Ayral X, Bonvarlet J P, Simonnet J, Amor B, Dougados M
Rheumatology Department, Cochin Teaching Hospital, Paris, France.
Rev Rhum Engl Ed. 1997 Apr;64(4):215-26.
The place of arthroscopy-assisted synovectomy in the treatment of inflammatory synovitis of the knee was evaluated by studying 26 patients who underwent this procedure between November 1992 and September 1995. Half the patients had rheumatoid arthritis. Twenty-three patients (28 knees) were reevaluated after a mean follow-up of 32 months (range, 4-50 months). The arthroscopic synovectomy was done either as the first-line synovectomy procedure, after failure of triamcinolone hexacetonide injection into the joint, or as the second-line synovectomy procedure, after failure of osmic acid or yttrium-90 synovectomy. Except in one patient with severe arthritis, arthroscopic synovectomy produced statistically significant improvements regarding pain (visual scale), function (Lequesne's index), range of flexion, amount of joint fluid and knee circumference. The range of extension of the knee was normal at baseline and remained so after the procedure. Overall efficacy was similar for first-line and second-line procedures. Results were rated good to very good by 71% of the patients and 61% of the physicians overall and the overall improvement in knee arthritis as perceived by the patients was 60%. The procedure was well tolerated in 93% of cases. The mean time needed to achieve a stable improvement was 3.2 weeks for pain, 4.7 weeks for swelling and 3.6 weeks for range of motion. One case each of hemarthrosis and stiffness of the knee were recorded, with a full recovery in both cases. Arthroscopic synovectomy is effective and safe but more burdensome and expensive than osmic acid or radiation synovectomy, and consequently deserves a place of choice in patients who have failed to respond to either of the last two methods.
通过研究1992年11月至1995年9月间接受关节镜辅助滑膜切除术的26例患者，评估了该手术在治疗膝关节炎性滑膜炎中的地位。半数患者患有类风湿关节炎。23例患者（28个膝关节）在平均随访32个月（范围4 - 50个月）后接受了重新评估。关节镜滑膜切除术可作为一线滑膜切除手术，即在关节内注射己曲安奈德失败后进行；或作为二线滑膜切除手术，即在锇酸或钇-90滑膜切除术后失败后进行。除1例患有严重关节炎的患者外，关节镜滑膜切除术在疼痛（视觉评分）、功能（Lequesne指数）、屈曲范围、关节液量和膝关节周长方面产生了具有统计学意义的改善。膝关节伸直范围在基线时正常，术后保持不变。一线和二线手术的总体疗效相似。总体而言，71%的患者和61%的医生将结果评为良好至非常好，患者感知的膝关节关节炎总体改善率为60%。93%的病例对该手术耐受性良好。疼痛达到稳定改善所需的平均时间为3.2周，肿胀为4.7周，活动范围为3.6周。记录到1例膝关节积血和1例膝关节僵硬，两例均完全康复。关节镜滑膜切除术有效且安全，但比锇酸或放射性滑膜切除术更繁琐且昂贵，因此在对后两种方法均无反应的患者中应作为首选。
