关节镜下手术治疗中晚期类风湿关节炎

目的 探讨关节镜手术治疗中、晚期类风湿关节炎的疗效。方法 2003年5月至2004年8月，我科对22例类风湿关节炎患者36侧膝关节进行关节镜手术治疗。术中经多入路切除全关节滑膜，同时清理关节腔。结果 20例患者在术后平均30个月时接受随访。Lysholm评分术前平均36．4分，术后平均68．3分；HAQ评分术前平均12．9分，术后平均10．5分。血沉术前平均37．5mm／1h，术后平均24．3mm／1h；C反应蛋白术前平均132．6mg／L。术后平均72．1mg／L;改良sharp评分术前平均19．7分，术后平均21．3分。术前与术后各指标比较显示，Lysholm评分、HAQ评分、血沉、C反应蛋白均有显著性差异，而改良sharp评分未见显著性差异。结论 对于中、晚期类风湿关节炎，关节镜手术可以改善膝关节的局部功能,并部分改善全身症状。

Clinical Effect of Arthroscopic Treatment on Moderate or Severe Rheumatoid Arthritis

Objective To assess the therapeutic results of rheumatoid arthritis (RA) at moderate or severe stage treated by the arthroscopic surgery.Methods Twenty-two cases of RA patients (36 knees) were treated by arthroscopic surgery.The total synovectomy and debridement using multi-portal approach were performed during the operation.Results Twenty patients were followed up at an average 30 months rang from 19 to 34 months.Lysholm score increased from 36.4 pre-operatively to 68.3 post-operatively.HAQ score decreased from 12.9 pre-operatively to 10.5 post-operatively.ESR decreased from 37.5 pre-operatively to 24.3 post-operatively.CRP decreased from 132.6 mg/L pre-operatively to 72.1 mg/L post-operatively.Sharp score increased from 19.7 pre-operatively to 21.3 post-operatively.There was significant difference between pre and post-operation for Lysholm score,HAQ score,ESR and CRP.There was no significant difference between pre and post operation for modified Sharp score.Conclusion For moderate or severe RA patients,arthroscopic surgery of the knee joint can improve not only the knee function,but also the general symptoms.