关节镜下滑膜切除术治疗肘关节类风湿性关节炎

Arthroscopic synovectomy for the rheumatoid elbow

目的探讨肘关节类风湿性关节炎(RA)关节镜的手术方法和临床疗效。方法从2000年1月～2007年12月,本组对23例肘关节RA患者行肘关节镜下滑膜切除术。肘关节镜手术采用俯卧位,使用直径4mm的关节镜。本组患者男4例,女19例;平均年龄(49±7.8)岁(38～59岁),发病时间平均(12.2±5.8)年(5～20年);全部患者术前X线检查均有关节间隙狭窄和侵蚀,为Larsen3～4期的晚期病变。术后随访门诊复查时间平均4.3(0.5～6)年,术者对关节屈伸活动度进行了测量,患者对关节肿痛和不适进行了主观评价。结果本组患者术后无出现并发症。关节伸直角度术前平均差(40±25)°(10～75°),术后平均差(25±18)°(10～50°);关节屈曲角度术前平均(90±14)°(70～110°),术后平均(104±16)°(80～120°)。关节活动度得以保持。患者自诉肿痛及关节不适明显改善,全部患者在主观上感到非常满意。结论采用俯卧位技术关节镜下滑膜切除术治疗肘关节RA安全有效,即使晚期患者仍可在较长时间内保持活动度,并可明显改善肿痛症状,患者主观评价非常满意。

Objective To investigate the techniques and results of arthroscopic synovectomy of the elbow in rheumatoid arthritis （RA）. Methods Arthroscopic synovectomy was performed on 23 rheumatoid elbows between 2000 and 2007. The elbow arthroscopy was performed by prone position. The arthroscope with 4 mm in diameter was used. This series included 4 male cases and 19 female cases, the mean age was （49±7.8） years old （38-59 years old）, the mean morbidity duration was （12.2±5.8） years （5-20 years）. The joint spaces of all elbows were narrow by radiography classifying into late stage for grade 3-4 according to Larsen system. The mean duration of follow-up was 4.3 years （0.5-6 years）. The ROM was measured by the first surgeon. The patients evaluated subjectively the swelling, pain and discomfort. Results The nerve and vessle complications had not been found in any cases by prone position. The mean extention angle changed from minus （40±25）°（10-75°）preopertively to minus （25±18）° （10-50°） postopertively. The mean flexion angle changed from （90±14）°（70-110°）preopertively to （104±16）°（80-120°） postopertively. The ROM had been maintained. The patients complained that the swelling, pain and discomfort were relieved. All patients were satisfied. Conclusions The arthroscopic synovectome by prone position for elbow in RA is safe and effective. The elbows in late stage of RA maintain the ROM at long-term follow-up. The swelling, pain and other discomfort can be relieved. The patients are very satisfied.