膝类风湿性关节炎MRI早期诊断价值与关节镜下全滑膜切除术治疗

Early diagnosis value of MRI and the treatment for rheumatoid arthritis of the knee by arthroscopic synovectomy

目的：探讨膝类风湿性关节炎（RA）MRI检查的早期诊断价值，观察膝关节镜下全滑膜切除术的临床疗效。方法回顾性分析2008年1月至2012年12月梅州市人民医院收治的68例行膝关节镜下全滑膜切除术RA患者的临床资料，术前行X线片和注射钆对比剂MRI检查，术后常规病理检查。观察X线片、MRI检查诊断早期RA的准确性，记录患者术前，术后3、6、12个月Lysholm评分及类风湿因子（RF）、红细胞沉降率（ESR）、C反应蛋白（CRP）等实验室检查结果的变化。结果根据病理学检查结果，X线片、MRI检查诊断早期RA的准确率分别为66%（29/44）和97%（29/30），两者比较，差异有统计学意义（P＜0.05）。所有患者获得随访，随访时间12～38个月，平均随访时间18.6个月。术后3、6、12个月Lysholm评分及RF、ESR、CRP等指标明显优于术前，差异有统计学意义（P＜0.05）。结论MRI检查诊断早期膝RA较X线片检查准确；全滑膜切除术是治疗膝RA较好的术式选择，术后患者关节功能恢复明显，RF、ESR和CRP等临床指标显著改善，近期效果满意。

Objective To explore early diagnosis value of MRI in rheumatoid arthritis （RA） of the knee, and to observe the clinical effectiveness of arthroscopic synovectomy. Methods Six-eight patients with knee RA were treated by arthroscopic synovectomy in the People＆#39;s Hospital of Meizhu from January 2008 to December 2012, and their clinical data were analyzed retrospectively. All patients performed preoperative X-ray, gadolinium contrast enhanced MRI and postoperative pathological examination, the accurate rates of two imaging methods were observed, Lysholm score and blood rheumatoid factor （RF）, erythrocyte sedimentation rate （ESR） and C-reative protein （CRP） before the surgery and 3, 6, 12 months after the surgery were recorded respectively. Results According to the pathological results, the accurate rate of X-ray and MRI examination was 66% （29/44）and 97% （29/30） respectively, there was statistical difference between two diagnosis methods （P ＆lt;0.05）. All patients were followed up for 12-38 months, with the average of 18.6 months. Postopertive Lysholm score and blood RF, ESR and CRP were higher than preoperative ones, the differences had statistical significance （P ＆lt;0.05）. Conclusions Compared with X-ray, MRI was more accurate to early diagnosis of RA of the knee. Arthroscopic synovectomy is a good surgical option for knee, after the surgery, the knee joint function of the patient has been improved obviously, the postoperative clinical parameters such as blood RF, ESR and CRP enhanced markedly, and as a result, the satisfied short-term effect could be obtained.