研究目的：明确类风湿关节炎合并肘关节受累的患者，通过关节镜切除滑膜的治疗后，其关节肿痛，关节功能及关节活动度改善情况的长期评估。

研究方法：13例患者包含15个肘关节，其传统DMARDS药物治疗效果不佳，影响学评估其周关节受累情况≤Larsen评分3分，患者经过关节镜滑膜切除手术治疗。分别通过下列评价方式评估患者手术获益情况：总体评估— MEPS)评分量表；疼痛评分—VAS评分；影像学进展；病情活动度—DAS28评分；关节活评价—AOM；并发症。分别于6个月、24个月及30个月评价患者术后上述指标变化情况，通过不同统计学方式，评估患者治疗效果。

结果：试验组患者术后均收获明显的治疗效果，相较于其基线值(VAS 1.28, MEPS 81.07 and mean flexionRAnge 858) (p value <0.001).病情患者术后均未发生明显的并发症发生。

结论：关节镜滑膜切除治疗，对于类风湿周关节受累的患者来讲具有重要的治疗价值。

Effectiveness of arthroscopic elbow synovectomy in rheumatoid arthritis patients: Long-term follow-up of clinical and functional outcomes。

Vivek Shankar a, Pankaj Sharma b,*, Ravi Mittal b, Samarth Mittal b,Uma Kumar c, Shivanand Gamanagatti d

Journal of Clinical Orthopaedics and Trauma xxx (2016) JCOT-259; No. of Pages 6

Objective:To determine the long-term clinical and functional results of arthroscopic elbow synovectomy in rheumatoid arthritis patients with refractory elbow synovitis in terms of improvement in pain, function, and active range of motion (AROM) or arc of motion.

Method: Fifteen rheumatoid elbows in 13 patients, not responding to DMARD therapy and with radiological changes not more than Larsen grade 3 were taken, who underwent arthroscopic elbow synovectomy. The main outcome measured in forms of Mayo Elbow Performance Scale (MEPS) score, measurement of pain using a Visual Analogue Scale (VAS), radiological angles of elbow, disease activity score (DAS-28), arc of motions (AOM) and complications, which were assessed at follow-up periods of 6 months, 24 months, and 30 months. Statistical analysis was done both qualitatively and quantitatively. Mann–Whitney U test, chi-square test, and Student t test were used as the statistical test for determining significance.

Results: In the study group, the improvement was sustained and significant as compared to baseline (VAS 1.28, MEPS 81.07 and mean flexion range 858) (p value <0.001). No significant complications were encountered postoperatively after elbow synovectomy.

Conclusion: The study assesses the long-term results of arthroscopic synovectomy in elbow synovitis secondary to rheumatoid arthritis with significant results favoring arthroscopic synovectomy.