关节镜治疗肘关节类风湿性关节炎的临床疗效观察

Arthroscopic synovectomy of the elbow in rheumatoid arthritis

目的观察采用关节镜技术治疗肘关节类风湿性关节炎(RA)的临床疗效及其手术方法。方法采用肘关节镜技术治疗RA肘关节病变共28例(32肘),据术前X线检查,按照Larsen诊断分级标准,将本组患者分为A、B两组。A组为1、2级共8例(8肘),B组为3、4级共20例(24肘)。主要施行关节镜下全关节滑膜切除术,术中将关节腔分为前方间室、后方间室和肱桡间室,要求按顺序依次切除,避免遗漏。对于手术前后的肘关节疼痛评分(VAS评分法)、肘关节平均伸屈活动度和肘关节功能评分(Mayo肘关节功能评分)进行疗效评定。结果术后随访复查时间0.5～4.5年,平均3.1年。在6个月复查时肘关节伸直角度从术前平均98.1°增加到113.3°。最终随访时VAS评分从术前平均6.9分下降到2.5分,Mayo肘关节功能评分(Mayo Elbow Performance Score)平均分从58.5分改善到77.4分,有2例滑膜炎复发。结论采用关节镜下滑膜切除术治疗RA肘关节病变疗效可靠,通过关注手术细节,可全面切除滑膜组织,并减少并发症的发生。

Objective To investigate the clinical outcomes of arthroscopic synovectomy in patients with rheumatoid elbow and to present an arthroscopic technique for complete removal of the synovium from the elbow joint. Methods Arthroscopic synovectomy was performed on 32 rheumatoid elbows in 28 patients. According to radiologic changes and the Larsen grading system the cases were divided into group A （Larsen grade 1 or 2 ） and group B （Larsen grade 3 or 4 ）. Total synovectomy of the elbow was performed by multiple portals and the elbow was devided into anterior, posterior, and radioeapitellar compartments. Pain was evaluated with a visual analog scale and the range of motion was measured. The flexion arc and the Mayo Elbow Performance Score were used to assess elbow function. Results At an average follow-up time of 3.1 years （ range, 0. 5 to 4. 5 years ） , the average visual analog scale score-for pain decreased from 6. 5 to 3.1, and the mean flexion arc increased from 98.1 degrees to 113.3 degrees after the operation. The average Mayo Elbow Performance Score improved from 58.5 to 77. 4 points. Clinically apparent synovitis recurred in two elbows, in which the results were considered as unsuccessful. Conclusions Arthroscopic synoveetomy of the elbow by multiple portals is a technically feasible procedure. It can effectively relieve pain, increase range of motion, improve Mayo Elbow Performance Score, and delay radiologic progression in rheumatoid elbows, resulting in a high satisfaction rate, although recurrent synovitis occurs in some patients.