关节镜与切开手术在类风关膝关节滑膜清理术的疗效比较

The Comparison between Arthroscopy and Open Synovectomy in Knee Rheumatoid Arthritis

目的评价关节镜与切开术对类风关滑膜清理术的疗效。方法对1993年3月至2000年3月膝关节滑膜清理术的52例患者进行随访,其中24例行切开术,28例行关节镜术。切开组21例,关节镜组27例平均随访5年。观察疼痛缓解程度、滑膜炎复发情况、影像学改变、接受关节置换或关节融合比例进行比较。结果关节镜滑膜切除与切开相比,疼痛减轻相似,但滑膜炎复发比例更高,影像学骨关节炎进展更快。患者关节镜滑膜切除与切开相比,后期膝关节置换比例降低。结论关节镜下类风关滑膜切除可缓解疼痛,但滑膜炎复发比例高,影像学进展更快,不增加需要人工关节置换的比例。

Objective To compare the effect of arthroscopic versus open synovectomy on rheumatoid arthritis.Methods From March 1993 to March 2000,fifty-two cases of rheumatoid arthritis underwent synovectomy,24 of them received open synovectomy,28 cases underwent arthroscopic synovectomy,twenty-one cases open synovectomy and 27 cases arthroscopic synovectomy were followed-up for 5 years.All patients were compared with pain alleviation,recurrence of synovitis,radiographic progression,and need for subsequent total joint arthroplasty.Results Patients underwent arthroscopic synovectomy had similar pain reduction,but more frequent recurrences of synovitis and radiographic progression than patients with open synovectomy.Patients undergoing arthroscopic synovectomy had decreased risks of subsequent knee arthroplasties.Conclusion Arthroscopic synovectomy,while providing similar pain relief,may place patients at higher risk for recurrence and radiographic progression of RA,but it does not increase the need of arthroplasty.