Tanaka N, Sakahashi H, Sato E, Hirose K, Ishii S
Sapporo Gorinbashi Orthopaedic Hospital, Sapporo Hokkaido, Japan.
Clin Rheumatol. 2002 Feb;21(1):4-9. doi: 10.1007/s100670200002.
To determine the appropriate volume of physiological fluid needed to effectively reduce synovitis and to determine the indications for intra-articular lavage of knee joints with rheumatoid arthritis (RA), intraarticular lavage with different volumes of physiological fluid via needle arthroscopy were performed on 102 rheumatoid knees in 98 patients (25 males, 77 females) with an average age of 46 years at the time of operation. Intra-articular lavage of a knee joint with 5 or 10 l of physiological fluid gave better clinical results than did intra-articular lavage with 0.5-1.5 l. There was no difference between the beneficial effects of intraarticular lavage using 5 1 or 10 l of fluid. The preoperative conditions (CRP, frequency of the susceptible factors of HLA-DRB1 alleles, radiological change in the knee joint) and the intraoperative chondroscopic assessments were correlated with clinical improvement. Our study demonstrated that intra-articular lavage with 5 l of physiological fluid performed using needle arthroscopy was beneficial. The following points at least should be checked before performing intra-articular lavage: (1) CRP is not elevated to a high level (> or =5 mg/dl), (2) the patient does not have susceptible factors in both HLA-DRB1 alleles, (3) the grade of rheumatoid knee is below Larsen II in preoperative X-ray findings, and (4) the degree of cartilage damage is not more than grade 3 in arthroscopic findings.
为确定有效减轻滑膜炎所需的生理液体适宜量，并确定类风湿关节炎（RA）膝关节关节腔内灌洗的适应证，对98例患者（25例男性，77例女性）的102个类风湿膝关节，通过针式关节镜用不同量的生理液体进行关节腔内灌洗，手术时患者平均年龄为46岁。用5升或10升生理液体进行膝关节关节腔内灌洗比用0.5 - 1.5升进行灌洗临床效果更好。使用5升或10升液体进行关节腔内灌洗的有益效果之间无差异。术前状况（CRP、HLA - DRB1等位基因易感因素频率、膝关节放射学改变）及术中关节镜评估与临床改善相关。我们的研究表明，通过针式关节镜用5升生理液体进行关节腔内灌洗是有益的。在进行关节腔内灌洗前至少应检查以下几点：（1）CRP未升高到高水平（≥5mg/dl），（2）患者HLA - DRB1等位基因不存在易感因素，（3）类风湿膝关节分级在术前X线检查结果中低于Larsen II级，（4）关节镜检查结果中软骨损伤程度不超过3级。
