[1]程亚博,杨顺.腕关节镜下滑膜切除术治疗Ⅰ、Ⅱ期类风湿性腕关节炎的临床研究[J].中医正骨,2021,33(02):30-37.
　CHENG Yabo,YANG Shun.A clinical study of wrist arthroscopic synovectomy for treatment of phaseⅠandⅡrheumatoid arthritis of wrist[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(02):30-37.
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腕关节镜下滑膜切除术治疗Ⅰ、Ⅱ期类风湿性腕关节炎的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年02期
页码:
30-37
栏目:
临床研究
出版日期:
2021-02-20

文章信息/Info

Title:
A clinical study of wrist arthroscopic synovectomy for treatment of phaseⅠandⅡrheumatoid arthritis of wrist
作者:
程亚博; 杨顺
(四川省骨科医院,四川 成都 610041)
Author(s):
CHENG Yabo; YANG Shun
Sichuan Provincial Orthopedics Hospital,Chengdu 610041,Sichuan,China
关键词:
桡腕关节;  关节炎; 类风湿;  关节镜检查;  滑膜切除术;  临床试验
Keywords:
wrist joint;  arthritis; rheumatoid;  arthroscopy;  synovectomy;  clinical trial
摘要:
目的:探讨腕关节镜下滑膜切除术治疗Ⅰ、Ⅱ期类风湿性腕关节炎的临床疗效和安全性。方法:回顾性分析116例类风湿性腕关节炎患者的病例资料,其中采用腕关节镜下滑膜切除术联合常规方法(包括口服西药、电针、中药外敷、中药薰蒸)治疗58例(手术联合治疗组),采用常规方法治疗58例(常规治疗组)。比较2组患者的红细胞沉降率、C反应蛋白血清含量、类风湿因子血清含量、晨僵时间、腕关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、Cooney腕关节评分及并发症发生情况。结果:①红细胞沉降率。时间因素和分组因素存在交互效应(F=32.110,P=0.000); 2组患者的红细胞沉降率比较,组间差异有统计学意义,即存在分组效应(F=63.231,P=0.000); 治疗前后不同时间点红细胞沉降率的差异有统计学意义,即存在时间效应(F=38.300,P=0.000); 2组患者治疗前后红细胞沉降率均呈下降趋势,但2组的下降趋势不完全一致[(54.80±3.81)mm·h-1,(21.42±1.61)mm·h-1,(20.10±1.91)mm·h-1,F=18.352,P=0.000;(53.60±3.72)mm·h-1,(32.21±2.10)mm·h-1,(30.20±1.71)mm·h-1,F=11.946,P=0.000]; 治疗前、治疗结束后3个月2组患者红细胞沉降率组间比较,差异无统计学意义(t=0.941,P=0.971; t=0.871,P=0.820); 治疗结束后12个月,手术联合治疗组红细胞沉降率低于常规治疗组(t=-7.740,P=0.000)。②C反应蛋白血清含量。时间因素和分组因素存在交互效应(F=38.100,P=0.000); 2组患者的C反应蛋白血清含量比较,组间差异有统计学意义,即存在分组效应(F=54.310,P=0.000); 治疗前后不同时间点C反应蛋白血清含量的差异有统计学意义,即存在时间效应(F=23.510,P=0.000); 2组患者治疗前后C反应蛋白血清含量均呈下降趋势,但2组的下降趋势不完全一致[(36.60±4.23)mg·L-1,(13.22±3.14)mg·L-1,(11.90±3.10)mg·L-1,F=20.352,P=0.000;(34.90±4.31)mg·L-1,(20.31±3.62)mg·L-1,(18.60±2.91)mg·L-1,F=10.206,P=0.000]; 治疗前、治疗结束后3个月2组患者C反应蛋白血清含量组间比较,差异无统计学意义(t=0.620,P=1.930; t=0.961,P=0.571); 治疗结束后12个月,手术联合治疗组C反应蛋白血清含量低于常规治疗组(t=-6.210,P=0.000)。③类风湿因子血清含量。时间因素和分组因素存在交互效应(F=29.110,P=0.000); 2组患者的类风湿因子血清含量比较,组间差异有统计学意义,即存在分组效应(F=56.210,P=0.000); 治疗前后不同时间点类风湿因子血清含量的差异有统计学意义,即存在时间效应(F=25.100,P=0.000); 2组患者治疗前后类风湿因子血清含量均呈下降趋势,但2组的下降趋势不完全一致[(60.10±1.42)U·mL-1,(24.12±8.20)U·mL-1,(22.40±8.71)U·mL-1,F=19.250,P=0.000;(59.30±12.12)U·mL-1,(30.32±1.22)U·mL-1,(28.60±3.71)U·mL-1,F=11.940,P=0.000]; 治疗前、治疗结束后3个月2组患者类风湿因子血清含量组间比较,差异无统计学意义(t=0.908,P=0.873; t=1.250,P=0.631); 治疗结束后12个月,手术联合治疗组类风湿因子血清含量低于常规治疗组(t=-5.741,P=0.000)。