关节镜技术治疗血友病A膝关节滑膜炎Arthroscopic synovectomy in chronic synovitis of the knee in patients with hemophilia A
白正武;朱本珂;张明;闫新峰;王呈;贺业腾;袁振;
摘要(Abstract)：
[目的]总结关节镜技术在血友病A膝关节滑膜炎中的应用,探讨其疗效。[方法]自2002年9月～2007年1月对25例血友病A膝关节滑膜炎患者,行关节镜下滑膜切除,围手术期内适量Ⅷ因子滴注,进行系统康复训练。采用HSS评分标准,对术前、术后结果进行综合评估。根据关节镜下软骨Outerbridge分期分组,按照Insall疗效标准,分别评估各组手术效果。[结果]23例患者得以随访,平均随访时间27个月。术前平均输血次数(23.4±4.6)次/年,术后(9.8±2.5)次/年(P<0.01)。HSS评分术前(58.6±4.7)分,术后(80.5±6.8)分(P<0.01)。OuterbridgeI期术后优良率100%(4/4),II期83.3%(10/12),Ⅳ期优良率差(0/2)。[结论]对于早中期血友病A膝关节滑膜炎,关节镜下滑膜切除是一种安全、有效的治疗方法。
关键词(KeyWords)： 血友病A;慢性滑膜炎;关节镜;滑膜切除;膝关节
基金项目(Foundation):
作者(Author): 白正武;朱本珂;张明;闫新峰;王呈;贺业腾;袁振;
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参考文献(References)：
- [1]Outerbridge RE.Further studies in etiology of chondromalacia of the patella[J].J Bone Joint Surg,1974,4:179.
- [2]蒋协远,王大伟,主编.骨科临床疗效评价标准[M].第1版.北京:人民卫生出版社,2005,171-172.
- [3]Mulder K,Llinas A.The target joint[J].Haemophilia,2004,104:152-156.
- [4]Rodriguez-Merchan EC.Methods to treat chronic haemophilic syno-vitis[J].Haemophilia,2001,7:1-5.
- [5]Ramseier LE,Exner GU.Arthropathy of the knee joint caused by syn-ovial hemangioma[J].J Pediatr Orthop,2004,24:83-86.
- [6]Silva M,Luck JV Jr,Siegel ME.32P chromic phosphate radiosyno-vectomy for chronic haemophilic synovitis[J].Haemophilia,2001,72:40-49.
- [7]陈焯文,冯彦林.硫化铼关节腔注射治疗血友病性滑膜炎疗效观察[J].中华内科杂志,2006,45:409-410.
- [8]徐瑞焱,赵永强,康增寿,等.32磷胶体滑膜切除术治疗慢性血友病滑膜炎[M].血栓与止血学,2003,9:56-57.
- [9]Yoon KH,Bae DK,KimHS,et al.Arthroscopic synovectomy in hae-mophilic arthropathy of the knee[J].Int Orthop,2005,29:296-300.
- [10]Dunn AL,Busch MT,Wyly JB,et al.Arthroscopic synovectomy for hemophilic jiont disease in a pediatric population[J].J Pediatr Or-thop,2004,24:414-426.
- [11]Menart C,Lalain JJ,Lienhart A,et al.Safety and efficacy of three ar-throscopic procedures using Holmium:Yag laser in two high responder haemophiliacs[J].Haemophilia,1999,5:278-281.
- [12]Helm M,Israeli A,Varon D,et al.Expanding portal haemotomata as a complication of knee arthroscopies in persons with haemophilia[J].Haemophilia,1999,5:213-215.
- [13]Wiedel JD.Arthroscopic synovectomy:state of the art[J].Haemo-philia,2002,8:372-374.
- [14]Journeycake JM,Miller KL,Anderson AM,et al.Arthroscopic syno-vectomy in children and adolescents with haemophilia[J].J Pediatr Hematol Oncol,2003,25:726-731.
- [15]Tamurian RM,Spencer EE,Wojtys EM.The role of arthroscopic sy-novectomy in the management of hemarthrosis in haemophilia patients:financial perspectives[J].Arthroscopy,2002,18:789-794.
- [16]吴莹光,李晓光,张凯宁,等.骨科血友病甲患者的围手术期处理[J].中华外科杂志,2004,42:1430-1433.