类风湿性关节炎的关节镜手术

Arthroscopic procedures for rheumatoid arthritis

目的探讨关节镜下滑膜切除关节清理术治疗类风湿性关节炎的临床疗效。方法对18例34个关节(双膝15例,单膝2例,双踝1例)用关节镜下滑膜切除关节清理术配合抗风湿药物、心理治疗和关节功能康复训练综合治疗类风湿性关节炎。结果术后17例随访1￣3a,优4例8个关节,良9例17个关节,优良率占76.47%,可4例7个关节,占23.53%,但全组病例均继续小剂量服用抗风湿药物。结论关节镜手术早作疗效好,晚作只能改善关节肿痛症状,关节功能改善不够理想。类风湿性关节炎是全身性疾病,滑膜切除是一种姑息性手术,可以减小抗风湿药物用量控制病情,降低药物副作用,不能彻底停药。

[Objective] To assess the effectiveness of treatment of synovectomy and joint debridement under arthroscope to rheumatoid arthritis. [Methods] 18 patients （34 joints） included 15 patients of two knees, 2 patients of one knee and 1 patient of two ankles with rheumatoid arthritis had been treated with synovetomy and joint debridement uader arthroscope, combined with the antirheumatic drugs, mentality therapy and arthrosis got mell training. [Results] 17 of 18 patients were followed up from one to three years, 4 patients （8 joints） were evaluated as excellent, 9 patients（17 joints ） as good, the choiceness rate was 76.47%, 4 patients （7 joints） as fair （23.53%）. But all patients of the group are taking antirheumatic drugs of small dose. [Conclusions] The operation with arthroscope has a good result in ill forepart. Belated operation can only improve symptoms, but functional improvement is not ideal. Rheumatoid arthritis is a disease of whole body. Synovectomy is an assuasive operation. It can minish the dosage of artirheumatic drugs for cortroling state of an illness, reduce the drug＇s side-effect, but can not stop it.