| Objective:To compare the clinical efficacy of arthroscopic synovectomy combined with intra-articular radiotherapy with simple arthroscopic synovectomy for the patients with rheumatoid arthritis,summarize the effective control method which can reduce recurrence of rheumatoid arthritis effectively.Methods:A retrospective analysis was performed on 46 patients in 51 knees with rheumatoid arthritis of knee joint who were admitted to the Qianfoshan Hospital Affiliated to Shandong University from June 2011 to June 2014.26 patients in 30 knees underwent arthroscopic synovectomy,called the simple operation group,including 14 males and 12 females.with a mean age of(49.2± 12.36)years;20 patients in 21 knees underwent arthroscopic synovectomy combined with postoperative intra-articular radiotherapy,called the combined operation group,including 5 cases of male and 15 cases of female,age(45.3± 16.38)years old.All patients were evaluated with the Lysholm score before operation.The pain,swelling,activity and recurrence of the knee joint were observed and followed up for half a year,1 year and 2 years after operation,and the Lysholm score was evaluated meanwhile.The prognosis and the therapeutic effects of the the two treatment methods were evaluated by comparing the Lysholm scores.Results:All patients were followed up for an average of(41.8 ± 10.16)months.There was no significant difference between the two groups in gender,age,Larsen stage and course of disease.The Lysholm score of the simple operation group was(39.9± 7.218)points before surgery,(67.5 ±.4.703)points half a year after operation,(59.6 ± 8.724)points after surgery for a period of 1 year,(50.6 ± 8.319)points after surgery for 2 years.The Lysholm score of the combined operation group was(38.8 ± 7.035)points before surgery,(66.2 ± 6.524)points half a year after operation,(58.2± 8.994)points after surgery for a period of 1 year,(49.9±3.576)points after surgery for 2 years.The Lysholm scores of the two groups of patients were both significantly improved after surgery for half a year,1 year and 2 years compared with the score of preoperation,and the differences were statistically significant(the simple operation group:t=17.548,P<0.01;t=9.530,P<0.01;t=5.321,P<0.01 and the combined operation group:t=13.101,P<0.01;t=7.8]6;P<0.01;t=6.470.P<0.010).The Lysholm scores of preoperative,postoperative half a year,postoperative 1 year and postoperative 2 years were compared between the two groups,the results were not statistically significant(P>0.05).The Lysholm scores were compared respectively between half a year after surgery and 1 year after surgery,1 year after surgery and 2 years after surgery in the simple operation group,the difference was statistically significant(t=4.366,P<0.01;t=4.089,P<0.01).And the Lysholm scores were compared respectively between half a year after surgery and 1 year after surgery,1 year after surgery and 2 years after surgery in the combined operation group,the difference was statistically significant(t=3.280,P<0.01;t=3.946,P<0.01).Among the 30 cases in the simple operation group,7 cases suffered recurrence after surgery for half a year,9 cases suffered recurrence after surgery for 1 year,13 cases suffered recurrence after surgery for 2 years,and the recurrence rates were 23.3%.30.0%and 43.3%,respectively.Among the 21 cases in the combined operation group,no cases suffered recurrence after surgery for half a year,3 cases suffered recurrence after surgery for 1 year,5 cases suffered recurrence after surgery for 2 years,and the recurrence rates were 0、14.3%and 23.8%,respectively.The recurrence rate of the simple operation group was higher than that of the combined group at half a year after operation,and the difference was statistically significant(χ2=3.880,P<0.050).However,compared the recurrence rate between 1 year and 2 years after operation,there was no statistically significant difference(χ2=0.934,P>0,05;χ2=3.710,P>0.05).Conclusion:Both simple arthroscopic synovectomy and arthroscopic synovectomy combined with postoperative intra-articular radiotherapy can effectively improve the knee function in patients with rheumatoid arthritis,and there was no significant difference,moreover,the function of knee joint was worse in the middle stage than that in the early stage.Compared with the former therapeutic method,the latter one can significantly reduce the recurrence rate,while the median recurrence rate is similar. |
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