类风湿关节炎滑膜切除手术时机的选择

目的探讨类风湿关节炎（ＲＡ）滑膜切除的最佳时机。方法７年间对６４例ＲＡ患者８６个膝关节行开放性滑膜切除术,双侧滑膜切除２２例,单侧４２例,６４例中Ⅰ期８例,Ⅱ期２６例,Ⅲ期２２例,ＩＶ期８例。术后随访时间２～９２个月,平均３８．２个月。疼痛缓解,肿胀减轻是滑膜切除最明显的疗效指标。结果本组患者Ⅰ期优良率１００．０％,Ⅱ期８７．２％（Ⅰ、Ⅱ期总优良率９０．０％以上）,Ⅲ、Ⅳ期３１．５％。本组共７２．９％的患者自我评价满意。结论ＲＡ患者经严格内科保守治疗半年以上,关节炎仍继续发展,特别是在膝关节,如关节持续肿胀,滑膜肥厚硬韧,而浮髌感并不明显时,应及早行滑膜切除术,Ⅰ、Ⅱ期手术优良率高于Ⅲ、Ⅳ期。

Time selection for RA synovectomy

OBJECTIVE: To discuss the time selection for RA synovectomy. METHOD: Eighty-six knees in 64 RA patients underwent synovectomy in 7 years. 8 of the 64 patients were in RA stage I, 26 in II, 24 in III, 8 in IV. The mean age was 43.9 years and the average follow-up period lasted 38.2 months. RESULTS: Pain relief and swelling reduction were significant clinical features after synovectomy. The overall assessment of the effect of synovectomy showed satisfactory results (72.9%) including all RA-I, and RA-II (87.2%). CONCLUSION: If the patients have sustained or intractable joint swollening with exuberant synovium after strict drug therapy over half a year, synovectomy is an appropriate consideration, it is very important to select the time for synovectomy.