膝关节镜下滑膜切除术治疗难治性膝关节炎临床随访分析

发布时间：2019-01-15 06:44

【摘要】：目的:评价膝关节镜下滑膜切除术治疗难治性炎性关节炎膝关节受累的临床疗效。通过对炎性关节炎膝关节滑膜病变超声与关节镜诊断一致性的对比,探讨超声对炎性关节炎膝关节滑膜病变的诊断价值。方法:纳入18例(RA=13 SpA=5)行膝关节镜下滑膜切除术的难治性炎性关节炎患者,共23例病变膝关节,通过比较患者术前、术后3个月及术后6个月的膝关节HSS评分、关节不适程度评分、膝关节周径、膝关节活动度、膝关节髌上囊滑膜厚度、患者疾病总体评分、HAQ评分、疾病活动度、炎症标志物及超声滑膜增生分级等临床及影像学指标,评价膝关节镜下滑膜切除术治疗难治性炎性关节炎膝关节受累的临床疗效。术中评价患者关节镜下滑膜增生分级,将超声判断膝关节滑膜增生分级与关节镜下滑膜增生分级结果进行对比,评价超声与关节镜对膝关节滑膜病变的诊断一致性。结果:术后3个月及6个月随访各项指标与术前对比,膝关节HSS评分、关节不适程度评分、膝关节髌上囊滑膜厚度、患者疾病总体评分、HAQ评分及疾病活动度均有明显改善,差异具有统计学意义(P0.05);超声滑膜增生及血流分级也较术前明显下降(P0.05)。灰阶超声滑膜增生分级与关节镜下滑膜增生分级比较,在髌上囊、内侧沟及外侧沟的Kappa值分别为0.412、0.410、0.563,二者具有中高度一致性。结论:膝关节镜下滑膜切除术治疗难治性炎性关节炎膝关节受累具有良好的疗效,可迅速改善关节症状,降低疾病活动度,提高患者生活质量。灰阶超声评价膝关节滑膜增生分级与关节镜分级具有较好的一致性,可作为临床判断膝关节滑膜病变严重程度的辅助手段。目的:探讨强直性脊柱炎(ankylosing spondylitis, AS )患者临床特征和生活质量的性别差异。方法:纳入2013年8月一2015年9月在本院门诊就诊的AS患者522例,其中女性80例,男性442例。比较男性与女性组发病年龄、病程、家族史、HLA-B27阳性率、临床症状、炎性标记物、Bath AS疾病活动指数(BASDAI)、AS病情活动度评分(ASDAS)、BathAS功能指数(BASFI)、BathAS测量指数(BASMI)及SF-36生活质量量表各维度的差异。结果:女性发病年龄较男性晚(24.3±9.2vs20.5±7.5, P 0.001),外周关节受累比例明显高于男性(55.6%vs40.5%,P0.05), BASMI评分低于男性,生活质量方面在精神健康维度得分低于男性(54.2±15.4vs58.2±16.9, P0.05),背痛程度、患者总体评价、附着点炎比例、BASDAI、BASFI及ASDAS等方面男女两组无显著差异。在小于40岁年龄层中,女性ASDAS评分低于男性(2.5± 1.3vs2.7±1.2,P0.05),精神健康维度得分较男性低(54.8±14.8vs58.5±17.0,P0.05)。在大于或等于40岁年龄层,女性躯体功能及躯体疼痛维度得分低于男性。HLA-B27阳性女性患者躯体疼痛和精神健康维度得分较男性低,高疾病活动度(BASDAI4)的女性患者躯体疼痛得分较男性低。随访发现,高疾病活动度的女性患者正规治疗后ASDAS改善程度大于男性(1.3±1.7vs0.9±1.0,P=0.044)。结论:女性AS患者发病年龄较晚,更易出现外周关节受累,生活质量特别是躯体疼痛和精神健康维度较差,而男性在脊柱活动度方面较女性差,但在疾病活动度及功能等方面未表现出性别差异。高疾病活动度的女性患者疗效优于男性,提示对病情活动度高的女性患者应给予积极治疗。女性患者疾病严重程度与男性相当,在临床诊治中应得到与男性患者相同的重视。
[Abstract]:Objective: To evaluate the clinical effect of knee arthroscopy in the treatment of patients with refractory inflammatory arthritis. To evaluate the diagnostic value of ultrasound on the synovial lesions of the knee joint of the patients with inflammatory arthritis by the comparison of the consistency of the ultrasonic and arthroscopy in the synovium of the knee joint of the inflammatory arthritis. Methods: 18 cases (RA = 13 SpA = 5) were included in the treatment of refractory inflammatory arthritis of the knee arthroscopy, 23 cases of the knee joint, and the knee joint HSS score, the joint discomfort score and the knee diameter of the knee joint were compared before and after operation, 3 months after operation and 6 months after the operation. the clinical and imaging indexes of the motion of the knee joint, the thickness of the synovial membrane of the knee joint, the overall score of the patient's disease, the HAQ score, the disease activity, the inflammatory marker and the ultrasonic synovial proliferation and the like, To evaluate the clinical effect of knee arthroscopy in the treatment of patients with refractory inflammatory arthritis. During the operation, the arthroscope of the knee joint was graded, and the diagnosis and consistency of the ultrasound and the arthroscope on the synovial lesions of the knee joint were evaluated. Results: The follow-up of the three-month and 6-month follow-up were compared with the pre-operation, the HSS score, the joint discomfort score, the thickness of the synovium of the knee joint, the overall score of the patient's disease, the score of the HAQ and the range of activity of the disease, and the difference was statistically significant (P0.05). Ultrasound synoviocytes and blood flow were also significantly decreased before operation (P <0. 