中国医药
中國醫藥
중국의약
CHINA MEDICINE
2015年
1期
106-110
,共5页
晋松%郑红梅%林俊%马莎%李芹
晉鬆%鄭紅梅%林俊%馬莎%李芹
진송%정홍매%림준%마사%리근
类风湿关节炎%膝关节%关节镜%抗类风湿药
類風濕關節炎%膝關節%關節鏡%抗類風濕藥
류풍습관절염%슬관절%관절경%항류풍습약
Rheumatoid arthritis%Knee joint%Arthroscopic synovectomy%Antirheumatoid drug
目的 探讨关节镜下膝关节滑膜切除术联合抗类风湿药治疗类风湿关节炎(RA)的疗效.方法 选择膝关节损伤的RA患者143例,根据患者关节损伤程度及关节功能将其分为对照组(74例)和联合治疗组(69例).对照组仅给予常规的抗类风湿药甲氨蝶呤7.5 mg/周,顿服,来氟米特20 mg 1次/d口服治疗;联合治疗组69例共73个关节,依据1987年美国风湿病学学会RA分类标准,将患者依X线检查分成3期,其中一期17例患者共17个关节,二期38例患者共41个关节,三期14例患者共15个关节,除给予常规的抗类风湿药治疗外,行关节镜下膝关节滑膜切除术治疗.2组患者于术后第6、12个月进行随访,行关节功能评估及膝关节磁共振成像(MRI)检查,随访内容包括健康评估问卷(HAQ)评分和关节炎影响测量量表(AIMS)评分,关节功能评价采用Ishikawa疗效评分,MRI检查膝关节软骨损伤采用Recht标准评分.结果 联合治疗组患者治疗后6、12个月的HAQ评分和AIMS评分均明显低于对照组,差异有统计学意义[治疗后6个月:HAQ评分(7±6)分比(13±11)分,AIMS评分(10±5)分比(18±10)分;治疗后12个月:HAQ评分(6±5)分比(14±11)分,AIMS评分(8±6)分比(18±10)分,P＜0.05].治疗后6、12个月联合治疗组Recht标准评分明显低于对照组,差异有统计学意义[治疗后6个月:(2.8±0.7)分比(3.4±0.8)分;治疗后12个月:(2.7±0.6)分比(3.5±0.9)分,P＜0.05].联合治疗组患者于术后6、12个月进行膝关节功能Ishikawa疗效评分比较,结果显示一、二期患者关节功能优良率均明显高于三期患者,差异均有统计学意义[治疗后6个月:100.0％ (17/17)、90.2％ (37/41)比80.0％ (12/15);治疗后12个月:94.1％ (16/17)、92.4％(38/41)比73.3％(11/15),均P＜0.05].结论 对RA患者进行关节镜下膝关节滑膜切除术可明显延缓关节软骨的破坏,较单独使用抗类风湿药效果更好,且与X线分期有关,一、二期患者疗效优于三期,同时可改善关节功能,提高生活质量.
目的 探討關節鏡下膝關節滑膜切除術聯閤抗類風濕藥治療類風濕關節炎(RA)的療效.方法 選擇膝關節損傷的RA患者143例,根據患者關節損傷程度及關節功能將其分為對照組(74例)和聯閤治療組(69例).對照組僅給予常規的抗類風濕藥甲氨蝶呤7.5 mg/週,頓服,來氟米特20 mg 1次/d口服治療;聯閤治療組69例共73箇關節,依據1987年美國風濕病學學會RA分類標準,將患者依X線檢查分成3期,其中一期17例患者共17箇關節,二期38例患者共41箇關節,三期14例患者共15箇關節,除給予常規的抗類風濕藥治療外,行關節鏡下膝關節滑膜切除術治療.2組患者于術後第6、12箇月進行隨訪,行關節功能評估及膝關節磁共振成像(MRI)檢查,隨訪內容包括健康評估問捲(HAQ)評分和關節炎影響測量量錶(AIMS)評分,關節功能評價採用Ishikawa療效評分,MRI檢查膝關節軟骨損傷採用Recht標準評分.結果 聯閤治療組患者治療後6、12箇月的HAQ評分和AIMS評分均明顯低于對照組,差異有統計學意義[治療後6箇月:HAQ評分(7±6)分比(13±11)分,AIMS評分(10±5)分比(18±10)分;治療後12箇月:HAQ評分(6±5)分比(14±11)分,AIMS評分(8±6)分比(18±10)分,P＜0.05].治療後6、12箇月聯閤治療組Recht標準評分明顯低于對照組,差異有統計學意義[治療後6箇月:(2.8±0.7)分比(3.4±0.8)分;治療後12箇月:(2.7±0.6)分比(3.5±0.9)分,P＜0.05].聯閤治療組患者于術後6、12箇月進行膝關節功能Ishikawa療效評分比較,結果顯示一、二期患者關節功能優良率均明顯高于三期患者,差異均有統計學意義[治療後6箇月:100.0％ (17/17)、90.2％ (37/41)比80.0％ (12/15);治療後12箇月:94.1％ (16/17)、92.4％(38/41)比73.3％(11/15),均P＜0.05].結論 對RA患者進行關節鏡下膝關節滑膜切除術可明顯延緩關節軟骨的破壞,較單獨使用抗類風濕藥效果更好,且與X線分期有關,一、二期患者療效優于三期,同時可改善關節功能,提高生活質量.
