关节镜下滑膜切除术治疗早、中期类风湿性关节炎的疗效

目的探讨关节镜下滑膜切除术治疗早期和中期类风湿性关节炎(类风关)的疗效. 方法对34例早中期的类风关42个膝关节(早期类风关组22例,24个关节;中期类风关组12例,18个关节),在关节镜下施行以滑膜切除术为主处理,其中32个膝关节辅助使用双极射频进行滑膜的清除和止血.术后给予正规抗类风湿药物治疗,对早、中期两组进行随访(平均25月),包括关节功能的评定,检测血沉(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C reaction protein)和类风湿因子(rheumatoid factor,RF ). 结果早期类风关组24个膝关节术后优良率为91.7%(22/24),中期类风关组18个膝关节优良率为66.7%(12/18),二者优良率差异无显著性(χ2=2.705,P=0.100). 结论早期和中期类风关关节镜下滑膜切除术治疗,均可以取得较满意的疗效,二者疗效无差别.双极射频有助于彻底清除病变滑膜、减少关节血肿、利于关节功能康复.     

Semiarthroscopic synovectomy of the hip

Summary A new surgical procedure, semiarthros-copic synovectomy of the hip is described. The operation enables a radical synovectomy to be performed without the risk of necrosis of the femoral head from temporary luxation. The early results have been encouraging and the method appears to offer a low-risk alternative to conventional radical synovectomy.

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Résumé Présentation d'une nouvelle technique chirurgicale, la synovectomie semi-arthroscopique de la hanche. Cette opération permet de réaliser une synovectomie totale sans encourir le risque de nécrose de la tête fémorale du fait d'une luxation temporaire de la hanche. Les premiers résultats sont encourageants et cette méthode semble apporter une alternative moins dangereuse à la synovectomie totale réalisée selon la technique habituelle.

     

关节镜联合髌上囊小切口滑膜切除术治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的疗效分析

目的：探讨应用关节镜结合髌上囊小切口切开滑膜切除治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎（ PVNS）患者的疗效。方法本组对2006年1月至2011年12月因膝关节弥漫型PVNS的32例患者进行回顾性分析,该组患者全部采用膝关节镜结合髌上囊局部切开滑膜切除的治疗方法。本研究对患者的基本情况、治疗方法、复发率和症状进展进行的记录,最短随访时间为7个月（平均中位数为49.8个月;范围7～141个月）。结果应用膝关节镜结合髌上囊局部切开滑膜切除方法治疗PVNS的复发率低（6.3％）,肿胀和疼痛术后好转,其中明显好转没有疼痛和活动不适的为50％,而关节炎持续进展的为11.1％,但是没有患者在最后随访期内发展进行膝关节置换。最常见的并发症为血肿,发生率为3％,但是没有发现对患者术后疗效产生明显影响。术前KSS临床评分为（62.7±17.7）分;功能评分为（45.0±24.0）分,术后临床KSS评分（85.2±10.9）分;功能评分（79.5±12.3）分,比较均有统计学差异（临床KSS评分：t＝4.456,P＜0.001;功能KSS评分：t＝5.279,P＜0.001）;而Lysholm评分术前（64.7±15.0）分,术后提高到（83.2±8.4）分,二者间比较有统计学差异（ t＝4.451,P＜0.001）。结论结合相关文献报道,膝关节镜结合髌上囊局部切开滑膜切除方法是治疗膝关节弥漫型PVNS的较好方法,有着较低的复发率和并发症。     

Long-term results of knee synovectomy in early cases of rheumatoid arthritis

Summary Five hundred and eight cases of early synovectomy of the knee in rheumatoid arthritis are reported from nine clinics in a retrospective multi-center follow-up study. Observation time covers at least ten years in each case. Sixty-five per cent of the cases are reported as being subjectively and objectively good. The mean roentgenological grade, according to Larsen, was 1.7 preoperatively and 2.7 at follow-up.A multi-center retrospective study presented by European Rheumatoid Arthritis Surgical Society (ERASS) at the Tenth European Congress of Rheumatology in Moscow 1983.     

