膝关节镜下滑膜切除术治疗难治性膝关节炎及合并腘窝囊肿153例分析

The effect of arthroscopic synovectomy on refractory knee arthritis with popliteal cyst in 153 patients

目的探讨关节镜下膝关节滑膜切除术对难治性膝关节炎及合并腘窝囊肿的疗效。方法回顾性分析2010—2017年行膝关节镜下滑膜切除术的153例[类风湿关节炎(RA)95例,脊柱关节炎(SpA)58例]难治性关节炎患者的临床资料,其中合并腘窝囊肿者20例(RA 16例,SpA 4例)。比较关节镜手术前后患者红细胞沉降率(ESR)、C反应蛋白(CRP)、膝关节不适评分、超声下膝关节积液量、RA患者类风湿因子和28个关节疾病活动度评分(DAS28)、SpA患者背部疼痛评分及合并腘窝囊肿和分级情况,评价关节镜手术对难治性膝关节炎及合并腘窝囊肿的疗效。结果RA患者关节镜术后ESR[58(17,79)mm/1h比19(9,30)mm/1h,P<0.001]、CRP[3.72(0.92,8.14)mg/L比0.85(0.10,3.08)mg/L,P<0.001]、类风湿因子滴度[64.6(20.2,193.3)比20.5(10.0,58.4),P<0.001)、DAS28[(4.67±1.25)分比(2.81±1.23)分,P<0.001]、膝关节不适评分[5(4,6)分比2(1,3)分,P<0.001]及超声下膝关节积液量(P<0.05)均较术前明显下降。SpA患者关节镜术后ESR[27(12,54)mm/1h比20(16,28)mm/1h,P<0.001]、CRP[3.27(1.06,6.95)mg/L比1.41(0.34,3.03)mg/L,P<0.001]、膝关节不适评分[2(0,5)分比1(0,3)分,P<0.05]、背部疼痛评分[5(4,5)分比2(1,3)分,P<0.001]及超声下膝关节积液量(P<0.001)均较术前明显下降。16例RA合并腘窝囊肿患者,术后减少至6例,腘窝囊肿分级较术前明显下降。4例SpA合并腘窝囊肿患者,术后减少至3例,腘窝囊肿分级较术前下降。结论膝关节镜下滑膜切除术治疗难治性膝关节炎具有较好的疗效,可降低疾病活动度及改善患者症状,同时可降低腘窝囊肿分级。

Objective To investigate the efficacy of arthroscopic synovectomy on refractory knee arthritis complicated with popliteal cyst. Methods Patients diagnosed as rheumatoid arthritis (RA) or spondyloarthritis (SpA) with refractory knee arthritis who underwent knee arthroscopic synovectomy in our hospital from 2010 to 2017 were enrolled, including 20 patients (16 RA, 4 SpA) with popliteal cyst. Clinical data, RA disease activity score (DAS28), SpA back pain score, etc, were collected to evaluate the efficacy of knee surgery. Results Erythrocyte sedimentation rate (ESR)[58(17, 79)mm/1h vs. 19(9, 30)mm/1h, P< 0.001],C reactive protein (CRP)[3.72(0.92,8.14) mg/L vs. 0.85(0.10,3.08) mg/L,P<0.001], rheumatoid factor [64.6(20.2,193.3) vs. 20.5(10.0,58.4),P<0.001], DAS28 score(4.67±1.25 vs. 2.81±1.23,P<0.001), knee joint discomfort score [5(4,6) vs. 2(1,3),P<0.001] and the volume of knee joint effusion by ultrasound (P<0.05) in 95 RA patients were significantly decreased compared to those before operation. ESR [27(12,54)mm/1h vs. 20 (16,28) mm/1 h,P<0.001], CRP [3.27(1.06,6.95) mg/L vs. 1.41(0.34,3.03)mg/L,P<0.001],knee discomfort score [2(0,5) vs. 1(0,3),P<0.05], back pain visual analogue score (VAS)[5(4,5) vs. 2(1,3), P<0.001], and the volume of knee joint effusion by ultrasound (P<0.001) in 58 SpA patients were significantly lower than those before the operation.The rate [16.84%(16/95) vs. 6.32%(6/95),P=0.023] and grading (P=0.007) of popliteal cyst in RA were decreased after the operation. No statistically difference was observed in the rate [6.90%(4/58) vs. 5.17%(3/58), P=0.697] of popliteal cyst in patients with SpA, yet with a trend of decrease in 4 patients. Conclusion This study provide evidence that knee arthroscopic synovectomy has a good effect for refractory knee arthritis, which can reduce disease activity, improve joint symptoms and decrease the grading of popliteal cyst.