关节镜下滑膜切除术在治疗类风湿性关节炎中价值的探讨  

Evaluation of arthroscopic synovectomy in treatment of rheumatoid arthritis

作　　者：张峻[1] 侯筱魁[1] 王友[1] 史定伟[1] 

机构地区：[1]上海第二医科大学附属第九人民医院骨科,200011

出　　处：《上海医学》2004年第2期94-97,共4页Shanghai Medical Journal

摘　　要：目的　探讨关节镜下滑膜切除术在治疗类风湿性关节炎 (类风关 )中的价值。方法　在关节镜下对 34例早、中期类风关患者共 4 2个膝关节 (早期 2 2例 ,2 4个关节 ;中期 12例 ,18个关节 )行滑膜切除术 ,其中32个膝关节使用双极射频对残留的滑膜进行清除和止血。术后给予正规抗类风湿药物治疗。所有的 4 2个关节得到了 6个月的随访 ,31个关节得到 2年的随访 ,14个关节得到 4年的随访。随访内容包括关节功能的评定和红细胞沉降率 (ESR)、C反应蛋白 (CRP)和类风湿因子 (RF)的测定。结果　术后 6个月的关节功能的优良率为 95 .2 % (4 0 / 4 2个 ) ,术后 2年为 87.1% (2 7/ 31个 ) ,术后 4年为 6 4 .3% (9/ 14个 )。术后 3个月 ,早期类风关组的ESR、CRP和RF较术前明显下降 (P <0 .0 5 ) ,中期类风关组的ESR和CRP较术前明显下降 (P <0 .0 5 )。结论　对早、中期类风关患者进行关节镜下滑膜切除术 ,术后给予正规的抗类风湿药物治疗 ,可取得比较满意的疗效。双极射频能够彻底清除滑膜 ,有利于减少关节血肿的发生 ,促进关节功能康复。Objective To appraise the value of arthroscopic synovectomy in early and midstages rheumatoid arthritis. Methods 42 knees in 34 rheumatoid arthritis patients(24 knees of 22 early-stage cases, 18 knees of 12 mid-stage cases) were performed with arthroscopic synovectomy and received anti-rheumatoid drug therapy postoperatively. We used bipolar radiofrequency in treating 32 knees. All 42 knees were followed-up for 6 months, with 31 knees followed-up for 2 years, and 14 knees evaluated at 4-year after operation. All patients were evaluated by knee function, erythrocyte sedimentation rate (ESR), C reaction protein(CRP) and rheumatoid factor(RF). Results At 6 months postoperatively, the rate of excellent and good effects was 95.2%(40/42). At 2 years, 87.1% of knees (27/31) were considered to have excellent and good result, and at 4 year 64.3% of knees(9/14)continued to do well. ESR, CRP and RF significantly decreased postoperatively in early stage group(P<0.05). Whereas in mid-stage group, CRP and RF also decreased significantly postoperatively (P<0.05).Conclusions Satisfactory results can be obtained through arthroscopic synovectomy and concomitent anti-rheumatoid drug therapy in early and mid-stages rheumatoid arthritis. Bipolar radiofrequency is helpful in eliminating synovia, preventing knee joint hematoma and favoring rehabilitation.

关 键 词：关节镜 滑膜切除术 治疗 类风湿性关节炎 

分 类 号：R687[医药卫生—骨科学]