【摘要】：目的:比較關(guān)節(jié)鏡下滑膜切除術(shù)聯(lián)合關(guān)節(jié)腔內(nèi)放療與單純關(guān)節(jié)鏡下滑膜切除術(shù)治療膝關(guān)節(jié)類風(fēng)濕性關(guān)節(jié)炎的臨床療效,總結(jié)有效降低本病復(fù)發(fā)率的治療方法。方法:回顧性分析2011年6月至2014年6月于山東大學(xué)附屬山東省千佛山醫(yī)院住院,且均確診為膝關(guān)節(jié)類風(fēng)濕性關(guān)節(jié)炎的患者46例51膝,26例30膝行單純關(guān)節(jié)鏡下滑膜切除術(shù),稱為單純手術(shù)組,其中男14例,女12例,年齡(49.2± 12.36)歲;20例21膝行關(guān)節(jié)鏡下滑膜切除術(shù)聯(lián)合術(shù)后關(guān)節(jié)腔內(nèi)放療,稱為聯(lián)合手術(shù)組,其中男5例,女15例,年齡(45.3±16.38)歲。所有患者術(shù)前均進(jìn)行Lysholm評(píng)分評(píng)定膝關(guān)節(jié)功能。隨訪術(shù)后半年、1年、2年時(shí)膝關(guān)節(jié)的疼痛、腫脹、活動(dòng)度及復(fù)發(fā)等,并進(jìn)行Lysholm評(píng)分。通過(guò)Lysholm評(píng)分的比較,判斷預(yù)后,并比較兩種治療方案的治療效果。結(jié)果:所有患者平均隨訪(41.8±10.16)個(gè)月。兩組患者的一般資料比較,差異無(wú)統(tǒng)計(jì)學(xué)意義。單純手術(shù)組Lysholm評(píng)分:術(shù)前(39.9±7.218)分、術(shù)后半年(67.5±4.703)分、術(shù)后1年(59.6±8.724)分、術(shù)后2年(50.6±8.319)分。聯(lián)合手術(shù)組Lysholm評(píng)分:術(shù)前(38.8±7.035)分、術(shù)后半年(66.2±6.524)分、術(shù)后1年(58.2±8.994)分、術(shù)后2年(49.9±3.576)分。兩組患者在術(shù)后半年、1年、2年時(shí)的Lysholm評(píng)分均較術(shù)前顯著改善,且差異有統(tǒng)計(jì)學(xué)意義(單純手術(shù)組:t=17.548,P0.01;t=9.530,P0.01;t=5.321,P0.01 聯(lián)合手術(shù)組:t=13.101,P0.01;t=7.816,P0.01;t=6.470,P0.010)。分別對(duì)兩組患者術(shù)前、術(shù)后半年、術(shù)后1年和術(shù)后2年Lysholm評(píng)分進(jìn)行比較,結(jié)果無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。再分別比較單純手·術(shù)組術(shù)后半年和術(shù)后1年、術(shù)后1年和術(shù)后2年的Lysholm評(píng)分,差異有統(tǒng)計(jì)學(xué)意義(t=4.366,P0.01;t=4.089,P0.01)。分別比較聯(lián)合手術(shù)組術(shù)后半年和術(shù)后1年、術(shù)后1年和術(shù)后2年的Lysholm評(píng)分,差異有統(tǒng)計(jì)學(xué)意義(t=3.280,P0.01;t=3.946,P0.01)。單純手術(shù)組共30膝,術(shù)后半年復(fù)發(fā)7膝,術(shù)后1年復(fù)發(fā)9膝,術(shù)后2年復(fù)發(fā)13膝,復(fù)發(fā)率分別為23.3%、30.0%、43.3%;聯(lián)合手術(shù)組共21膝,術(shù)后半年無(wú)復(fù)發(fā),術(shù)后1年復(fù)發(fā)3膝,術(shù)后2年復(fù)發(fā)5膝,復(fù)發(fā)率分別為0、14.3%、23.8%。在術(shù)后半年時(shí),單純手術(shù)組的復(fù)發(fā)率高于聯(lián)合手術(shù)組,且差異有統(tǒng)計(jì)學(xué)意義(χ2=3.880,P0.050),而在術(shù)后1年、2年時(shí)的復(fù)發(fā)率比較,單純手術(shù)組與聯(lián)合手術(shù)組之間差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2 =0.934,P0.05;χ2=3.710,P0.05)。結(jié)論:單純關(guān)節(jié)鏡下滑膜切除術(shù)與關(guān)節(jié)鏡下滑膜切除術(shù)聯(lián)合術(shù)后關(guān)節(jié)內(nèi)放療均可有效改善膝關(guān)節(jié)類風(fēng)濕性關(guān)節(jié)炎患者早中期的膝關(guān)節(jié)功能,無(wú)明顯差別,且中期的膝關(guān)節(jié)功能均較早期差。后者較前者能顯著降低早期復(fù)發(fā)率,而中期復(fù)發(fā)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 鹵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 鹵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 鹵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 鹵7.218) before operation, (67.5 鹵4.703) half a year after operation, (59.6 鹵8.724) at 1 year and (50.6 鹵8.319) at 2 years after operation. In the combined operation group, the Lysholm score was (38.8 鹵7.035) before operation, (66.2 鹵6.524) half a year after operation, (58.2 鹵8.994) at 1 year and (49.9 鹵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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