关节镜下滑膜切除术治疗膝关节类风湿关节炎的临床疗效观察

Clinical Efficacy of Arthroscopic Synovectomy for Rheumatoid Knee

目的观察采用关节镜技术治疗膝关节类风湿关节炎（RA）的临床疗效。方法 2009年1月-2013年3月对31例RA患者（32膝）行滑膜切除。患者男10例,女21例;年龄23~51岁,平均（35.5±8.7）岁;患病时间5~21年,平均（12.0±5.5）年。观察患者术前、术后1年以及术后2年X线检查结果并用Larsen法进行评估。比较术前和术后1年C反应蛋白、红细胞沉降率（血沉）、膝关节疼痛评分的改变。结果行关节镜下滑膜切除术后1年,膝关节疼痛评分从术前的（4.23±0.96）分下降至（2.21±0.87）分,类风湿因子从（265.3±120.1）U/m L下降至（89.2±12.1）U/m L,C反应蛋白从（89.36±32.12）mg/L降至（20.12±10.21）mg/L,血沉从（86.56±12.32）mm/h降至（45.23±11.12）mm/h,差异均有统计学意义（P〈0.05）。X线Larsen评价术后1年有明显改善。结论关节镜下行滑膜切除可缓解疼痛,阻止局部病变进展和改善关节周围骨质破坏。

Objective To investigate the clinical outcome of arthroscopic synovectomy for inpatients with rheumatoid knee. Methods Arthroscopic synovectomy was performed on 32 rheumatoid knees in 31 patients, including 10 males and 21 females with an average age of（35.5±8.7） years（23 to 51 years） between January 2009 and MarcTh2013. The patients’ mean morbidity duration was（12.0±5.5） years（5 to 21 years）. X-ray examination results were observed before the operation, 1 year and 2 years at er the operation, and then Larsen method was used for assessment. Pain alleviation, C-reactive protein（CRP）, rheumatoid factors（RF）, and erythrocyte sedimentation rate（ESR） were compared before and at er operation. Results The follow-up averaged 1.7 years, and the average pain score decreased from 4.23±0.96 before surgery to 2.21±0.87 one year at er surgery; RF decreased from（265.3±120.1） U/m L to（89.2±12.1） U/m L; CRP decreased from（89.36±32.12） mg/L to（20.12±10.21） mg/L; and ESR decreased from（86.56±12.32） mm/Thto（45.23±11.12） mm/h.Conclusion Arthroscopic synovectomy can ef ectively relieve pain and delay radiologic progression in patients with rheumatoid knees.