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[1]程亞博,楊順.腕關節(jié)鏡下滑膜切除術治療Ⅰ、Ⅱ期類風濕性腕關節(jié)炎的臨床研究[J].中醫(yī)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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腕關節(jié)鏡下滑膜切除術治療Ⅰ、Ⅱ期類風濕性腕關節(jié)炎的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年02期
頁碼:
30-37
欄目:
臨床研究
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:
程亞博; 楊順
(四川省骨科醫(yī)院,四川 成都 610041)
Author(s):
CHENG Yabo; YANG Shun
Sichuan Provincial Orthopedics Hospital,Chengdu 610041,Sichuan,China
關鍵詞:
橈腕關節(jié);  關節(jié)炎; 類風濕;  關節(jié)鏡檢查;  滑膜切除術;  臨床試驗
Keywords:
wrist joint;  arthritis; rheumatoid;  arthroscopy;  synovectomy;  clinical trial
摘要:
目的:探討腕關節(jié)鏡下滑膜切除術治療Ⅰ、Ⅱ期類風濕性腕關節(jié)炎的臨床療效和安全性。方法:回顧性分析116例類風濕性腕關節(jié)炎患者的病例資料,其中采用腕關節(jié)鏡下滑膜切除術聯(lián)合常規(guī)方法(包括口服西藥、電針、中藥外敷、中藥薰蒸)治療58例(手術聯(lián)合治療組),采用常規(guī)方法治療58例(常規(guī)治療組)。比較2組患者的紅細胞沉降率、C反應蛋白血清含量、類風濕因子血清含量、晨僵時間、腕關節(jié)疼痛視覺模擬量表(visual analogue scale,VAS)評分、Cooney腕關節(jié)評分及并發(fā)癥發(fā)生情況。結果:①紅細胞沉降率。時間因素和分組因素存在交互效應(F=32.110,P=0.000); 2組患者的紅細胞沉降率比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=63.231,P=0.000); 治療前后不同時間點紅細胞沉降率的差異有統(tǒng)計學意義,即存在時間效應(F=38.300,P=0.000); 2組患者治療前后紅細胞沉降率均呈下降趨勢,但2組的下降趨勢不完全一致[(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]; 治療前、治療結束后3個月2組患者紅細胞沉降率組間比較,差異無統(tǒng)計學意義(t=0.941,P=0.971; t=0.871,P=0.820); 治療結束后12個月,手術聯(lián)合治療組紅細胞沉降率低于常規(guī)治療組(t=-7.740,P=0.000)。②C反應蛋白血清含量。時間因素和分組因素存在交互效應(F=38.100,P=0.000); 2組患者的C反應蛋白血清含量比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=54.310,P=0.000); 治療前后不同時間點C反應蛋白血清含量的差異有統(tǒng)計學意義,即存在時間效應(F=23.510,P=0.000); 2組患者治療前后C反應蛋白血清含量均呈下降趨勢,但2組的下降趨勢不完全一致[(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]; 治療前、治療結束后3個月2組患者C反應蛋白血清含量組間比較,差異無統(tǒng)計學意義(t=0.620,P=1.930; t=0.961,P=0.571); 治療結束后12個月,手術聯(lián)合治療組C反應蛋白血清含量低于常規(guī)治療組(t=-6.210,P=0.000)。③類風濕因子血清含量。時間因素和分組因素存在交互效應(F=29.110,P=0.000); 2組患者的類風濕因子血清含量比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=56.210,P=0.000); 治療前后不同時間點類風濕因子血清含量的差異有統(tǒng)計學意義,即存在時間效應(F=25.100,P=0.000); 2組患者治療前后類風濕因子血清含量均呈下降趨勢,但2組的下降趨勢不完全一致[(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]; 治療前、治療結束后3個月2組患者類風濕因子血清含量組間比較,差異無統(tǒng)計學意義(t=0.908,P=0.873; t=1.250,P=0.631); 治療結束后12個月,手術聯(lián)合治療組類風濕因子血清含量低于常規(guī)治療組(t=-5.741,P=0.000)。④晨僵時間。時間因素和分組因素存在交互效應(F=58.120,P=0.000); 2組患者的晨僵時間比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=69.320,P=0.000); 治療前后不同時間點晨僵時間的差異有統(tǒng)計學意義,即存在時間效應(F=40.310,P=0.000); 2組患者晨僵時間均呈先減短后增長趨勢,但2組的變化趨勢不完全一致[(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]; 治療前、治療結束后3個月2組患者晨僵時間組間比較,差異無統(tǒng)計學意義(t=0.721,P=1.981; t=0.871,P=1.391); 治療結束后12個月,手術聯(lián)合治療組晨僵時間短于常規(guī)治療組(t=-6.210,P=0.000)。⑤腕關節(jié)疼痛VAS評分。時間因素和分組因素存在交互效應(F=28.120,P=0.000); 2組患者的腕關節(jié)疼痛VAS評分比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=38.730,P=0.000); 治療前后不同時間點腕關節(jié)疼痛VAS評分的差異有統(tǒng)計學意義,即存在時間效應(F=20.230,P=0.000); 手術聯(lián)合治療組腕關節(jié)疼痛VAS評分呈先升高后下降趨勢,常規(guī)治療組腕關節(jié)疼痛VAS評分呈下降趨勢[(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]; 治療前、治療結束后3個月2組患者腕關節(jié)疼痛VAS評分組間比較,差異無統(tǒng)計學意義(t=0.480,P=0.970; t=1.310,P=0.950); 治療結束后12個月,手術聯(lián)合治療組腕關節(jié)疼痛VAS評分低于常規(guī)治療組(t=-4.301,P=0.000)。⑥Cooney腕關節(jié)評分。時間因素和分組因素存在交互效應(F=28.120,P=0.000); 2組患者的Cooney腕關節(jié)評分比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=76.210,P=0.000); 治療前后不同時間點Cooney腕關節(jié)評分的差異有統(tǒng)計學意義,即存在時間效應(F=48.110,P=0.000); 2組患者治療前后Cooney腕關節(jié)評分均呈上升趨勢,但2組的上升趨勢不完全一致[(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]; 治療前、治療結束后3個月2組患者Cooney腕關節(jié)評分組間比較,差異無統(tǒng)計學意義(t=0.700,P=0.920; t=0.860,P=0.061); 治療結束后12個月,手術聯(lián)合治療組Cooney腕關節(jié)評分高于常規(guī)治療組(t=-9.861,P=0.001)。⑦安全性。2組患者均未發(fā)生藥物不良反應,手術聯(lián)合治療組均未出現(xiàn)感染、神經肌腱損傷等并發(fā)癥。結論:腕關節(jié)鏡下滑膜切除術聯(lián)合常規(guī)方法治療類風濕性腕關節(jié)炎,能夠有效抑制機體炎癥反應和免疫反應,緩解疼痛、減少晨僵、改善腕關節(jié)功能,療效優(yōu)于單純的常規(guī)治療,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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備注/Memo

備注/Memo:
基金項目:四川省干部保健科研課題(川干研2015-603)
通訊作者:程亞博 E-mail:[email protected]
更新日期/Last Update: 2021-02-20