic drugs.The postoperative pathological results showed diffuse infiltration of lymphocytes and plasma cells.After operation,the VAS of patients decreased from(6.5±3.2)points to(1.4±2.1)points,and the Mayo score increased from(47.2±10.4)points to(78.3±11.8)points.Larsen grading showed that the wrist joint had no change in imaging before and after operation.The C-reactive protein was(32.2±5.2)mg/L before operation and(14.3±3.2)mg/L after operation.The erythrocyte sedimentation rate was(51.3±3.8)mm/1h before operation and(24.7±3.6)mm/1h after operation.The wrist flexion and extension range of motion was(71.3±16.8)°before operation and(124.7±19.6)°at the last follow-up.There were statistically significant differences between each index and that before operation(P<0.05).Conclusion The arthroscopic synovectomy for the treatment of undifferentiated arthritis involving the wrist can assist in determining the diagnosis,effectively relieve wrist pain in the early stage,incr

关 键 词：腕关节 关节镜 关节炎 未分化 

分 类 号：R687.4[医药卫生—骨科学]