Horiuchi Kiwamu, Momohara Shigeki, Tomatsu Taisuke, Inoue Kazuhiko, Toyama Yoshiaki
Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.
J Bone Joint Surg Am. 2002 Mar;84(3):342-7. doi: 10.2106/00004623-200203000-00002.
The purpose of this study was to investigate the results of arthroscopic synovectomy for the treatment of elbows affected by rheumatoid arthritis.
Arthroscopic synovectomy was performed on twenty-nine elbows (twenty-seven patients) between 1984 and 1996. Twenty-one elbows (twenty patients), followed for a minimum of forty-two months, were evaluated clinically with use of the Mayo elbow performance score and radiographic findings. The mean duration of follow-up was ninety-seven months. With use of the system of Larsen et al., we classified all elbows into three groups--Grades 1 and 2, Grade 3, and Grade 4--according to the preoperative radiographic findings. These groups were then compared.
The mean Mayo elbow performance score improved from 48.3 points preoperatively to 77.5 points (an excellent result in two elbows, a good result in thirteen, a fair result in six, and a poor result in none) at two years after the operation and 69.8 points (an excellent result in two elbows, a good result in seven, a fair result in seven, and a poor result in five) at the final follow-up evaluation. The mean score for pain improved from 9.3 points preoperatively to 31.4 points at two years after the operation and 27.9 points at the final follow-up evaluation. Clinically apparent synovitis recurred in five of the twenty-one elbows, and two of the five required total elbow arthroplasty. Among the three groups, only elbows with Larsen Grade-1 or 2 arthritis had a favorable long-term result with regard to total function. The postoperative results were unsatisfactory for Larsen Grade-4 elbows.
Arthroscopic synovectomy in an elbow affected by rheumatoid arthritis is a reliable procedure that can alleviate pain. Our results suggest that one of the most favorable indications for arthroscopic synovectomy is a preoperative radiographic rating of Grade 1 or 2.
本研究的目的是调查关节镜下滑膜切除术治疗类风湿性关节炎累及肘部的效果。
1984年至1996年间，对29个肘部（27例患者）实施了关节镜下滑膜切除术。对21个肘部（20例患者）进行了至少42个月的随访，采用梅奥肘关节功能评分和影像学检查结果进行临床评估。平均随访时间为97个月。根据术前影像学检查结果，我们使用拉森等人的系统将所有肘部分为三组——1级和2级、3级和4级——然后对这些组进行比较。
术后两年，梅奥肘关节功能评分平均从术前的48.3分提高到77.5分（2个肘部为优，13个为良，6个为中，无差）；在最终随访评估时为69.8分（2个肘部为优，7个为良，7个为中，5个为差）。疼痛平均评分从术前的9.3分提高到术后两年的31.4分，在最终随访评估时为27.9分。21个肘部中有5个出现临床明显的滑膜炎复发，其中2个需要进行全肘关节置换术。在这三组中，只有拉森1级或2级关节炎的肘部在总功能方面有良好的长期效果。拉森4级肘部的术后结果不理想。
类风湿性关节炎累及肘部的关节镜下滑膜切除术是一种可靠的手术方法，可以缓解疼痛。我们的结果表明，关节镜下滑膜切除术最有利的适应证之一是术前影像学评分为1级或2级。
