Chung Chor-yat Stephen, Yen Chi-Hung, Yip Man-Lung Ronald, Koo Siu-Cheong Jeffrey Justin, Lao Weng-Nga Virginia
Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Hong Kong.
J Orthop Surg (Hong Kong). 2012 Aug;20(2):219-23. doi: 10.1177/230949901202000217.
To evaluate the treatment outcome of wrist and elbow arthroscopic synovectomy for patients with rheumatoid arthritis.
3 men and 18 women aged 27 to 71 (mean, 54) years underwent arthroscopic synovectomy for rheumatoid arthritis of the wrist (n=12) and elbow (n=13). All patients had received multiple medications including non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and steroids, as well as physiotherapy and splintage for 6 months, but the joint pain and disability persisted. The median duration of rheumatoid arthritis was 89 (range, 24-156) and 108 (range, 36-360) months for the wrist and elbow joints, respectively. According to the Larsen grading, the radiographic stages of the wrists and elbows were classified as grade 1 (n=4+4), grade 2 (n=4+5), and grade 3 (n=4+4). Visual analogue scale for pain, the wrist and elbow flexion-extension arcs, grip strength, key pinch strength, inflammatory markers, disability and symptoms were compared pre- and post-operatively.
The median follow-up period was 30 (range, 18-78) and 34 (range, 18-78) months for wrists and elbows, respectively. There was significant improvement in pain, joint motion, inflammatory markers, and disability score. All patients were satisfied with the surgery. There was no neurovascular or wound complication. No patient was taking longterm pain-control drugs. One patient underwent a second arthroscopic synovectomy after 15 months owing to exacerbation of arthritis.
Arthroscopic synovectomy is recommended for patients with rheumatoid arthritis who fail conservative treatment.
评估类风湿关节炎患者腕关节和肘关节镜下滑膜切除术的治疗效果。
3名男性和18名女性，年龄27至71岁（平均54岁），因类风湿关节炎接受腕关节镜下滑膜切除术（n = 12）和肘关节镜下滑膜切除术（n = 13）。所有患者均接受了多种药物治疗，包括非甾体类抗炎药、改善病情抗风湿药和类固醇，以及物理治疗和夹板固定6个月，但关节疼痛和功能障碍仍持续存在。腕关节和肘关节类风湿关节炎的中位病程分别为89个月（范围24 - 156个月）和108个月（范围36 - 360个月）。根据 Larsen 分级，腕关节和肘关节的影像学分期分为1级（n = 4 + 4）、2级（n = 4 + 5）和3级（n = 4 + 4）。比较术前和术后的疼痛视觉模拟评分、腕关节和肘关节屈伸弧、握力、捏力、炎症指标、功能障碍和症状。
腕关节和肘关节的中位随访期分别为30个月（范围18 - 78个月）和34个月（范围18 - 78个月）。疼痛、关节活动度、炎症指标和功能障碍评分均有显著改善。所有患者对手术满意。无神经血管或伤口并发症。无患者服用长期止痛药物。1例患者在15个月后因关节炎加重接受了第二次关节镜下滑膜切除术。
对于保守治疗失败的类风湿关节炎患者，推荐进行关节镜下滑膜切除术。
