Abstract
摘要
Jointfluidaftertotalkneearthroplasty(TKA)hasvariouscauses,andthespecificcausemustbeidentified.Evenifjointfluidoccursinrheumatoidarthrosis(RA)patientsafterTKA,othercausesstillhavetoberuledout.WedescribefourcasesofjointfluidafterTKAinRApatients,inatotalof34consecutivepatients(50knees),andreviewtheliterature.Whenadefinitivediagnosisortreatmentofjointfluidisdifficult,synovectomybyarthroscopymaybeeffectivebothforthe
diagnosisandtreatment.
全膝关节置换术（TKA）后关节积液有多种病因，但也必须确定其具体病因。类风湿性关节炎（RA）患者TKA之后可能会出现关节积液，但是应排除其他病因。研究了34例（50个膝关节积液）患者，本文呈现了类风湿性关节炎患者全膝关节置换术后关节积液4例，并进行了文献综述。关节积液的确诊和治疗相当困难，关节镜下滑膜切除术或可有助于其诊断和治疗。
Keywords:Jointfluid;Rheumatoidarthrosis;Synovectomy;Totalkneearthroplasty
关键词：关节积液；类风湿性关节炎；滑膜切除术；全膝关节置换术
Introduction
引言
Jointfluidaftertotalkneearthroplasty(TKA)hasvariouscauses,andthespecificcausemustbeidentified.Evenifjointfluidoccursinrheumatoidarthrosis(RA)patientsafterTKA,wehavetodistinguishothercauses,suchasinfection,excludinganincreaseinRAactivity.BecausetherehavebeenonlyafewsystematicreportsofjointfluidafterTKAinRApatients,thecausesandfrequencyhavenotbeenclearlyestablished.WehereindescribefourcasesofjointfluidafterTKAinRApatients,andreviewtheliterature.
全膝关节置换术（TKA）后关节积液有多种病因，但也必须确定其具体病因。类风湿性关节炎患者TKA之后可能会出现关节积液，但也应与其他病因相鉴别，如感染，排除类风湿新关节炎活动性增加。关于类风湿性关节炎患者全膝关节置换术后关节积液仅有少数报道，其病因和发病率尚不明确，本文呈现了类风湿性关节炎患者全膝关节置换术后关节积液4例，并进行了文献综述。
CaseReports
病例报告
Atotalof34consecutivepatients(50knees)withRAreceivingTKAwhovisitedaregionalcenterhospitalinAkita,JapanbetweenAprilandMarchwereinvestigatedinthisstudy.Therewerefourmalesand30females,withameanageatthetimeofsurgeryof67.3years(47-80years).Themeanpostoperativeobservationperiodwas6.6years(3-12years).Inthesepatients,therewerefourpatients(fourknees)withkneejointfluidmorethan1yearaftersurgery.Theagesofthefourpatientsatthetimeofjointfluidrangedfrom52to74years,withameanof67.3years,andallpatientswerefemale.Theperioduptojointfluidonsetaftersurgeryrangedfrom14to63months,withameanof39.5months.
本研究共医院年4月至年3月年间的34位接受TKA的RA患者（共50个膝关节积液），其中男性4例，女性30例，手术时平均年龄67.3岁(47-80岁)，平均术后观察期为6.6年（3-12年）。其中，4例（4个膝关节积液）患者术后1年多出现关节积液，出现关节积液时的年龄范围为52-74岁，平均年龄为67.3岁，均为女性。术后至关节积液发作的时间为14-63个月，平均时长39.5个月。
Case1
A74-year-oldwomanpresentedtoouroutpatientclinicwithjointfluidoftheleftkneewithayearand4-monthhistory.ShehadbeentreatedforRAinanotherhospitalfor34years,andhadreceivedleftTKAsurgeryinourhospital2yearsand6monthsago.Shehadbeenprescribedmethotrexate(MTX)forRAtreatment.Althoughherleftkneeshowedjointfluid,rednessandheartsensationwerenotpresent.Onlaboratoryexaminations,C-reactiveprotein(CRP)andmatrixmetalloproteinase-3(MMP-3)oftheplasmawerehigh(CRP:10.4mg/dL,MMP-3:ng/mL).Enhanced