Schmidt K, Knorth H, Willburger R E
Abteilung für Rheumaorthopädie, Orthopädische Universitätsklinik, St.Josef Hospital Bochum.
Orthopade. 2002 Dec;31(12):1145-58. doi: 10.1007/s00132-002-0402-1.
With the progression of rheumatoid arthritis (RA),more than half of the patients develop an affliction of the elbow.Cub arthritis has to be regarded as a part of systemic rheumatoid disease. Thus, the indication for operative treatment depends not only on local changes but is determined by the pattern of all affected joints, the activity of the basic rheumatic disease as well as the effect of physical therapy and medication. The complexity of the rheumatic disease, which typically affects many joints, demands an individual therapeutic plan that can only be developed and accomplished successfully when rheumatologists, rheumatoid surgeons and other specialists cooperate. In cases of recurrent cub arthritis,in spite of adequate medication, synoviorthesis or synovectomy should be performed. This may relieve pain and swelling,however if lesions of the cartilage already exist,progressive joint destruction cannot be prevented. Arthroscopic surgery of the elbow provides all of the known advantages of minimal traumatisation. In RA,it is used mainly when there is ligament laxity in late synovectomies eventually combined with arthroscopically assisted resection of caput radii. In contrast to monoarticular diseases in RA,the adjoining bursa olecrani, neighbouring joints and nerve entrapment syndromes also require treatment. The treatment for advanced cub arthritis is arthroplasty. Due to progress in the development of elbow endoprotheses, the range of indications for resection (interposition) arthroplasty has increased. It is now preferred mainly in younger patients with ankylosing arthritis. Rheumatoid changes in the bone and soft tissue impede the implantation of artificial joints and require time consuming and precise preparation techniques. When choosing either an unconstrained or semi-constrained prosthesis,one has to bear in mind the actual ligament stability and its often unpredictable changes during the course of the disease.Perioperative measures, postoperative care and therapy is made even more difficult due to the involvement of several joints, often extensive permanent medication, secondary lesions such as ldquo;corticoid skin" and in most cases the multimorbidity of patients after many years of chronic disease. When comparing elbow surgery in osteoarthritis and RA,we found that patients with RA clearly required more elaborate surgery and more extensive perioperative and postoperative care.
随着类风湿关节炎（RA）病情的发展，超过半数的患者会出现肘部病变。鹰嘴关节炎必须被视为全身性类风湿疾病的一部分。因此，手术治疗的指征不仅取决于局部变化，还由所有受累关节的状况、基础风湿性疾病的活动程度以及物理治疗和药物治疗的效果来决定。风湿性疾病通常会累及多个关节，情况复杂，这就需要一个个体化的治疗方案，而只有风湿病学家、类风湿外科医生和其他专科医生合作，才能成功制定并实施该方案。对于复发性鹰嘴关节炎，尽管药物治疗充分，仍应进行滑膜关节固定术或滑膜切除术。这可能会缓解疼痛和肿胀，然而，如果软骨已经受损，则无法阻止关节的渐进性破坏。肘关节镜手术具有微创的所有已知优势。在类风湿关节炎中，它主要用于晚期滑膜切除术中出现韧带松弛并最终联合关节镜辅助下桡骨头切除术的情况。与类风湿关节炎中的单关节疾病不同，相邻的鹰嘴滑囊、邻近关节和神经卡压综合征也需要治疗。晚期鹰嘴关节炎的治疗方法是关节成形术。由于肘关节假体的发展进步，切除（植入）关节成形术的适应证范围有所增加。目前，它主要适用于年轻的强直性关节炎患者。骨骼和软组织的类风湿性改变会妨碍人工关节的植入，需要耗时且精确的准备技术。在选择无约束或半约束假体时，必须考虑到实际的韧带稳定性及其在疾病过程中往往不可预测的变化。由于多个关节受累、通常需要长期大量用药、继发病变如“皮质激素性皮肤”，以及在大多数情况下患者经过多年慢性病后存在多种合并症，围手术期措施、术后护理和治疗变得更加困难。在比较骨关节炎和类风湿关节炎的肘关节手术时，我们发现类风湿关节炎患者显然需要更复杂的手术以及更广泛的围手术期和术后护理。
