32P-胶体滑膜切除术治疗血友病性关节病326例疗效观察

Therapeutic response of radiosynovectomy with p-32 colloid in 326 patients with hemophilic arthropathy

目的观察32P-胶体滑膜切除术治疗血友病性关节病的疗效，并评估MRI Denver评分对血友病性关节病进行分期的临床意义。 方法对326例血友病患者的405个关节进行32P-胶体滑膜切除术治疗，根据MRI表现对102个关节进行Denver评分并比较0~6分和7~10分组临床疗效的差异，观察29个膝关节治疗前后滑膜体积变化。 结果①全部326例血友病性关节病患者治疗前的疼痛评分为（3.2±2.4）分，治疗后6个月及1、2、3年分别为（1.2±0.6）分（285例）、（1.7±0.5）分（242例）、（2.1±1.1）分（212例）、（2.2±1.6）分（176例），均低于治疗前（P值分别为0.021、0.032、0.030、0.037）。②全部326例血友病患者治疗前的出血频次为（15.1±3.6）次/年，治疗后1、2、3年分别为（2.1±0.7）、（4.3±0.6）、（4.8±0.8）次/年，均低于治疗前（P值分别为0.016、0.011、0.025）。③治疗后6个月及1、2、3年靶关节活动度明显改善的比例分别为68.50%（248/362）、58.39%（181/310）、55.67%（162/239），42.61%（75/176）；Denver评分0~6分组治疗后6个月、1年和2年的HSS评分均高于7~10分组（P值分别为0.011、0.007、0.026）。④Denver评分0~6分组（45个靶关节）治疗前出血频次为（13.0±1.9）次/年，治疗后1、2年分别为（1.3±0.6）、（3.1±0.9）次/年，均低于治疗前（P值分别为0.002、0.009）；Denver评分7~10分组（57个靶关节）治疗前出血频次为（16.6±2.1）次/年，治疗后1、2年分别为（3.1±0.9）、（5.7±1.1）次/年，均低于治疗前（P值分别为0.008、0.004）。Denver评分7~10分组治疗前出血频次与0~6分组差异无统计学意义（P=0.773），治疗后1、2年均高于0~6分组（P值分别为0.028、0.042）。⑤29个膝关节治疗后6个月滑膜体积小于治疗前[（2 362.15±32.41）mm3对（3 012.40±39.78）mm3，t=7.621，P〈0.001]。 结论32P-胶体滑膜切除术治疗血友病性关节病安全有效。Denver评分0~6分的患者行滑膜切除术治疗效果更佳。

Objective To observe the therapeutic response ofradiosynovectomy with p-32 colloid on hemophilic arthropathy, and to assess the effects of radiosynovectomy with Denver Score on hemophilic arthritis staging. Methods Radiosynovectomy with p-32 colloid was performed on 326 hemophilic arthritis patients （405 joints）, and recorded bleeding before and after treatment. The MRI performance of 102 joints was evaluated by using Denver scoring system, then was divided into 0-6 and 7-10 groups. Finally, the differences between 2 groups were analyzed. Results Average pain score of all hemophilic arthritis patients at 6 months, 1, 2 and 3 years post treatment decreased from 3.2±2.4 （n=326） to 1.2±0.6 （n=285, P=0.021 ）, 1.7±0.5 （n=242, P=-0.032）, 2.1±1.1 （n=212, P=0.030） and 2.2±1.6 （n=176, P=0.037）, respectively. The frequency of bleeding in 405 joints at 1, 2 and 3 years post treatment decreased from 15.1 ± 3.6 to 2.1±0.7, 4.3±0.6, and 4.8±0.8 times per year （P 〈 0.01 ）, respectively; Meanwhile, the proportions of significantly ameliorated joints＇ activities were observed as of 68.50% （248/362）, 58.39% （181/310）, 55.67% （162/239） and 42.61% （75/176）, respectively. The frequencies of haemarthrosis at 1 and 2 years post treatment in patients with 0-6 Denver Score （45 target joints） reduced from 13.0±1.9 to 1.3±0.6 （P=- 0.002） and 3.1±0.9 （P=0.009） times per year, respectively, which also decreased in 7-10 group （57 target joints） from 16.6±2.1 to 3.1±0.9 （P=-0.00g） and 5.7±1.1 （P=0.004） times per year, respectively. There yeas no statistical difference between 0-6 and 7-10 groups before treatment in the terms of haemarthrosis frequency （P=0.773）. However, 7- 10 group had higher haemarthrosis frequency at 1 and 2 years post treatment compare with 0-6 group （P=-0.028 and 0.042, respectively）. Synovial volumes in 29 joints reduced after 6 month when compared with baseline [ （2 362.15±32.41 ）mm3 vs （3 012.40±39.78） mm3, t= 7.621, P〈0.001 ]. Conelusion Radiosynovectomy with p-32 colloid on haemophilic synovitis was a safe and effective procedure. The patients with Denver Score of 0-7 had lower frequency of haemarthrosis.