④晨僵时间。时间因素和分组因素存在交互效应(F=58.120,P=0.000); 2组患者的晨僵时间比较,组间差异有统计学意义,即存在分组效应(F=69.320,P=0.000); 治疗前后不同时间点晨僵时间的差异有统计学意义,即存在时间效应(F=40.310,P=0.000); 2组患者晨僵时间均呈先减短后增长趋势,但2组的变化趋势不完全一致[(47.60±1.12)min,(2.12±1.30)min,(2.80±0.91)min,F=26.001,P=0.000;(48.20±1.42)min,(3.10±1.12)min,(8.70±1.31)min,F=11.002,P=0.000]; 治疗前、治疗结束后3个月2组患者晨僵时间组间比较,差异无统计学意义(t=0.721,P=1.981; t=0.871,P=1.391); 治疗结束后12个月,手术联合治疗组晨僵时间短于常规治疗组(t=-6.210,P=0.000)。⑤腕关节疼痛VAS评分。时间因素和分组因素存在交互效应(F=28.120,P=0.000); 2组患者的腕关节疼痛VAS评分比较,组间差异有统计学意义,即存在分组效应(F=38.730,P=0.000); 治疗前后不同时间点腕关节疼痛VAS评分的差异有统计学意义,即存在时间效应(F=20.230,P=0.000); 手术联合治疗组腕关节疼痛VAS评分呈先升高后下降趋势,常规治疗组腕关节疼痛VAS评分呈下降趋势[(7.80±1.21)分,(8.22±0.90)分,(1.10±0.81)分,F=18.012,P=0.000;(7.90±1.31)分,(7.10±1.60)分,(2.70±1.10)分,F=12.616,P=0.000]; 治疗前、治疗结束后3个月2组患者腕关节疼痛VAS评分组间比较,差异无统计学意义(t=0.480,P=0.970; t=1.310,P=0.950); 治疗结束后12个月,手术联合治疗组腕关节疼痛VAS评分低于常规治疗组(t=-4.301,P=0.000)。⑥Cooney腕关节评分。时间因素和分组因素存在交互效应(F=28.120,P=0.000); 2组患者的Cooney腕关节评分比较,组间差异有统计学意义,即存在分组效应(F=76.210,P=0.000); 治疗前后不同时间点Cooney腕关节评分的差异有统计学意义,即存在时间效应(F=48.110,P=0.000); 2组患者治疗前后Cooney腕关节评分均呈上升趋势,但2组的上升趋势不完全一致[(47.00±2.42)分,(76.41±3.40)分,(90.10±2.81)分,F=18.012,P=0.000;(45.90±3.52)分,(60.40±2.61)分,(68.30±3.21)分,F=15.901,P=0.000]; 治疗前、治疗结束后3个月2组患者Cooney腕关节评分组间比较,差异无统计学意义(t=0.700,P=0.920; t=0.860,P=0.061); 治疗结束后12个月,手术联合治疗组Cooney腕关节评分高于常规治疗组(t=-9.861,P=0.001)。⑦安全性。2组患者均未发生药物不良反应,手术联合治疗组均未出现感染、神经肌腱损伤等并发症。结论:腕关节镜下滑膜切除术联合常规方法治疗类风湿性腕关节炎,能够有效抑制机体炎症反应和免疫反应,缓解疼痛、减少晨僵、改善腕关节功能,疗效优于单纯的常规治疗,且安全性高。
Abstract:
To explore the clinical curative effects and the safety of wrist arthroscopic synovectomy for treatment of phaseⅠandⅡrheumatoid arthritis(RA)of wrist.Methods:The medical records of 116 patients with RA of wrist were analyzed retrospectively.Fifty-eight patients were treated with wrist arthroscopic synovectomy combined with conventional therapies including oral application of western medicine,electroacupuncture,external application of traditional Chinese drugs and Chinese herbal steaming(combination therapy group),while the others were treated with conventional therapies(conventional therapy group).The erythrocyte sedimentation rate(ESR),serum contents of C-reactive protein(CRP)and rheumatoid factor(RF),morning stiffness(MS)duration,wrist pain visual analogue scale(VAS)scores,Cooney wrist scores and complication incidences were compared between the 2 groups.Results:There