153 Sm-柠檬酸-羟基磷灰石滑膜切除术治疗类风湿关节炎膝关节积液

目的观察^153Sm-柠檬酸-羟基磷灰石（HA）滑膜切除术治疗类风湿关节炎（RA）持续性膝关节积液的疗效和安全性.方法常规抗风湿药物治疗无效的RA患者43例,共67个持续性积液的膝关节,行^153Sm-柠檬酸-HA滑膜切除术,观察其疗效和不良反应.结果注射后24 h 8例患者关节外放射性泄漏占注射总量的百分比均＜1%.随访至治疗后3、6、12、24和36个月,总有效率分别为65.7%、85.1%、77.6%、64.2%和56.7%.随访至36个月时,治疗有效的关节复发率为33.3%.治疗有效的关节表现为肿痛缓解,积液量减少,滑膜厚度减小,关节功能活动改善.不良反应主要为一过性关节肿痛加重.结论^153Sm-柠檬酸-HA滑膜切除术治疗RA持续性膝关节积液短期、中期疗效及安全性较好.

A study of 153Sm-citrate-hydroxyapatite synovectomy in knee synovitis with rheumatoid arthritis

Objective To investigate the efficaey and safety of ~(153)Sm-citrate-hydroxyapatite(HA) synovectomy in knee synovitis with rheumatoid arthritis (RA).Methods In 43 RA patients ineffective to routine anti-rheumatic drugs(DMMARDs) therapy,radiation synovectomy was performed by ~(153)Sm-citrate- HA in 67 joints and its efficacy and safety were evaluated.Results Radioactivity was evenly distributed as observed by gamma camera after injection.In 8 cases leakage of radioactivity was detected after 24 h,and accounted to<1% of the total activity.After follow-up for 3,6,12,24 and 36 months,the effective rates were 65.7%,85.1%,77.6%,64.2% and 56.7% respectively.The swelling and pain were released, synovia in the articular cavity was reduced,thickness of synovium was reduced and the joint function was improved.The relapse rate was 33.3% after 36 months.The adverse effect was transient with local swelling and pain.Conclusion The treatment of knee synovitis in RA by ~(153)Sm-citrale-HA synovectomy is effective after short-term and medium-term follow-up and it is a sate procedure.