膝關(guān)節(jié)鏡下滑膜切除術(shù)治療難治性膝關(guān)節(jié)炎臨床隨訪分析
發(fā)布時(shí)間：2019-01-15 06:44
【摘要】：目的:評價(jià)膝關(guān)節(jié)鏡下滑膜切除術(shù)治療難治性炎性關(guān)節(jié)炎膝關(guān)節(jié)受累的臨床療效。通過對炎性關(guān)節(jié)炎膝關(guān)節(jié)滑膜病變超聲與關(guān)節(jié)鏡診斷一致性的對比,探討超聲對炎性關(guān)節(jié)炎膝關(guān)節(jié)滑膜病變的診斷價(jià)值。方法:納入18例(RA=13 SpA=5)行膝關(guān)節(jié)鏡下滑膜切除術(shù)的難治性炎性關(guān)節(jié)炎患者,共23例病變膝關(guān)節(jié),通過比較患者術(shù)前、術(shù)后3個(gè)月及術(shù)后6個(gè)月的膝關(guān)節(jié)HSS評分、關(guān)節(jié)不適程度評分、膝關(guān)節(jié)周徑、膝關(guān)節(jié)活動度、膝關(guān)節(jié)髕上囊滑膜厚度、患者疾病總體評分、HAQ評分、疾病活動度、炎癥標(biāo)志物及超聲滑膜增生分級等臨床及影像學(xué)指標(biāo),評價(jià)膝關(guān)節(jié)鏡下滑膜切除術(shù)治療難治性炎性關(guān)節(jié)炎膝關(guān)節(jié)受累的臨床療效。術(shù)中評價(jià)患者關(guān)節(jié)鏡下滑膜增生分級,將超聲判斷膝關(guān)節(jié)滑膜增生分級與關(guān)節(jié)鏡下滑膜增生分級結(jié)果進(jìn)行對比,評價(jià)超聲與關(guān)節(jié)鏡對膝關(guān)節(jié)滑膜病變的診斷一致性。結(jié)果:術(shù)后3個(gè)月及6個(gè)月隨訪各項(xiàng)指標(biāo)與術(shù)前對比,膝關(guān)節(jié)HSS評分、關(guān)節(jié)不適程度評分、膝關(guān)節(jié)髕上囊滑膜厚度、患者疾病總體評分、HAQ評分及疾病活動度均有明顯改善,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);超聲滑膜增生及血流分級也較術(shù)前明顯下降(P0.05)�；译A超聲滑膜增生分級與關(guān)節(jié)鏡下滑膜增生分級比較,在髕上囊、內(nèi)側(cè)溝及外側(cè)溝的Kappa值分別為0.412、0.410、0.563,二者具有中高度一致性。結(jié)論:膝關(guān)節(jié)鏡下滑膜切除術(shù)治療難治性炎性關(guān)節(jié)炎膝關(guān)節(jié)受累具有良好的療效,可迅速改善關(guān)節(jié)癥狀,降低疾病活動度,提高患者生活質(zhì)量�；译A超聲評價(jià)膝關(guān)節(jié)滑膜增生分級與關(guān)節(jié)鏡分級具有較好的一致性,可作為臨床判斷膝關(guān)節(jié)滑膜病變嚴(yán)重程度的輔助手段。目的:探討強(qiáng)直性脊柱炎(ankylosing spondylitis, AS )患者臨床特征和生活質(zhì)量的性別差異。方法:納入2013年8月一2015年9月在本院門診就診的AS患者522例,其中女性80例,男性442例。比較男性與女性組發(fā)病年齡、病程、家族史、HLA-B27陽性率、臨床癥狀、炎性標(biāo)記物、Bath AS疾病活動指數(shù)(BASDAI)、AS病情活動度評分(ASDAS)、BathAS功能指數(shù)(BASFI)、BathAS測量指數(shù)(BASMI)及SF-36生活質(zhì)量量表各維度的差異。結(jié)果:女性發(fā)病年齡較男性晚(24.3±9.2vs20.5±7.5, P 0.001),外周關(guān)節(jié)受累比例明顯高于男性(55.6%vs40.5%,P0.05), BASMI評分低于男性,生活質(zhì)量方面在精神健康維度得分低于男性(54.2±15.4vs58.2±16.9, P0.05),背痛程度、患者總體評價(jià)、附著點(diǎn)炎比例、BASDAI、BASFI及ASDAS等方面男女兩組無顯著差異。在小于40歲年齡層中,女性ASDAS評分低于男性(2.5± 1.3vs2.7±1.2,P0.05),精神健康維度得分較男性低(54.8±14.8vs58.5±17.0,P0.05)。在大于或等于40歲年齡層,女性軀體功能及軀體疼痛維度得分低于男性。HLA-B27陽性女性患者軀體疼痛和精神健康維度得分較男性低,高疾病活動度(BASDAI4)的女性患者軀體疼痛得分較男性低。隨訪發(fā)現(xiàn),高疾病活動度的女性患者正規(guī)治療后ASDAS改善程度大于男性(1.3±1.7vs0.9±1.0,P=0.044)。結(jié)論:女性AS患者發(fā)病年齡較晚,更易出現(xiàn)外周關(guān)節(jié)受累,生活質(zhì)量特別是軀體疼痛和精神健康維度較差,而男性在脊柱活動度方面較女性差,但在疾病活動度及功能等方面未表現(xiàn)出性別差異。高疾病活動度的女性患者療效優(yōu)于男性,提示對病情活動度高的女性患者應(yīng)給予積極治療。女性患者疾病嚴(yán)重程度與男性相當(dāng),在臨床診治中應(yīng)得到與男性患者相同的重視。
[Abstract]:Objective: To evaluate the clinical effect of knee arthroscopy in the treatment of patients with refractory inflammatory arthritis. To evaluate the diagnostic value of ultrasound on the synovial lesions of the knee joint of the patients with inflammatory arthritis by the comparison of the consistency of the ultrasonic and arthroscopy in the synovium of the knee joint of the inflammatory arthritis. Methods: 18 cases (RA = 13 SpA = 5) were included in the treatment of refractory inflammatory arthritis of the knee arthroscopy, 23 cases of the knee joint, and the knee joint HSS score, the joint discomfort score and the knee diameter of the knee joint were compared before and after operation, 3 months after operation and 6 months after the operation. the clinical and imaging indexes of the motion of the knee joint, the thickness of the synovial membrane of the knee joint, the overall score of the patient's disease, the HAQ score, the disease activity, the inflammatory marker and the ultrasonic synovial proliferation and the like, To evaluate the clinical effect of knee arthroscopy in the treatment of patients with refractory inflammatory arthritis. During the operation, the arthroscope of the knee joint was graded, and the diagnosis and consistency of the ultrasound and the arthroscope on the synovial lesions of the knee joint were evaluated. Results: The follow-up of the three-month and 6-month follow-up were compared with the pre-operation, the HSS score, the joint discomfort score, the thickness of the synovium of the knee joint, the overall score of the patient's disease, the score of the HAQ and the range of activity of the disease, and the difference was statistically significant (P0.05). Ultrasound synoviocytes and blood flow were also significantly decreased before operation (P <0. 05). The results showed that the Kappa values of the inner and lateral grooves were 0. 