The therapeutic outcome of minimally invasive synovectomy assisted with arthroscopy in the rheumatoid knee

The purpose of the present study was to retrospectively evaluate the therapeutic outcome of minimally invasive synovectomy assisted with arthroscopy (MISAA). From 1995 to 2003, MISAA was performed on 30 knees of 18 rheumatoid arthritis patients. The mean follow-up period was 74.4 months. Radiographic assessment according to Larsen's radiological classification, the conversion ratio to total knee arthroplasty (TKA), and postoperative change of the range of flexion were evaluated retrospectively. There were 10 knees in grade I, 14 knees in grade II, and 6 knees in grade III, preoperatively. All the knees in grade I and 8 of 14 knees in grade II maintained the same grade until the latest follow-up. The other 6 knees in grade II and all the knees in grade III deteriorated to grade IV and were converted to TKA after MISAA. The mean range of flexion significantly increased postoperatively except the knees that were converted to TKA. MISAA is effective for rheumatoid knees in grade I or II, and improves range of flexion.     

利福平化学性滑膜切除术治疗血友病慢性滑膜炎

目的 了解利福平化学性滑膜切除术对血友病慢性滑膜炎的疗效.方法 报道成都市妇女儿童中心医院首例用利福平化学性滑膜切除术治疗血友病慢性滑膜炎并进行文献复习.患儿9岁,诊断为血友病甲（重型）,左膝关节慢性滑膜炎.坐轮椅,左膝关节明显肿胀、压痛,关节活动明显受限.入院后输注FⅧ,使FⅧ活性＞30％,立即在B超引导下行关节内注射利福平,每周1次,共9次.结果 随访3年,膝关节外观正常,行走及常规活动正常,左膝关节未再发生出血事件.结论 利福平用于化学性滑膜切除术,控制出血疗效好,操作方便,药源丰富,价格低廉,尤其适用于儿童.     

Wrist synovectomy confirmed tuberculous tenosynovitis in 8 cases: A follow-up study

Aim of the workTuberculosis is still one of the important health problems. Because of its insidious evolution, tuberculous (TB) tenosynovitis (TS) is usually misdiagnosed and undertreated. The aim of this study was to investigate clinical and therapeutic outcomes of TB TS.Patients and methodsA retrospective study of 8 patients followed-up for TB TS was conducted. Clinical and therapeutic data were collected.ResultsThe median age was 45 years (range 33–59 years), they were 5 females and 3 males with a median duration till diagnosis of 15 months. Fever, night sweats, and weight loss were reported by 3 patients. Physical examination showed swelling of the wrist and crepitation of the palmar side with affected fingers movements in 7 cases. A carpal tunnel syndrome was found in another case. The median erythrocyte sedimentation rate was 15 mm/1st hour and the C-reactive protein 5 mg/dl. Plain radiographies of the wrists were normal. Ultrasonography showed flexor TS in all cases. Since tuberculin skin tests were positive in all patients, TB TS was suspected. Surgical synovectomy was conducted and histological examination confirmed TB. In addition to surgical synovectomy, patients were treated with anti-TB drugs for 12 months. No relapse was noted for a mean follow-up duration of 2 years.ConclusionsTB TS can be misdiagnosed because of its insidious evolution. Histological examination confirms the diagnosis. Surgical synovectomy could confirm the diagnosis rapidly by the histological examination and be part of the treatment. Medical treatment should be well-conducted and maintained to avoid relapse and future complications.     

关节镜下诊断和治疗膝关节滑膜炎的临床分析

目的探讨关节镜对膝关节滑膜炎的诊断和治疗价值。方法对35例膝关节滑膜炎患者进行关节镜检查明确诊断,进行镜下滑膜切除术,观察疗效。结果镜检结合滑膜病理,明确诊断病例为：18例类风湿性关节炎,8例慢性非特异性滑膜炎,4例色素沉着绒毛结节性滑膜炎,3例关节结核,2例慢性化脓性关节炎。滑膜切除术后随访6—40个月,平均随访26个月。疗效优者20例（57．1％）,良10例（28．6％）和差5例（14．3％）。结论关节镜检查及滑膜活检可明显提高滑膜炎的诊断率,关节镜下滑膜切除术治疗膝关节滑膜炎疗效较好,创伤小,并发症很少,是一种理想的外科治疗方法。     