05). The results showed that the Kappa values of the inner and lateral grooves were 0. 412, 0. 410, and 0. 563, respectively. Conclusion: The treatment of the knee joint of the knee arthroscope has good curative effect on the treatment of the patients with refractory inflammatory arthritis, and can improve the joint symptoms and reduce the range of motion of the patients and improve the quality of life of the patients. Gray-scale ultrasonography in the evaluation of the degree of synovial proliferation of the knee joint and the classification of the arthroscope have good consistency, and can be used as an auxiliary means for judging the severity of the synovial lesion of the knee joint. Objective: To study the difference of clinical characteristics and quality of life of patients with ankylosing spondylitis (AS). Methods: 522 cases of AS were included in the outpatient department of our hospital from August, 2013 to September, 2015, of which 80 were female and 442 were male. The age, course, family history, HLA-B27 positive rate, clinical symptoms, inflammatory markers, Bath AS disease activity index (BASDAI), AS's disease activity score (ASDAS) and Bathias function index (BASFI) were compared. The differences in the dimensions of the BATHAS measurement index (BASMI) and the SF-36 life quality scale. Results: The age of the female was higher than that of the male (24. 3, 9. 2vs20. 5, 7. 5, P 0.001). The proportion of the peripheral joint involvement was significantly higher than that of the male (55.6% vs40.5%, P0.05). The score of BASMI was lower than that of the male (55.2% 15.4vs58. 2, 16.9, P0.05), and the degree of back pain. There were no significant differences in the overall evaluation of the patient, the proportion of the attachment point, the BASDAI, the BASFI, and the ASDAS. In the age group of less than 40 years, the score of ASDAS of female was lower than that of male (2.5% 1. 3vs2. 7, 1.2, P0.05), and the mental health dimension score was lower than that of the male (54. 8, 14. 8vs58. 5, 17. 0, P0.05). In the age of greater than or equal to the age of 40, the female body function and the body pain dimension score was lower than that of the male. The body pain and mental health dimension score of HLA-B27 positive female patients was lower than that of men, and the body pain score of female patients with high disease activity (BASDA4) was lower than that of men. Follow-up showed that the degree of ASAS improvement after normal treatment of women with high range of activity was greater than that of male (1. 3-1. 7vs0. 9-1.0, P = 0. 044). Conclusion: The onset age of the female AS is relatively late, the peripheral joint involvement, the quality of life, especially the physical and mental health dimensions, and the difference of the male in the range of motion of the spine, but there is no gender difference in the range of activity and function of the disease. The efficacy of women with high range of activity is superior to that of men, and it is suggested that female patients with high range of activity should be treated with active treatment. The severity of the disease in female patients is comparable to that of the male, and the same attention should be paid to the male patients in the clinical diagnosis and treatment.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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