七分区法关节镜下滑膜全切术治疗类风湿性肘关节炎的中期随访结果

Seven-division Arthroscopic Synovectomy for Rheumatoid Elbow:Mid-term Follow-up Results

目的评价七分区法关节镜下滑膜全切术治疗类风湿性肘关节炎的疗效。方法 2002～2008年,行关节镜下滑膜切除肘关节清理术治疗类风湿性肘关节炎11例,共13个肘关节,4例左侧,5例右侧,2例双侧。平均病程60个月(5～120个月)。手术通过近端前内及前外入路、软点入路和后外入路,使用关节镜进行滑膜全切。在关节镜下,将肘关节分为内侧区、外侧区、桡骨头前下区、鹰嘴窝、后外区、桡骨头后下区和后内侧区,共七区,逐区切除滑膜。术前术后进行Mayo评分及HSS评分。结果随访时间12～72个月,平均34.6月。术后7个月复发1例,再次行手术治疗。其余10例12个肘关节屈肘角度由102.1°±15.9°增加至123.3°±21.4°(t=-3.275,P=0.007),伸肘角度由33.8°±21.4°改善至20.0°±17.8°(t=3.572,P=0.004)。HSS评分由48.8±18.1分改善为87.9±15.9分(t=-8.125,P=0.000)。Mayo评分由39.6±16.6分改善为92.9±13.9分(t=-9.918,P=0.000)。结论关节镜下滑膜全切术是治疗类风湿性肘关节炎的有效手段之一,多入路七分区法切除肘关节类风湿性滑膜对于提高疗效、降低复发率有一定意义,可有效缓解疼痛,增加肘关节活动度,术后Mayo评分及HSS评分均有显著提高。

Objective To evaluate the outcomes of arthroscopic synovectomy with seven-division method for elbows with rheumatoid arthritis.Methods Between 2002 and 2008,we performed arthroscopic synovectomy on 13 elbows（11 patients） with rheumatoid arthritis（4 on the left side,5 on the right,and 2 cases of bilateral）.The average disease course of the patients was 60 months（5 to 120 months）.Anteromedial,anterolateral,soft spot,and posterolateral routes were employed to conduct arthroscopic synovectomy.Synovium was removed step by step in the following seven areas：media,lateral,anteroinferior radial head,olecranon fossa,posterolateral,posteroinferior radial head,and posteromedial areas.The Mayo and HSS scores were measured pre-and post-operatively to evaluate the outcomes of the operation.Results The patients were followed up for 12-72 months with a mean of 34.6,during which one patient had to accept a second operation because of recurrence at 7 months after the primary surgery.In the other 10 patients（12 elbows）,the mean degree of elbow flexion increased from 102.1°±15.9° to 123.3°±21.4°（t=-3.275,P=0.007）,the mean degree of extension was improved from 33.8°±21.4° to 20.0°±17.8°（t=3.572,P=0.004）,HSS score rose from 48.8±18.1 to 87.9±15.9（t=-8.125,P=0.000） and Mayo score was improved from 39.6±16.6 to 92.9±13.9（t=-9.918,P=0.000）.Conclusions Seven-division arthroscopic synovectomy is one of the effective means in the treatment of the rheumatoid elbow arthritis.Multi-route seven-division arthroscopic synovectomy for the rheumatoid elbow is of a certain meaning in improving surgical efficacy and reducing the rate of recurrence.It can effectively relieve pain and increase the mobility of the elbow joint,as well as Mayo and HSS scores.