关节镜下滑膜切除联合射频汽化治疗膝关节类风湿关节炎

Treatment of rheumatoid gonarthritis by arthroscopic synovectomy combined with radiofrequency vaporization

目的探讨关节镜下滑膜切除联合射频汽化治疗膝关节类风湿关节炎的疗效。方法对36例有膝关节滑膜炎表现的类风湿关节炎，在内科正规药物治疗的同时，关节镜下膝下前内、前外常规入路及膝外上、内上入路，对膝关节增生滑膜、血管翳行刨削切除及射频汽化，其中21例附加膝后内、后外侧入路，处理膝后间室病变滑膜。术后3d开始进行系统关节功能锻炼。结果36例随访4～26个月，平均16个月，优21例，良13例，可2例，优良率94．4％（34／36）。类风湿膝关节炎关节功能术前评分为（58．6±5．3）分，术后升至（91．6±5．8）分（t=2．723，P=0．003）；Lysholm膝关节功能术前评分为（42．3±3．8）分，术后升至（90．2±4．4）分（t=2．437，P=0．001）。结论关节镜下滑膜切除联合射频汽化，具有创伤小、出血少、关节功能恢复快的优点，有效地控制类风湿关节炎病情发展，可最大程度恢复病变膝关节功能。

Objective To investigate clinical effects of arthroscopic synovectomy combined with radiofrequency vaporization for the treatment of rheumatoid synovitis of the knee joint. Methods In 36 cases of rheumatoid gonarthritis with chronic synovitis of the knee joint, with simultaneous administration of regular medication, we had applied arthroscopic synovectomy combined with radiofrequency vaporization to remove the hyperplastic synovium and pannus through standard anteromedial and anterolateral approaches, and superolateral and superomedial approaches. In 21 out of 36 cases, diseased synovium in the posterior compartment was resected via additional posteromedial and posterolateral approaches. A systematic rehabilitation program was practiced 3 days after operation. Results All the 36 cases were followed for 4～26 months （mean, 16 months）. Clinical effects evaluation showed ＂excellent＂ in 21 cases, ＂good＂ in 13 cases, and ＂fair＂ in 2, with a total excellent-or-good rate of 94.4% （34/36）. The knee joint function scores were significantly elevated from 58.6±5.3 preoperatively to 91.6±5.8 postoperatively （t = 2.723, P = 0.003）. The Lysholm scores were significantly elevated from 42.3±3.8 preoperatively to 90.2±4.4 postoperatively （t = 2.437, P = 0.001）. Conclusions Combined use of arthroscopic synovectomy with radiofrequency vaporization for the treatment of rheumatoid gonarthritis has advantages of minimal trauma, little blood loss, and rapid recovery of joint function. The procedure can effectively control the progression of rheumatoid arthritis and restore the knee joint function to the greatest possible extent.