关节镜联合膝关节放射性滑膜切除术治疗类风湿性关节炎：14 年随访。

Combined arthroscopic and radiation synovectomy of the knee joint in rheumatoid arthritis: 14-year follow-up.

机构信息

Division of Orthopedic Rheumatology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.

出版信息

Arthroscopy. 2011 Jan;27(1):52-9. doi: 10.1016/j.arthro.2010.06.003. Epub 2010 Oct 15.

DOI:10.1016/j.arthro.2010.06.003

PMID:20950987

Abstract

PURPOSE

To investigate the long-term outcome of combined arthroscopic and radiation synovectomy of the knee joint in early cases of rheumatoid arthritis (RA) with regard to knee function and the need for surgical re-interventions.

METHODS

Between 1993 and 1997, a consecutive series of 38 RA patients with therapy-refractory synovitis of the knee joint and only mild cartilage lesions (not exceeding Outerbridge grade II at surgery) were treated with combined arthroscopic and radiation synovectomy. Knee function was assessed preoperatively; at 6 months, 1 year, and 5 years; and finally, at a mean of 14 years with 4 different functional scores. A Kaplan-Meier survival curve was calculated with "any re-intervention" and "total knee arthroplasty" as endpoints.

RESULTS

Of 38 knees, 32 were available for the final 14-year follow-up with a total of 22 re-interventions: intra-articular steroid injection (n = 3), arthroscopic (n = 2) or radiation (n = 1) re-synovectomy, and total knee arthroplasty (n = 16). The remaining 10 patients with no re-intervention showed knee function not significantly different from the postoperative state. With any surgical re-intervention as the endpoint, the survival rate was 84% at 5 years (95% confidence interval [CI], 67.0% to 86.7%), 44% at 10 years (95% CI, 26.7% to 60.0%), and 32% at the 14-year assessment (95% CI, 16.0% to 49.3%). With total knee arthroplasty as the endpoint, the joint survival rate was 88.5% at 5 years (95% CI, 68.5% to 96.2%), 53.9% at 10 years (95% CI, 33.3% to 71.6%), and 39.6% at 14 years (95% CI, 18.9% to 48.6%).

CONCLUSIONS

Combined arthroscopic and radiation synovectomy leads to a stable improvement of knee function for a minimum of 5 years, but surgical re-interventions were frequently observed at the 14-year assessment and challenge the long-term benefit of the procedure. Patients with no interventions had a significantly shorter history of disease (7 v 11 years).

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

摘要

目的

研究关节镜下联合放射滑膜切除术治疗早期类风湿关节炎（RA）患者膝关节的长期疗效，主要关注膝关节功能和再次手术干预的需求。

方法

1993 年至 1997 年间，连续纳入 38 例接受关节镜下联合放射滑膜切除术治疗的膝关节难治性滑膜炎合并早期软骨损伤（术中未超过 Outerbridge Ⅱ级）的 RA 患者。术前、术后 6 个月、1 年和 5 年评估膝关节功能，平均 14 年后随访时采用 4 种不同的功能评分。以“任何再次手术干预”和“全膝关节置换术”为终点，计算 Kaplan-Meier 生存曲线。

结果

38 例膝关节中，32 例在最终的 14 年随访中获得了完整资料，共发生 22 次再次手术干预：关节内类固醇注射（n=3）、关节镜（n=2）或放射（n=1）滑膜切除术和全膝关节置换术（n=16）。10 例未行再次手术干预的患者膝关节功能与术后相比无明显差异。以任何再次手术干预为终点，5 年时的生存率为 84%（95%置信区间[CI]，67.0%至 86.7%），10 年时为 44%（95% CI，26.7%至 60.0%），14 年时为 32%（95% CI，16.0%至 49.3%）。以全膝关节置换术为终点，5 年时的关节生存率为 88.5%（95% CI，68.5%至 96.2%），10 年时为 53.9%（95% CI，33.3%至 71.6%），14 年时为 39.6%（95% CI，18.9%至 48.6%）。