412, 0. 410, and 0. 563, respectively. Conclusion: The treatment of the knee joint of the knee arthroscope has good curative effect on the treatment of the patients with refractory inflammatory arthritis, and can improve the joint symptoms and reduce the range of motion of the patients and improve the quality of life of the patients. Gray-scale ultrasonography in the evaluation of the degree of synovial proliferation of the knee joint and the classification of the arthroscope have good consistency, and can be used as an auxiliary means for judging the severity of the synovial lesion of the knee joint. Objective: To study the difference of clinical characteristics and quality of life of patients with ankylosing spondylitis (AS). Methods: 522 cases of AS were included in the outpatient department of our hospital from August, 2013 to September, 2015, of which 80 were female and 442 were male. The age, course, family history, HLA-B27 positive rate, clinical symptoms, inflammatory markers, Bath AS disease activity index (BASDAI), AS's disease activity score (ASDAS) and Bathias function index (BASFI) were compared. The differences in the dimensions of the BATHAS measurement index (BASMI) and the SF-36 life quality scale. Results: The age of the female was higher than that of the male (24. 3, 9. 2vs20. 5, 7. 5, P 0.001). The proportion of the peripheral joint involvement was significantly higher than that of the male (55.6% vs40.5%, P0.05). The score of BASMI was lower than that of the male (55.2% 15.4vs58. 2, 16.9, P0.05), and the degree of back pain. There were no significant differences in the overall evaluation of the patient, the proportion of the attachment point, the BASDAI, the BASFI, and the ASDAS. In the age group of less than 40 years, the score of ASDAS of female was lower than that of male (2.5% 1. 3vs2. 7, 1.2, P0.05), and the mental health dimension score was lower than that of the male (54. 8, 14. 8vs58. 5, 17. 0, P0.05). In the age of greater than or equal to the age of 40, the female body function and the body pain dimension score was lower than that of the male. The body pain and mental health dimension score of HLA-B27 positive female patients was lower than that of men, and the body pain score of female patients with high disease activity (BASDA4) was lower than that of men. Follow-up showed that the degree of ASAS improvement after normal treatment of women with high range of activity was greater than that of male (1. 3-1. 7vs0. 9-1.0, P = 0. 044). Conclusion: The onset age of the female AS is relatively late, the peripheral joint involvement, the quality of life, especially the physical and mental health dimensions, and the difference of the male in the range of motion of the spine, but there is no gender difference in the range of activity and function of the disease. The efficacy of women with high range of activity is superior to that of men, and it is suggested that female patients with high range of activity should be treated with active treatment. The severity of the disease in female patients is comparable to that of the male, and the same attention should be paid to the male patients in the clinical diagnosis and treatment.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4
本文編號：2408938
[Abstract]:Objective: To evaluate the clinical effect of knee arthroscopy in the treatment of patients with refractory inflammatory arthritis. To evaluate the diagnostic value of ultrasound on the synovial lesions of the knee joint of the patients with inflammatory arthritis by the comparison of the consistency of the ultrasonic and arthroscopy in the synovium of the knee joint of the inflammatory arthritis. Methods: 18 cases (RA = 13 SpA = 5) were included in the treatment of refractory inflammatory arthritis of the knee arthroscopy, 23 cases of the knee joint, and the knee joint HSS score, the joint discomfort score and the knee diameter of the knee joint were compared before and after operation, 3 months after operation and 6 months after the operation. the clinical and imaging indexes of the motion of the knee joint, the thickness of the synovial membrane of the knee joint, the overall score of the patient's disease, the HAQ score, the disease