老年类风关膝关节滑膜炎关节镜下滑膜切除临床评估

CLINICAL EVALUATION OF ARTHROSCOPY SYNOVECTOMY FOR THE PATIENT WITH RHEUMATOID ARTHRITIS

目的目前对类风湿性关节炎引起的膝关节滑膜炎．大部分风湿病医师均采用关节镜下滑膜切除来治疗，但对手术后膝关节好转期能维持多久临床风湿病医师有不同的看法。方法1988～2004年12月本院对88例124膝类风湿性关节炎的患者行关节镜下膝关节滑膜切除，所有接受手术的患者年龄均〉60岁。18病例采用Pridie方法处理裸露的软骨下骨。结果手术后采用膝关节评价标准（HSS评分）来评定手术后的效果，其中85—100分64膝，70-84分41膝，60-69分14膝，60分以下5膝。Ⅲ～Ⅳ期关节的患者中，有17／19膝随访时的评分〈70分，而有86／95膝Ⅰ～Ⅱ期的膝关节手术后的好转期也仅为4～5年左右。结论关节镜下膝关节滑膜切除手术创伤小，对改善关节的炎症．遏制关节软骨溃疡的进展有一定的作用，而且对某些患者复发性的膝滑膜炎有一定的可重复性。镜下的滑膜切除对治疗类风关膝滑膜炎不失为一种简单且近期有效的手术方法。

Objective Nowadays most of surgeons prefer to treat the rheumatoid synovialitis by arthroscopy synovectomy. However, how long the ＂good result＂ can he kept is really unknown. Methods 88 patients （ 124 knees） with rheumatoid synovialitis were undergone synovectomy through arthroscope from 1988 to 2004. 18 knees with bared bone were dealed with ＂Pridie＂ method. Results All the cases were evaluated by the HSS Knee score before and after operation. 64 knees got the score of 85-100 points, 41 knees got 70-84 and 14 knees got 60-69. The score was below 60 in 5 knees. 17/19 knees of the arthritis- patient in grade Ⅲ - Ⅳ were below the score of 70,while 86/95 knees of the resolving stage of the arthritis- patient in grade Ⅰ～Ⅱ were only 4～5 years. Conclusions The synovialitis of knee by arthroscopy synovectomy has the benefit of little surgical trauma, improved function of articulation, holding back the ulceration of arthrodial cartilage and can be performed in some recurrence of the knee synovialitis. It is a simple and effective operation in the knee synovialitis in Rhumatoriod Arthritis.