关节镜联合康复治疗老年类风湿关节炎患者膝关节功能障碍的临床观察

Clinical observation of arthroscopy combined with rehabilitation in the treatment of knee joint dysfunction in elderly patients with rheumatoid arthritis

目的 观察关节镜联合康复治疗老年类风湿关节炎(RA)膝关节功能障碍的疗效及安全性,为促进RA治疗水平进步提供参考。方法 选取2018年6月—2021年6月于绵阳市中心医院就诊的老年RA膝关节功能障碍患者106例,根据数字表法随机分为观察组和对照组,每组53例。对照组实施常规抗风湿治疗联合康复治疗,观察组在对照组相同治疗的基础上加用关节镜治疗。比较2组治疗3个月后的膝关节功能改善情况、临床症状指标值[肿胀关节数(SJC)、疼痛关节数(TJC)、晨僵时间、视觉模拟评分法(VAS)评分、28个关节疾病活动度评分(DAS28)];观察并比较2组实验室指标值[C-反应蛋白(CRP)、类风湿因子(RF)、血沉(ESR)水平]以及并发症发生情况。结果 治疗3个月,观察组Lysholm评分高于对照组(P<0.05),膝关节功能改善总有效率显著高于对照组(P<0.05);2组SJC、TJC、VAS评分、DAS28评分、CRP水平、RF水平和ESR水平均较同组治疗前显著降低(P<0.05),且观察组上述指标值显著低于对照组(P<0.05);2组晨僵时间均较同组治疗前显著减少(P<0.05),且观察组晨僵时间显著少于对照组(P<0.05)。治疗后3个月内,观察组出现感染等并发症0例(0.00%),对照组发生骨性关节炎1例(1.89%),2组并发症发生率差异无统计学意义(P>0.05)。结论 关节镜联合康复治疗老年RA患者膝关节功能障碍,具有显著疗效,并有良好的安全性,具有一定的临床应用价值。

Objective To explore the efficacy and safety of arthroscopy combined with rehabilitation in the treatment of knee dysfunction in elderly patients with rheumatoid arthritis(RA),and provide reference for promoting the progress of RA treatment.Methods 106 elderly RA patients with knee joint dysfunction who were treated in Central Hospital of Mianyang City from June 2018 to June 2021 were selected and randomly divided into observation group and control group according to the digital table method,with 53 patients in each group.The control group received conventional anti-rheumatic therapy combined with rehabilitation therapy,while the observation group received arthroscopic therapy on the basis of the same treatment as the control group.After 3 months of treatment,the improvement of knee joint function,clinical symptom indexes [swollen joint count(SJC),tender joint count(TJC),morning stiffness time,visual analogue scale(VAS) score,Disease Activity Score in 28 Joints(DAS28)],laboratory indexes [C-reactive protein(CRP),rheumatoid factor(RF),erythrocyte sedimentation rate(ESR)] and the incidence of complications were compared between the two groups.Results After 3 months of treatment,the lysholm score of the observation group was higher than that of the control group(P<0.05),and the total effective rate of knee function improvement of the observation group was significantly higher than that of the control group(P<0.05);SJC,TJC,VAS score,DAS28 score,CRP level,RF level and ESR level of both groups were significantly lower than those of the same group before treatment(P<0.05),and the above indexes of the observation group were significantly lower than those of the control group(P<0.05);the morning stiffness time of both groups was significantly shorter than that of the same group before treatment(P<0.05),and the morning stiffness time of the observation group was significantly shorter than that of the control group(P<0.05).Within 3 months after treatment,there were 0 cases(0.00%) of complications in the observation group and 1 case(1.89%) of osteoarthritis in the control group.There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Arthroscopy combined with rehabilitation has significant curative effect and good safety in the treatment of knee joint dysfunction in elderly RA patients,and has certain clinical application value.