类风湿关节炎310膝次膝关节镜镜下分析

目的 探讨类风湿关节炎(RA)膝关节病变的关节镜下表现.方法 回顾分析2005年12月至2008年2月佛山市第一人民医院223例RA住院患者310膝次膝关节镜术中镜下所见,分析RA膝关节病变的特征.结果 310膝次中的305膝次(98.4%)有不同程度的滑膜增生,探查膝关节各区域以内侧间隙、髁间窝、外侧间隙滑膜增生明显增多,分别为274(88.4%)、267(86.1%)和258(83.2%)膝次,髌上囊滑膜增生最少见,为152膝次(49.0%);296膝次增生滑膜的镜下表现为珊瑚或棉絮样,9膝次表现为苔藓样增生.301膝软骨可见不同程度软骨变性或缺损,股骨内、外髁软骨变性合并软骨破坏或缺损分别为124、163膝.单纯软骨变性63膝.51膝的前交义韧带部分断裂,5膝次完全断裂,后交叉韧带部分断裂23膝,1膝次完伞断裂.内侧半月板撕裂、基本或完全消失的膝次分别为234、38膝次,外侧分别为214、45膝次.结论 RA膝关节多有滑膜增生,髁间窝及内、外侧问隙最多见,髌上囊相对较少;增生滑膜形态以珊瑚或棉絮样为主.RA膝关节软骨破坏常见,股骨内、外髁处最为明显;部分膝关节可见前、后交义韧带部分或完伞断裂;大部分RA膝关节有半月板病变.

The arthroscopic exhibition of 310 knee joints of 223 rheumatoid arthritis

Objective To investigate the arthroscopic presentations of knee joint of rheumatoid arthritis (RA). Methods During December 2005 to February 2008,223 patients with RA in our department underwent knee arthroscopy examination. The arthroscopic presentations of 310 knee joints were analyzed retrospectively. Results Synovial hyperplasia were observed in 305 knees (98.4% ) out of 310 ones. The medial part (88.4%), intercondylar fossa (86.1%) and lateral space (83.2%) were the most frequent localization of synovial hyperplasia, which was less common in the suprapatellar bursa. Hyperplastic synovium of 296 knees had coralloid or cotton-wool like presentation, with central nourishing vessels. Nine knees were lichen-like hyperplasia, without nourishing vessels. Different degrees of pathological changes or defect could be seen in 301 knees, including merely cartilage degeneration in 63 knees, cartilage degeneration plus cartilage damage or defect in femoral medial condyle or lateral condyle in 124, 163 knees, in which 53, 45 with the damage deep to the cancellous bone. Most anterior or posterior cruciate ligament (in 274 knees) were covered with hyperplastic synovium, anterior cruciate ligament of 51 knees were partial ruptured, 5 ones were completely ruptured,while 23 and 1 case had these presentations in the posterior cruciate ligament.. Meniscus damage was commonly seen under arthroscope. 234 and 38 knees had medial meniscus torn or disappeared completely, while 214 and 45 in the lateral meniscus. Conclusion Synovial hyperplasia is commonly seen in knee joints of RA and most commonly seen in the intercondylar fossa, medial space and lateral space, but less common in the suprapatellar bursa. The hyperplastic synovium appears most often in the coralloid or cotton-wool like form, Cartilage damage is commonly seen in knee joints of RA. The most serious damage of the cartilage is seen in the femoral medial condyle or lateral condyle. Partial or complete anterior cruciate ligament rupture can be seen in one proportion of knees. In most knees of RA, meniscus are torn or disappeared mostly or completely.