慢性関節リウマチ膝に対する鏡視下関節包滑膜切除術の成績

抄録

We performed 28 arthroscopic capsulo-synovectomies on 17 patients with rheumatoid knees. The results were assessed using the clinical and subjective criteria of Aritomi and criteria of the Japanese Orthopaedic Association. Nineteen knees were radiographically Larsen grade I, 7 were grade II, and 2 were grade III. Surgical techniques were divided into two steps, as follows. First step: Total synovectomy was perfomed in the posterior capsule with multiportal approach. Second step: Total synovectomy and capsulectomy were perfomed in the anterior capsule. The postoperative follow-up period ranged from 1 year to 4 years, 8 months (mean 2 years, 6 months) . Results were good or excellent in 71.4% of this series. The recurrence rate of synovitis was only 21%. Total score and pain score based on JOA criteria improved after operation and a significant difference was recognized (P<0.01) . Reduction of pain and morbidity continued for 3 years. Range of motion of the knee deteriorated in 5 knees and improved in 20 knees, and remained stationary in 2 knees, except for 1 knee which shifted to TKA. The mean improvement in overall ROM was approximately 13°. Larsen grade advanced 28.6% radiographically after operation. Arthroscopic capsulosynovectomy is comparable to open synovectomy in rate of recurrence and reduction of pain, and is equivalent to conventional arthroscopic synovectomy in range of motion. In conclusion, arthroscopic capsulo-synovectomy is essentially an alternative procedure for treating rheumatoid knees.