摘要
[目的]采用MRI增强扫描及滑膜测量的方法,比较类风湿关节炎患者（Rheumatoid Arthritis,RA）膝关节镜下滑膜切除术前后滑膜量的变化,评估手术的疗效。[方法]2012年2月-2013年6月,共有20例20膝符合入选标准,左膝11例,右膝9例,所有患者均为女性,平均年龄（43.8±16.24）岁（22-66岁）,术前和术后6个月分别行MRI平扫及静脉钆喷酸葡胺Gd-DTPA增强成像,在增强后的横断面T1加权像中,选取通过股骨内外上髁连线的层面,使用Image J 1.45 S医学图像软件勾画、测量关节腔面积、滑膜面积、滑液面积,临床观测指标包括VAS评分、血沉、Lysholm膝关节功能评分,对上述指标进行配对t检验。[结果]术后6个月时,MRI测量提示膝关节滑膜面积由术前的（1 235.00±251.19）mm2减少至（526.40±445.91）mm2（t=10.72,P〈0.01）,关节腔总面积由术前的（2 132.60±178.20）mm2减少至（1 294.4±664.16）mm2（t=7.41,P〈0.01）,滑液面积尽管较术前减少,但其差异没有统计学意义（t=1.86,P=0.08）;VAS疼痛评分由术前的（5.60±2.21）分减少至（2.20±1.36）（t=9.12,P〈0.01）,血沉由（54±15.59）mm/h降低至（23±6.32）mm/h（t=10.53.12,P〈0.01）,Lysholm评分由（56±8.05）分增加至（88±8.61）分（t=-11.43,P〈0.01）。[结论]关节镜下滑膜切除术能够直接减少关节腔内滑膜量、缓解RA患者的关节和全身症状,基于MRI的滑膜测量为该手术的疗效评估提供了新的手段。
[Objective] Most of the current reports of arthroscopic synovectomy in rheumatoid arthritis（ RA） are based on clinically derived indices or joint changes on radiography. In this study,we assessed the effect of arthroscopic synovectomy by comparing the preoperative and postoperative synovium quantity measured using contrast- enhanced magnetic resonance imaging（ MRI）.[Method]From February 2012 to June2013,20 knees of 20 RA patients were adopted according to the inclusion criteria,including 11 left knees and 9 right knees. All of the patients were women with a mean age of 43. 8 ± 16. 24（ 22- 66） years.Preoperative and 6- month postoperative synovium quantity of the knees was measured by outlining the synovial area in the largest section of gadolinium- DTPA- enhanced 5- mm transverse T1- weighted MR images. The visual analog scale（ VAS）pain score,erythrocyte sedimentation rate（ ESR）,and Lysholm knee scale score were also recorded. All data were evaluated with paired t- tests.[Result]Compared with the preoperative measurements,the synovial area decreased from 1 235. 00 ± 251.19 mm2 to 526. 40 ± 445. 91 mm2（ t =10.72,P 0.01） 6 months postoperatively. The total joint area decreased from 2132.60± 178. 20 mm2 to 1294. 4 ± 664. 16 mm2（ t =7.41,P 0.01）,and the synovial fluid area also decreased from 897.60 ±272.56 mm2 to 768. 00 ± 364. 30 mm2,but the difference was not significant（ t =1.86,P =0.08）. Other follow-up indices also improved： the VAS score decreased from 5. 60 ± 2. 21 to 2. 20 ± 1. 36（ t = 9. 12,P〈0. 01）,ESR decreased from 54 ± 15. 59 mm /h to 23 ± 6. 32 mm /h（ t = 10. 53. 12,P〈0. 01）,and the Lysholm score increased from 56 ± 8. 05 to 88 ± 8. 61（ t =- 11. 43,P〈0. 01）.[Conclusion]Arthroscopic synovectomy can relieve both knee and general symptoms of RA patients. MRI- determined synovium quantification is a new method to evaluate the results of arthroscopic synovectomy.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2014年第18期1651-1656,共6页
Orthopedic Journal of China
基金
上海市卫生局课题资助(课题编号:20114Y139)