목적 탐토관절경하슬관절활막절제술연합항류풍습약치료류풍습관절염(RA)적료효.방법 선택슬관절손상적RA환자143례,근거환자관절손상정도급관절공능장기분위대조조(74례)화연합치료조(69례).대조조부급여상규적항류풍습약갑안접령7.5 mg/주,돈복,래불미특20 mg 1차/d구복치료;연합치료조69례공73개관절,의거1987년미국풍습병학학회RA분류표준,장환자의X선검사분성3기,기중일기17례환자공17개관절,이기38례환자공41개관절,삼기14례환자공15개관절,제급여상규적항류풍습약치료외,행관절경하슬관절활막절제술치료.2조환자우술후제6、12개월진행수방,행관절공능평고급슬관절자공진성상(MRI)검사,수방내용포괄건강평고문권(HAQ)평분화관절염영향측량량표(AIMS)평분,관절공능평개채용Ishikawa료효평분,MRI검사슬관절연골손상채용Recht표준평분.결과 연합치료조환자치료후6、12개월적HAQ평분화AIMS평분균명현저우대조조,차이유통계학의의[치료후6개월:HAQ평분(7±6)분비(13±11)분,AIMS평분(10±5)분비(18±10)분;치료후12개월:HAQ평분(6±5)분비(14±11)분,AIMS평분(8±6)분비(18±10)분,P＜0.05].치료후6、12개월연합치료조Recht표준평분명현저우대조조,차이유통계학의의[치료후6개월:(2.8±0.7)분비(3.4±0.8)분;치료후12개월:(2.7±0.6)분비(3.5±0.9)분,P＜0.05].연합치료조환자우술후6、12개월진행슬관절공능Ishikawa료효평분비교,결과현시일、이기환자관절공능우량솔균명현고우삼기환자,차이균유통계학의의[치료후6개월:100.0％ (17/17)、90.2％ (37/41)비80.0％ (12/15);치료후12개월:94.1％ (16/17)、92.4％(38/41)비73.3％(11/15),균P＜0.05].결론 대RA환자진행관절경하슬관절활막절제술가명현연완관절연골적파배,교단독사용항류풍습약효과경호,차여X선분기유관,일、이기환자료효우우삼기,동시가개선관절공능,제고생활질량.
Objective To investigate the effect of arthroscopic synovectomy treating rheumatoid arthritis of knee joint cartilage.Methods One hundred and fourty three patients were divided into two groups:the control group (74 cases) and the treatment group (69 cases).The control group was only given conventional antirheumatoid drug therapy; treatment group (69 cases) were given surgical therapy for knee joint synovium resection under arthroscopy.Health assessment survey questions (HAQ scores),arthritis affecting measurement scale (AIMS scores),Joint function Ishikawa efficacy score and MRI of the knee joint cartilage injury Recht standard score were analyzed.Results The HAQ and AIMS scores of the treatment group after treatment of 6,12 months were significantly lower than those of the control group[after 6 months of treatment:HAQ scores (7 ± 6) vs (13 ± 11),AIMS scores(10 ±5) vs (18 ± 10) ;after 12 months of treatment:HAQ scores (6 ±5) vs (14 ± 11),AIMS scores (8 ± 6) vs (18 ± 10),P ＜ 0.05] ; the difference was statistically significant.The Recht scores of the treatment group after 6,12 months of treatment were significantly lower than those in the control group,the difference had statistical significance[after 6 months of treatment:(2.8 ± 0.7) vs (3.4 ± 0.8) ; after 12 months of treatment:(2.7 ± 0.6) vs (3.5 ± 0.9),P ＜ 0.05].The patients in the treatment group were evaluated by knee function after treatment of 6,12 months,the results showed that the excellent and good rate of first and second stage patients were significantly higher than those of the third stage patients,the difference had statistical significance [after treatment of 6 months:100.0％ (17/17),90.2％ (37/41) vs 80.0％ (12/15) ;after treatment of 12 months:94.1％ (16/17),92.4％(38/41) vs 73.3％ (11/15),P＜0.05].Conclusion The effect of arthroscopic synovectomy treating rheumatoid arthritis of knee joint cartilage is optimistic,it can significantly retard the destruction of articular cartilage,improve the function of joint and the quality of life.
