关节镜下手术治疗类风湿关节炎致顽固性膝滑膜炎疗效观察

Observation of Therapeutic Efficacy of Arthroscopic Surgery in Treating Refractory Gonyocele Caused by Rheumatoid Arthritis

目的:观察关节镜手术配合内服中西药及康复训练治疗类风湿关节炎致顽固性膝滑膜炎的疗效。方法:回顾性分析32例类风湿关节炎患者经常规标准系统治疗后漆关节滑膜炎仍不能控制者,施行关节镜手术前3d,手术后3月、6月的临床资料,对休息及活动时疼痛评分、主动及被动关节活动度,关节肿胀(积液)、Lysholm评分、HAQ评分、DAS28评分、血沉(ESR),C反应蛋白(CRP),类风湿因子(RF),抗CCP抗体等资料进行统计分析,比较术前与术后,术后短期与长期的疗效。结果:患者手术前3d与术后3月比较,术后3月与术后6月的关节疼痛评分(休息及活动)明显减低(P<0.01);关节活动度(主动,被动)明显增加(P<0.01);关节肿胀程度明显减轻(P<0.01);Lysholm评分(P<0.01)、HAQ评分明显降低(P<0.01),DAS28评分明显降低(P<0.01);血清ESR、C反应蛋白(CRP),类风湿因子(RF)浓度(P<0.01),差异均具有统计学意义。而血清抗CCP抗体浓度均未见明显改善,差异无统计学意义(P>0.05)。结论:关节镜下手术配合内服中西药及康复训练能有效治疗类风湿关节炎致顽固性膝滑膜炎,改善患者局部症状,增强关节功能,且术后中长期疗效稳固,但不能解除类风湿关节炎原发病因。

Objective：To observe the therapeutic efficacy of arthroscopic surgery accompanied with systemic TCM and western medicine and rehabilitation training in treating refractory gonyocele caused by rheumatoid arthritis.Methods：Clinical materials of 32 patients received arthroscopic surgery RA,who failed to control gonyocele by conventional criteria systemic therapy previously,were retrospectively analyzed.The rest and activity pain scores,active and passive range of motion translation,swelling of joint（effusion）,lysholm score,HAQ score,DAS28 score,ESR,RF and Anti-CCP were analyzed at the third day before operation,the 3rd month and the 6th month after operation.Result：Arthralgia scores（rest and activity） were decreased dramatically;The range of motion（active and passive） were increased significantly;The swollen degree of joint were decreased significantly;Lysholm scores and HAQ scores were decreased significantly;DAS28 scores,ESR,CRP and RF were also decreased significantly.There was significant difference in the above index（P0.01）.However,the titer of Anti-CCP in serum had no obvious improvement,There was no significant difference in the above index（P0.05）.Conclusions： Arthroscopic surgery accompanied with systemic TCM and western medicine and rehealthy training can be very useful in treating refractory gonyocele caused by rheumatoid arthritis.The therapeutic methods can effectively lighten the local symptoms and strengthen the flexibility of the joint function;the longer-term efficacy of postoperative was consistent,but they can not relieve the primary disease of RA.