关节镜手术联合关节内放疗对膝关节类风湿性关节炎的疗效观察

发布时间：2019-05-12 17:32

【摘要】：目的:比较关节镜下滑膜切除术联合关节腔内放疗与单纯关节镜下滑膜切除术治疗膝关节类风湿性关节炎的临床疗效,总结有效降低本病复发率的治疗方法。方法:回顾性分析2011年6月至2014年6月于山东大学附属山东省千佛山医院住院,且均确诊为膝关节类风湿性关节炎的患者46例51膝,26例30膝行单纯关节镜下滑膜切除术,称为单纯手术组,其中男14例,女12例,年龄(49.2± 12.36)岁;20例21膝行关节镜下滑膜切除术联合术后关节腔内放疗,称为联合手术组,其中男5例,女15例,年龄(45.3±16.38)岁。所有患者术前均进行Lysholm评分评定膝关节功能。随访术后半年、1年、2年时膝关节的疼痛、肿胀、活动度及复发等,并进行Lysholm评分。通过Lysholm评分的比较,判断预后,并比较两种治疗方案的治疗效果。结果:所有患者平均随访(41.8±10.16)个月。两组患者的一般资料比较,差异无统计学意义。单纯手术组Lysholm评分:术前(39.9±7.218)分、术后半年(67.5±4.703)分、术后1年(59.6±8.724)分、术后2年(50.6±8.319)分。联合手术组Lysholm评分:术前(38.8±7.035)分、术后半年(66.2±6.524)分、术后1年(58.2±8.994)分、术后2年(49.9±3.576)分。两组患者在术后半年、1年、2年时的Lysholm评分均较术前显著改善,且差异有统计学意义(单纯手术组:t=17.548,P0.01;t=9.530,P0.01;t=5.321,P0.01 联合手术组:t=13.101,P0.01;t=7.816,P0.01;t=6.470,P0.010)。分别对两组患者术前、术后半年、术后1年和术后2年Lysholm评分进行比较,结果无统计学意义(P0.05)。再分别比较单纯手·术组术后半年和术后1年、术后1年和术后2年的Lysholm评分,差异有统计学意义(t=4.366,P0.01;t=4.089,P0.01)。分别比较联合手术组术后半年和术后1年、术后1年和术后2年的Lysholm评分,差异有统计学意义(t=3.280,P0.01;t=3.946,P0.01)。单纯手术组共30膝,术后半年复发7膝,术后1年复发9膝,术后2年复发13膝,复发率分别为23.3%、30.0%、43.3%;联合手术组共21膝,术后半年无复发,术后1年复发3膝,术后2年复发5膝,复发率分别为0、14.3%、23.8%。在术后半年时,单纯手术组的复发率高于联合手术组,且差异有统计学意义(χ2=3.880,P0.050),而在术后1年、2年时的复发率比较,单纯手术组与联合手术组之间差异无统计学意义(χ2 =0.934,P0.05;χ2=3.710,P0.05)。结论:单纯关节镜下滑膜切除术与关节镜下滑膜切除术联合术后关节内放疗均可有效改善膝关节类风湿性关节炎患者早中期的膝关节功能,无明显差别,且中期的膝关节功能均较早期差。后者较前者能显著降低早期复发率,而中期复发率相近。
[Abstract]:Objective: to compare the clinical efficacy of arthroscopic synovectomy combined with intra-articular radiotherapy and arthroscopic synovial resection in the treatment of rheumatoid arthritis of knee joint, and to summarize the effective treatment methods to reduce the recurrence rate of rheumatoid arthritis of knee joint. Methods: from June 2011 to June 2014, 46 patients (51 knees) with rheumatoid arthritis of knee joint were hospitalized in Qianfoshan Hospital affiliated to Shandong University. 26 patients (30 knees) underwent simple arthroscopic synovectomy. It was called simple operation group, including 14 males and 12 females, aged (49.2 卤12.36) years. 20 cases (21 knees) underwent arthroscopic synovectomy combined with intra-articular radiotherapy, which was called combined operation group, including 5 males and 15 females, aged (45.3 卤16.38) years. All patients were evaluated by Lysholm score before operation. The knee joint pain, swelling, mobility and recurrence were followed up for 6 months, 1 year and 2 years after operation, and Lysholm score was performed. According to the comparison of Lysholm score, the prognosis was judged, and the therapeutic effects of the two treatments were compared. Results: all patients were followed up for an average of (41.8 卤10.16) months. There was no significant difference in general data between the two groups. In the simple operation group, the Lysholm score was (39.9 卤7.218) before operation, (67.5 卤4.703) half a year after operation, (59.6 卤8.724) at 1 year and (50.6 卤8.319) at 2 years after operation. In the combined operation group, the Lysholm score was (38.8 卤7.035) before operation, (66.2 卤6.524) half a year after operation, (58.2 卤8.994) at 1 year and (49.9 卤3.576) at 2 years after operation. The Lysholm scores of the two groups were significantly improved at 6 months, 1 year and 2 years after operation, and the difference was statistically significant (simple operation group: t 17.548, P0.01 t 9.530, P0.01). T = 5.321, P0.01: t = 13.101, P0.01t / 7.816, P0.01t / 6.470, P0.010). The Lysholm scores of the two groups were compared before operation, half a year after operation, 1 year after operation and 2 years after operation, and the results were not statistically significant (P 0.05). The Lysholm scores of the simple hand operation group were compared 6 months and 1 year after operation, 1 year after operation and 2 years after operation, the difference was statistically significant (t 鈮，

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