摘要
目的探讨应用膝关节镜滑膜切除术诊断及治疗早期类风湿关节炎(RA)的临床效果。方法选取我院于2015年7月至2017年7月收治的60例具有明确关节炎表现的患者,入选患者年龄均>16岁并且病程<1年,所有入选患者均行膝关节镜滑膜切除术,根据患者术后的滑膜形态改变和病理、生化免疫学检查以及影像学磁共振成像(MRI)检查等对RA进行明确诊断。分别在患者术后3个月和术后1年时进行随访,比较患者治疗前后的C反应蛋白(CRP)和红细胞沉降率(ESR)以及Lysholm评分和健康问卷评分(HAQ)。结果早期RA分类标准对于RA诊断的特异性为91%(21/23)、敏感度为81%(30/37)。在37例RA患者中,20例慢性滑膜炎,17例病变滑膜组织病理切片经苏木精-伊红(HE)染色结果诊断为RA。2组患者在术后3个月和术后1年时的HAQ评分、Lysholm评分、CRP水平、ESR等指标均优于术前(均P<0.05);RA组患者在术后1年时的HAQ评分、Lysholm评分、CRP水平、ESR等指标均优于本组术后3个月(均P<0.05)。结论早期RA分类标准具有简便和实用的优势,有助于临床上RA的早期诊断;在明确诊断RA后在早期及时应用膝关节镜滑膜切除术能够显著改善患者的生活质量和全身健康状况,大大缓解了患者的患膝症状。
Objective To analyze the clinical effect of arthroscopic synovectomy in the diagnosis and treatment of early rheumatoid arthritis(RA). Methods Select our hospital from July 2015 to July 2017 admitted during the period of 60 cases with specific arthritis patients,selected patients were greater than 16 years old and course of the disease under 1 year,all the patients were taken the arthroscopic synovectomy,according to the postoperative patients with synovial mor-phological changes and pathological, biochemical, immunological examination and magnetic resonance imaging(MRI) diagnosis of RA. Patients were followed up at 3 months after surgery and 1 year after surgery,and Creactive pro-tein(CRP) and erythrocyte sedimentation rate(ESR),as well as Lysholm and HAQ scores were compared before and after treatment. Results The specificity of early RA classification criteria was 91%(21/23)and the sensitivity was 81%(30/37). Of the 37 patients with RA,20 reported chronic synovitis,and 17 had pathological sections of synovial tissue that showed synovial hyperplasia,large numbers of lymphocytes,and monocyte infiltration by HE staining. Synovial cell edema,hyperemia,necrosis and erosion of superficial synovial cells,as well as fibrous sediment,were included in60 patients with RA. Three months after operation and 1 year after operation,the scores of Lysholm score,CRP and ESR were significantly higher than those before operation(all P<0.05). The scores of Lysholm score,CRP and ESR in RA group at 1 year after operation were significantly better than those in 3 months after operation(all P<0.05). There was no significant difference in Lysholm score,CRP level and ESR between patients with non-RA and 3 months after operation(all P>0.05). Conclusion The classification standard of early RA is simple and practical,which is helpful to the early diagnosis of RA. The early and timely application of arthroscopic synovectomy after the definite diagnosis of RA can significantly improve the patient′ s quality of life and general health,and greatly alleviate the knee symptoms of the patient.
作者
樊春亮
刘永红
郭爱
张学龙
Fan Chunliang;Liu Yonghong;Guo Ai;Zhang Xuelong(Department of Orthopedics,Shanxi Hospital of Integrated Traditional Chinese and Western Medicine,Taiyuan 030013,China)
出处
《实用医技杂志》
2019年第9期1097-1099,共3页
Journal of Practical Medical Techniques
关键词
关节炎
类风湿
关节镜检查
诊断
治疗效果
Arthritis rheumatoid
Arthroscopy
Diagnosis
Treatment outcome
