研究目的：明確類風濕關節炎合並肘關節受累的患者，通過關節鏡切除滑膜的治療後，其關節腫痛，關節功能及關節活動度改善情況的長期評估。

研究方法：13例患者包含15個肘關節，其傳統DMARDS藥物治療效果不佳，影響學評估其周關節受累情況≤Larsen評分3分，患者經過關節鏡滑膜切除手術治療。分別通過下列評價方式評估患者手術獲益情況：總體評估— MEPS)評分量表；疼痛評分—VAS評分；影像學進展；病情活動度—DAS28評分；關節活評價—AOM；並發症。分別於6個月、24個月及30個月評價患者術後上述指標變化情況，通過不同統計學方式，評估患者治療效果。

結果：試驗組患者術後均收獲明顯的治療效果，相較於其基線值(VAS 1.28, MEPS 81.07 and mean flexion RAnge 858) (p value <0.001).病情患者術後均未發生明顯的並發症發生。

結論：關節鏡滑膜切除治療，對於類風濕周關節受累的患者來講具有重要的治療價值。

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.