Surgery of the rheumatoid wrist through a dorsal approach combined with radio-lunate fusion

Surgical Principles Joint synovectomy; resection of ulnar head; anterior transposition of the extensor retinaculum; extensor tendon synovectomy; posterior displacement of extensor carpi ulnaris; realignment of carpal bones; fusion between radius and lunate using autogenous bone grafts.     

Photodynamic therapy using talaporfin sodium for synovial membrane from rheumatoid arthritis patients and collagen-induced arthritis rats

We investigated the efficacy of photodynamic therapy (PDT) using talaporfin sodium as a new method of synovectomy for rheumatoid arthritis (RA). We first used RA synovial membrane (RASM) for in vitro and in vivo study. The RASM was obtained from patients with RA during total knee replacement. In the in vitro study, RA fibroblast-like synoviocytes (RASCs) obtained from the RASM were examined by fluorescent microscopy to measure the intracellular localization of talaporfin sodium. The cells were then subjected to PDT, and their viability was examined by 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulphophenyl)-2H-tetrazolium inner salt assay. In the in vivo assay, RASM was obtained as described above, grafted onto severe combined immunodeficiency (SCID) mice and subjected to PDT. The damaged area of RASM was evaluated histologically at 1 day after PDT. Next, we performed a separate experiment using rats with collagen-induced arthritis (CIA). After intra-articular injection of talaporfin sodium, the concentration of talaporfin sodium accumulated in the CIA synovial membrane (CIASM) was compared with that in cartilage, periarticular muscle, and skin. We then performed PDT with intra-articular injection of talaporfin sodium and intra-articular irradiation. The damaged area of the CIASM was measured at 1 day after the PDT, and the articular histological and radiological changes of the ankle were observed at 56 days after the PDT. In RASM, talaporfin sodium accumulated in lysosomes in vitro, and the phototoxicity to RASCs in vitro and to RASM grafted onto SCID mice in vivo depended on the concentration of talaporfin sodium and the laser energy. In CIA rats, there was a greater accumulation of talaporfin sodium in the CIASM than in normal tissue. The CIASM was selectively damaged at 1 day after the PDT, and the bone and cartilage destruction were ameliorated at 56 days after the PDT. In conclusion, PDT using talaporfin sodium might be a new method for synovectomy in patients with RA.     

Synovial proliferative disorders: role of synovectomy

Synovectomy is an effective procedure in many of the synovial proliferative diseases. It is the treatment of choice in pigmented villonodular synovitis and synovial chondromatosis. In addition, it may be a useful adjunct to treatment in carefully selected patients with rheumatoid arthritis and hemophilia. Synovectomy can now be accomplished effectively with arthroscopic techniques, and this has greatly diminished the previous morbidity and cost associated with open synovectomy. However, the indications for synovectomy remain the same, regardless of the technique.     

一期双入路滑膜切除术合并放疗治疗膝关节弥漫性色素绒毛结节性滑膜炎

目的总结一期前后双入路行滑膜切除术及术后辅助放疗治疗膝关节弥漫性色素绒毛结节性滑膜炎(PVNS)的临床疗效.方法采用回顾性研究方法,从2007年10月至2009年6月,我院收治11位膝关节弥漫性色素绒毛结节性滑膜炎患者并进行分析.纳入标准为组织病理学确诊的膝关节内外弥漫性PVNS.男4例,女7例;年龄19~51岁,平均31岁.手术方式采用一期前后双入路滑膜切除术,术后给予局部放疗并进行随访.疗效评定包括:疾病复发情况、手术并发症、膝关节活动度、膝关节功能采用膝关节外科学会评分方法.结果平均手术时间3.5h (2.8-4.5h),术中出血平均800ml (500~1200ml).所有患者切口愈合良好,未出现感染、血管神经损伤等并发症.所有患者得到随访,平均随访时间是48个月(37-56个月).10例患者治愈,1例患者出现关节外非进展性局部复发.随访期间膝关节弯曲范围达90°~130°,其中3例患者出现5°的弯曲挛缩,膝关节等级和功能等级评分显著性地改善,从术前的63.2~70分到术后的94.7~95.6分,所有患者取得良好的临床疗效.结论一期前后双入路滑膜切除术结合术后膝关节外放射治疗的治疗方法,能够良好地控制膝关节弥漫性色素绒毛结节性滑膜炎,其复发率低,膝关节活动度恢复良好,膝关节功能结果满意.