activity, the inflammatory marker and the ultrasonic synovial proliferation and the like, To evaluate the clinical effect of knee arthroscopy in the treatment of patients with refractory inflammatory arthritis. During the operation, the arthroscope of the knee joint was graded, and the diagnosis and consistency of the ultrasound and the arthroscope on the synovial lesions of the knee joint were evaluated. Results: The follow-up of the three-month and 6-month follow-up were compared with the pre-operation, the HSS score, the joint discomfort score, the thickness of the synovium of the knee joint, the overall score of the patient's disease, the score of the HAQ and the range of activity of the disease, and the difference was statistically significant (P0.05). Ultrasound synoviocytes and blood flow were also significantly decreased before operation (P <0. 05). The results showed that the Kappa values of the inner and lateral grooves were 0. 412, 0. 410, and 0. 563, respectively. Conclusion: The treatment of the knee joint of the knee arthroscope has good curative effect on the treatment of the patients with refractory inflammatory arthritis, and can improve the joint symptoms and reduce the range of motion of the patients and improve the quality of life of the patients. Gray-scale ultrasonography in the evaluation of the degree of synovial proliferation of the knee joint and the classification of the arthroscope have good consistency, and can be used as an auxiliary means for judging the severity of the synovial lesion of the knee joint. Objective: To study the difference of clinical characteristics and quality of life of patients with ankylosing spondylitis (AS). Methods: 522 cases of AS were included in the outpatient department of our hospital from August, 2013 to September, 2015, of which 80 were female and 442 were male. The age, course, family history, HLA-B27 positive rate, clinical symptoms, inflammatory markers, Bath AS disease activity index (BASDAI), AS's disease activity score (ASDAS) and Bathias function index (BASFI) were compared. The differences in the dimensions of the BATHAS measurement index (BASMI) and the SF-36 life quality scale. Results: The age of the female was higher than that of the male (24. 3, 9. 2vs20. 5, 7. 5, P 0.001). The proportion of the peripheral joint involvement was significantly higher than that of the male (55.6% vs40.5%, P0.05). The score of BASMI was lower than that of the male (55.2% 15.4vs58. 2, 16.9, P0.05), and the degree of back pain. There were no significant differences in the overall evaluation of the patient, the proportion of the attachment point, the BASDAI, the BASFI, and the ASDAS. In the age group of less than 40 years, the score of ASDAS of female was lower than that of male (2.5% 1. 3vs2. 7, 1.2, P0.05), and the mental health dimension score was lower than that of the male (54. 8, 14. 8vs58. 5, 17. 0, P0.05). In the age of greater than or equal to the age of 40, the female body function and the body pain dimension score was lower than that of the male. The body pain and mental health dimension score of HLA-B27 positive female patients was lower than that of men, and the body pain score of female patients with high disease activity (BASDA4) was lower than that of men. Follow-up showed that the degree of ASAS improvement after normal treatment of women with high range of activity was greater than that of male (1. 3-1. 7vs0. 9-1.0, P = 0. 044). Conclusion: The onset age of the female AS is relatively late, the peripheral joint involvement, the quality of life, especially the physical and mental health dimensions, and the difference of the male in the range of motion of the spine, but there is no gender difference in the range of activity and function of the disease. The efficacy of women with high range of activity is superior to that of men, and it is suggested that female patients with high range of activity should be treated with active treatment. The severity of the disease in female patients is comparable to that of the male, and the same attention should be paid to the male patients in the clinical diagnosis and treatment.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4
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