关节镜下膝关节结核性滑膜炎的治疗(附10例报告)

Arthroscopic treatment for tuberculous synovitis of the knee: A report of 10 cases

目的探讨关节镜下结核性滑膜炎的特点和滑膜切除术的效果. 方法选择10例结核性滑膜炎,行关节镜下滑膜切除手术和活检.术后配合关节腔注射异烟肼和全身抗结核治疗. 结果所有病人随访6月～3年,术后第2天行CPM关节功能锻炼,9例膝关节屈曲从手术前90°±5°平均提高到120°±14°,伸直受限从手术前20°±3°提高到5°±1°,手术前后比较差异有显著性(t值分别为6.9、 6.3,P<0.01),JOA评分术前(44±8)分,术后(82±10)分(t=8.47,P<0.01),所有病人2个月后关节肿胀减轻,随访期间内无病变复发. 结论关节镜下切除滑膜和清理结核性肉芽组织,改善软骨营养,结合药物治疗可有效控制病情,改善关节功能.

Objective To observe the therapeutic effect of arthroscopic synovectomy for tuberculous synovitis of the knee. Methods Ten patients with tuberculous synovitis received arthroscopic biopsy and synovectomy. Postoperatively, isoniazid was injected into the articular cavity, and systemic antituberculosis drugs were administrated. Results These patients received continuous passive motion (CPM) from the second postoperative day. In 9 patients, the flexion ranges of the knee were improved from 90°±5° before the surgery to 120°±14° after the surgery, and the extension limit of the knee, from 20°±3° before the surgery to 5°±1° after the surgery, with statistical significant differences ( t =6.9 and 6.3, respectively; P <0.01). The Japanese Orthopaedic Association (JOA) scores were increased from 44±8 before operation to 82±10 after operation, with statistical significance ( t =8.47, P <0.01). Follow-up checkups for 6~36 months in all the patients found a relief of joint swelling 2 months after operation and no recurrence of tuberculosis of the knee. Conclusions Arthroscopic removal of synovial membranes and debridement of tuberculous granulation tissues can improve the cartilaginous nutrition. This operation coupled with antituberculosis drug administration will effectively control the disease and greatly improve the joint functions.