【摘要】：目的:比較關節(jié)鏡下滑膜切除術聯(lián)合關節(jié)腔內(nèi)放療與單純關節(jié)鏡下滑膜切除術治療膝關節(jié)類風濕性關節(jié)炎的臨床療效,總結有效降低本病復發(fā)率的治療方法。方法:回顧性分析2011年6月至2014年6月于山東大學附屬山東省千佛山醫(yī)院住院,且均確診為膝關節(jié)類風濕性關節(jié)炎的患者46例51膝,26例30膝行單純關節(jié)鏡下滑膜切除術,稱為單純手術組,其中男14例,女12例,年齡(49.2± 12.36)歲;20例21膝行關節(jié)鏡下滑膜切除術聯(lián)合術后關節(jié)腔內(nèi)放療,稱為聯(lián)合手術組,其中男5例,女15例,年齡(45.3±16.38)歲。所有患者術前均進行Lysholm評分評定膝關節(jié)功能。隨訪術后半年、1年、2年時膝關節(jié)的疼痛、腫脹、活動度及復發(fā)等,并進行Lysholm評分。通過Lysholm評分的比較,判斷預后,并比較兩種治療方案的治療效果。結果:所有患者平均隨訪(41.8±10.16)個月。兩組患者的一般資料比較,差異無統(tǒng)計學意義。單純手術組Lysholm評分:術前(39.9±7.218)分、術后半年(67.5±4.703)分、術后1年(59.6±8.724)分、術后2年(50.6±8.319)分。聯(lián)合手術組Lysholm評分:術前(38.8±7.035)分、術后半年(66.2±6.524)分、術后1年(58.2±8.994)分、術后2年(49.9±3.576)分。兩組患者在術后半年、1年、2年時的Lysholm評分均較術前顯著改善,且差異有統(tǒng)計學意義(單純手術組:t=17.548,P0.01;t=9.530,P0.01;t=5.321,P0.01 聯(lián)合手術組:t=13.101,P0.01;t=7.816,P0.01;t=6.470,P0.010)。分別對兩組患者術前、術后半年、術后1年和術后2年Lysholm評分進行比較,結果無統(tǒng)計學意義(P0.05)。再分別比較單純手·術組術后半年和術后1年、術后1年和術后2年的Lysholm評分,差異有統(tǒng)計學意義(t=4.366,P0.01;t=4.089,P0.01)。分別比較聯(lián)合手術組術后半年和術后1年、術后1年和術后2年的Lysholm評分,差異有統(tǒng)計學意義(t=3.280,P0.01;t=3.946,P0.01)。單純手術組共30膝,術后半年復發(fā)7膝,術后1年復發(fā)9膝,術后2年復發(fā)13膝,復發(fā)率分別為23.3%、30.0%、43.3%;聯(lián)合手術組共21膝,術后半年無復發(fā),術后1年復發(fā)3膝,術后2年復發(fā)5膝,復發(fā)率分別為0、14.3%、23.8%。在術后半年時,單純手術組的復發(fā)率高于聯(lián)合手術組,且差異有統(tǒng)計學意義(χ2=3.880,P0.050),而在術后1年、2年時的復發(fā)率比較,單純手術組與聯(lián)合手術組之間差異無統(tǒng)計學意義(χ2 =0.934,P0.05;χ2=3.710,P0.05)。結論:單純關節(jié)鏡下滑膜切除術與關節(jié)鏡下滑膜切除術聯(lián)合術后關節(jié)內(nèi)放療均可有效改善膝關節(jié)類風濕性關節(jié)炎患者早中期的膝關節(jié)功能,無明顯差別,且中期的膝關節(jié)功能均較早期差。后者較前者能顯著降低早期復發(fā)率,而中期復發(fā)率相近。
[Abstract]:Objective: to compare the clinical efficacy of arthroscopic synovectomy combined with intra-articular radiotherapy and arthroscopic synovial resection in the treatment of rheumatoid arthritis of knee joint, and to summarize the effective treatment methods to reduce the recurrence rate of rheumatoid arthritis of knee joint. Methods: from June 2011 to June 2014, 46 patients (51 knees) with rheumatoid arthritis of knee joint were hospitalized in Qianfoshan Hospital affiliated to Shandong University. 26 patients (30 knees) underwent simple arthroscopic synovectomy. It was called simple operation group, including 14 males and 12 females, aged (49.2 鹵12.36) years. 20 cases (21 knees) underwent arthroscopic synovectomy combined with intra-articular radiotherapy, which was called combined operation group, including 5 males and 15 females, aged (45.3 鹵16.38) years. All patients were evaluated by Lysholm score before operation. The knee joint pain, swelling, mobility and recurrence were followed up for 6 months, 1 year and 2 years after operation, and Lysholm score was performed. According to the comparison of Lysholm score, the prognosis was judged, and the therapeutic effects of the two treatments were compared. Results: all patients were followed up for an average of (41.8 鹵10.16) months. There was no significant difference in general data between the two groups. In the simple operation group, the Lysholm score was (39.9 鹵7.218) before operation, (67.5 鹵4.703) half a year after operation, (59.6 鹵8.724) at 1 year and (50.6 鹵8.319) at 2 years after operation. In the combined operation group, the Lysholm score was (38.8 鹵7.035) before operation, (66.2 鹵6.524) half a year after operation, (58.2 鹵8.994) at 1 year and (49.9 鹵3.576) at 2 years after operation. The Lysholm scores of the two groups were significantly improved at 6 months, 1 year and 2 years after operation, and the difference was statistically significant (simple operation group: t 17.548, P0.01 t 9.530, P0.01). T = 5.321, P0.01: t = 13.101, P0.01t / 7.816, P0.01t / 6.470, P0.010). The Lysholm scores of the two groups were compared before operation, half a year after operation, 1 year after operation and 2 years after operation, and the results were not statistically significant (P 0.05). The Lysholm scores of the simple hand operation group were compared 6 months and 1 year after operation, 1 year after operation and 2 years after operation, the difference was statistically significant (t 鈮，

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