关节镜技术治疗血友病A膝关节滑膜炎

[目的]总结关节镜技术在血友病A膝关节滑膜炎中的应用,探讨其疗效。[方法]自2002年9月～2007年1月对25例血友病A膝关节滑膜炎患者,行关节镜下滑膜切除,围手术期内适量Ⅷ因子滴注,进行系统康复训练。采用HSS评分标准,对术前、术后结果进行综合评估。根据关节镜下软骨Outerbridge分期分组,按照Insall疗效标准,分别评估各组手术效果。[结果]23例患者得以随访,平均随访时间27个月。术前平均输血次数(23.4±4.6)次/年,术后(9.8±2.5)次/年(P<0.01)。HSS评分术前(58.6±4.7)分,术后(80.5±6.8)分(P<0.01)。OuterbridgeI期术后优良率100%(4/4),II期83.3%(10/12),Ⅳ期优良率差(0/2)。[结论]对于早中期血友病A膝关节滑膜炎,关节镜下滑膜切除是一种安全、有效的治疗方法。

Arthroseopic synovectomy in chronic synovitis of the knee in patients with hemophilia A

[Objective] To introduce a method of arthroscopic synovectomy in chronic synovitis of the knee in patients with hemophilia A and to evaluate its clinical value.[Method]Arthroscopic synovectomy was performed in 25 patients with hemophilia A from Sept.2002 to Jan.2007.Sufficient factor replacement was used and systematic rehabilitation exercise was emphasized.HSS scores were used to evaluate the efficiency of the operation.Insall standard was used to determine the difference between groups according to Outerbridge grading of the cartilage.[Result]Twenty-three patients were followed up.The mean period of follow-up was 27 months.The average frequency of hemarthrosis reduced from 23.4 times per year preoperatively to 9.8 times per year postoperatively(P<0.01).The average HSS score increased from 58.6 before operation to 80.5 after operation(P<0.01).Outerbridge grade I and II had an excellent or good result(100% vs 83.3%).[Conclusion]Arthroscopic synovectomy is a safe and efficient method for the early and middle stage of synovectomy in patients with hemophilia A.