关节镜下膝关节滑膜切除术在类风湿性关节炎治疗中的作用

目的探讨关节镜下膝关节滑膜切除术对类风湿性关节炎的疗效。方法2003年5月～2004年3月间对34例类风湿性关节炎患者53侧膝关节进行关节镜下滑膜切除，术中多入路清扫全关节滑膜，清理关节腔。结果32例患者在术后平均31个月时接受随访。Lysholm评分术前平均40、6分，术后平均75，4分；HAQ评分术前平均11．6分．术后平均9．5分。血沉（ESR）术前平均31．2mm／h，术后平均17．5mm／h；C反应蛋白（CRP）术前平均116，9mg／L，术后平均54．3mg／L；改良sharp评分术前平均16．4分，术后平均17．2分。术前与术后各指标比较显示Lysholm评分、HAQ评分、血沉、CRP差异有统计学意义．而改良sharp评分差异无统计学意义。结论对于类风湿性关节炎．关节镜下膝关节滑膜切除术不仅能改善膝关节局部的功能．而且可以改善全身病情。

Effect of arthroscopic synovectomy of knee joint on rheumatoid arthritis

Objective To assess the result of rheumatoid arthritis(RA) treated by the arthroscopic knee synovectomy.Methods Thirty-four cases of RA patients(53 knees) were treated by arthroscopic knee synovectomy.The total synovectomy and debridement using multi-portal approach were performed during the operation.Results Thirty-four patients were followed up for an average 31 months ranging from 24 to 35 months.Lysholm score increased from 40.6 pre-operatively to 75.4 post-operatively.HAQ score decreased from 11.6 pre-operatively to 9.5 post-operatively.ESR decreased from 57.2 pre-operatively to 24.9 post-operatively.CRP decreased from 116.9 mg/L preoperatively to 54.3 mg/L post-operatively.Modified Sharp score increased from 16.4 pre-operatively to 17.2 post-operatively.There were 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 RA patients,Synovectomy of the knee joint can improve not only the knee function,but also the general symptoms.