关节镜滑膜切除术联合放射治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎

目的观察关节镜下滑膜切除术联合术后放射治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的疗效。方法26例膝关节弥漫型色素沉着绒毛结节性滑膜炎患者,行关节镜下滑膜切除术,同时6例伴有半月板损伤患者行半月板部分切除术,1例关节僵硬患者行关节松解术,1例软骨剥脱患者行微骨折术。手术后4周关节外放射治疗,采用直线型加速器6my—X线,照射范围包括患膝关节及手术切口上下缘3cm,每次2Gv,每周5次,总剂量30Gy。术后定期随访并进行Lysholm膝关节功能评分,评分结果进行统计学分析。结果所有患者均获得随访,随访时间12—40个月,平均29．5个月,术后未见复发及放射性治疗并发症,Lysholm评分术前43．28-4-4．1分,术后6个月85．73±3．4分,术后12个月94．89±5．1分,差别有统计学意义。结论关节镜下滑膜切除术联合术后放射治疗是治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎、减少术后复发的有效方法。     

Protracted familial Mediterranean fever arthritis

Familial Mediterranean fever (FMF) is an inherited disorder characterized by recurrent attacks of fever and abdominal, chest, and articular pain. The articular attack of FMF is typically an acute, self-limited, large joint monoarthritis most often affecting the knee or hip. Rarely, a more protracted arthritis may occur. We describe two unusual cases of long-standing FMF arthritis with excellent response to synovectomy. Received: 26 March 1999 / Accepted: 29 July 1999     

胶体磷酸铬32P放射性滑膜切除术治疗类风湿膝关节炎(附85例报告)

对85例类风湿膝关节炎患者的121个膝关节采用胶体磷酸铬^32P行放射性滑膜切除术。先将患者膝关节腔内积液抽出，然后每个膝关节给予92．5－129．5MBq胶体磷酸铬^32PT和1ml得宝松，同时给予慢作用义气风发风湿药物治疗。结果：88％的膝关节放射性滑膜切除术后1年疗效较好，关节积液得到有效控制，所有患者均未出现严重不良反应。认为胶体磷酸铬^32P治疗早期类风湿膝关节炎是安全有效的。     

Arthroscopic synovectomy for recurrent hemarthrosis of the ankle in hemophilia

Nine patients with a history of recurrent hemarthroses of the ankle due to severe hemophilia were evaluated following arthroscopic ankle synovectomy. Follow-up averaged 33 months (range, 9 to 67 months) and included ankle range of motion, frequency of ankle hemarthroses, radiographic findings, and a functional assessment. The average age at the time of surgery was 12.3 years (range, 6.1 to 21.9 years). The average are of ankle motion was 48.4° (range, 30° to 70°) postoperatively. The functional score as modified from Mazur averaged 36.1 points (range, 17 to 68 points) preoperatively, and 77.9 points (range, 32 to 100 points) postoperatively. Radiographic evidence of ankle arthropathy remained stable for most ankles. Arthoscopic ankle synovectomy for recurrent hemarthrosis due to hemophilia is a viable alternative to open ankle synovectomy for controlling the frequency of ankle bleeds and maintaining ankle function.     

关节镜下滑膜切除联合射频汽化治疗膝关节类风湿关节炎

目的探讨关节镜下滑膜切除联合射频汽化治疗膝关节类风湿关节炎的疗效。方法对36例有膝关节滑膜炎表现的类风湿关节炎,在内科正规药物治疗的同时,关节镜下膝下前内、前外常规入路及膝外上、内上入路,对膝关节增生滑膜、血管翳行刨削切除及射频汽化,其中21例附加膝后内、后外侧入路,处理膝后间室病变滑膜。术后3 d开始进行系统关节功能锻炼。结果36例随访4~26个月,平均16个月,优21例,良13例,可2例,优良率94.4%(34/36)。类风湿膝关节炎关节功能术前评分为(58.6±5.3)分,术后升至(91.6±5.8)分(t=2.723,P=0.003);Lysholm膝关节功能术前评分为(42.3±3.8)分,术后升至(90.2±4.4)分(t=2.437,P=0.001)。结论关节镜下滑膜切除联合射频汽化,具有创伤小、出血少、关节功能恢复快的优点,有效地控制类风湿关节炎病情发展,可最大程度恢复病变膝关节功能。     

小儿股骨颈无菌性坏死滑膜切除术患者护理体会

目的 探讨小儿股骨颈无菌性坏死滑膜切除术患者的护理对策。方法 对15例4岁-12岁小儿股骨颈无菌性坏死滑膜切除术患者术前、术后护理及术后随访。结果 15例惠儿术后,无任何并发症发生。结论 在护理过程中,必须重视小儿患者的生理和心理特点,做好心理护理,重视术前评估,做好术前、术后护理,出院后的随访,积极预防并发症发生。