关节镜下滑膜切除术在治疗类风湿性关节炎中价值的探讨

目的　探讨关节镜下滑膜切除术在治疗类风湿性关节炎 (类风关 )中的价值。方法　在关节镜下对 34例早、中期类风关患者共 4 2个膝关节 (早期 2 2例 ,2 4个关节 ;中期 12例 ,18个关节 )行滑膜切除术 ,其中32个膝关节使用双极射频对残留的滑膜进行清除和止血。术后给予正规抗类风湿药物治疗。所有的 4 2个关节得到了 6个月的随访 ,31个关节得到 2年的随访 ,14个关节得到 4年的随访。随访内容包括关节功能的评定和红细胞沉降率 (ESR)、C反应蛋白 (CRP)和类风湿因子 (RF)的测定。结果　术后 6个月的关节功能的优良率为 95 .2 % (4 0 / 4 2个 ) ,术后 2年为 87.1% (2 7/ 31个 ) ,术后 4年为 6 4 .3% (9/ 14个 )。术后 3个月 ,早期类风关组的ESR、CRP和RF较术前明显下降 (P <0 .0 5 ) ,中期类风关组的ESR和CRP较术前明显下降 (P <0 .0 5 )。结论　对早、中期类风关患者进行关节镜下滑膜切除术 ,术后给予正规的抗类风湿药物治疗 ,可取得比较满意的疗效。双极射频能够彻底清除滑膜 ,有利于减少关节血肿的发生 ,促进关节功能康复。

Evaluation of arthroscopic synovectomy in treatment of rheumatoid arthritis

Objective To appraise the value of arthroscopic synovectomy in early and midstages rheumatoid arthritis. Methods 42 knees in 34 rheumatoid arthritis patients(24 knees of 22 early-stage cases, 18 knees of 12 mid-stage cases) were performed with arthroscopic synovectomy and received anti-rheumatoid drug therapy postoperatively. We used bipolar radiofrequency in treating 32 knees. All 42 knees were followed-up for 6 months, with 31 knees followed-up for 2 years, and 14 knees evaluated at 4-year after operation. All patients were evaluated by knee function, erythrocyte sedimentation rate (ESR), C reaction protein(CRP) and rheumatoid factor(RF). Results At 6 months postoperatively, the rate of excellent and good effects was 95.2%(40/42). At 2 years, 87.1% of knees (27/31) were considered to have excellent and good result, and at 4 year 64.3% of knees(9/14)continued to do well. ESR, CRP and RF significantly decreased postoperatively in early stage group(P<0.05). Whereas in mid-stage group, CRP and RF also decreased significantly postoperatively (P<0.05).Conclusions Satisfactory results can be obtained through arthroscopic synovectomy and concomitent anti-rheumatoid drug therapy in early and mid-stages rheumatoid arthritis. Bipolar radiofrequency is helpful in eliminating synovia, preventing knee joint hematoma and favoring rehabilitation.