was interaction between time factor and group factor in ESR(F=32.110,P=0.000).There was statistical difference in ESR between the 2 groups,in other words,there was group effect(F=63.231,P=0.000).There was statistical difference in ESR between different timepoints before and after the treatment,in other words,there was time effect(F=38.300,P=0.000).The ESR presented a time-dependent decreasing trend in the 2 groups before and after the treatment,while the 2 groups were inconsistent with each other in the variation tendency(54.80±3.81,21.42±1.61,20.10±1.91 mm/h,F=18.352,P=0.000; 53.60±3.72,32.21±2.10,30.20±1.71 mm/h,F=11.946,P=0.000).There was no statistical difference in ESR between the 2 groups before the treatment and at 3 months after the end of the treatment(t=0.941,P=0.971; t=0.871,P=0.820).The ESR was lower in combination therapy group compared to conventional therapy group at 12 months after the end of the treatment(t=-7.740,P=0.000).There was interaction between time factor and group factor in serum content of CRP(F=38.100,P=0.000).There was statistical difference in serum content of CRP between the 2 groups,in other words,there was group effect(F=54.310,P=0.000).There was statistical difference in serum content of CRP between different timepoints before and after the treatment,in other words,there was time effect(F=23.510,P=0.000).The serum content of CRP presented a time-dependent decreasing trend in the 2 groups before and after the treatment,while the 2 groups were inconsistent with each other in the variation tendency(36.60±4.23,13.22±3.14,11.90±3.10 mg/L,F=20.352,P=0.000; 34.90±4.31,20.31±3.62,18.60±2.91 mg/L,F=10.206,P=0.000).There was no statistical difference in serum content of CRP between the 2 groups before the treatment and at 3 months after the end of the treatment(t=0.620,P=1.930; t=0.961,P=0.571).The serum content of CRP was lower in combination therapy group compared to conventional therapy group at 12 months after the end of the treatment(t=-6.210,P=0.000).There was interaction between time factor and group factor in serum content of RF(F=29.110,P=0.000).There was statistical difference in serum content of RF between the 2 groups,in other words,there was group effect(F=56.210,P=0.000).

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备注/Memo

备注/Memo:
基金项目:四川省干部保健科研课题(川干研2015-603)
通讯作者:程亚博 E-mail:282394857@qq.com
更新日期/Last Update: 2021-02-20