Alderman Amy K, Chung Kevin C, Kim H Myra, Fox David A, Ubel Peter A
Robert Wood Johnson Clinical Scholars Program, Ann Arbor, MI, USA.
J Hand Surg Am. 2003 Jan;28(1):3-11; discussion 12-3. doi: 10.1053/jhsu.2003.50034.
Surgical management of rheumatoid hand diseases is controversial with large variation in practice pattern in the U.S. The purpose of this study is to evaluate the attitudes of hand surgeons and rheumatologists toward the effectiveness of rheumatoid hand surgery.
We designed a survey instrument to examine physicians' opinions about the effectiveness of different surgical treatments for rheumatoid hand deformities. The self-administered survey was mailed to a national random sample of 500 members of the American Society for Surgery of the Hand and 500 members of the American College of Rheumatology.
Of survey responders, 82.5% of hand surgeons versus 34.1% of rheumatologists believe metacarpophalangeal joint arthroplasty improves hand function; 93.2% and 54.6%, respectively, believe prophylactic extensor tenosynovectomy prevents tendon rupture; and 52.5% and 12.6%, respectively, believe small joint synovectomy delays joint destruction.
Rheumatologists view rheumatoid hand surgery as significantly less effective than do hand surgeons, which highlights the disagreements between the 2 specialties about the management of this clinical problem.
在美国，类风湿性手部疾病的外科治疗存在争议，实际治疗模式差异很大。本研究的目的是评估手外科医生和风湿病学家对类风湿性手部手术有效性的态度。
我们设计了一份调查问卷，以了解医生对类风湿性手部畸形不同手术治疗效果的看法。这份自行填写的调查问卷被邮寄给美国手外科学会的500名成员和美国风湿病学会的500名成员组成的全国随机样本。
在调查回复者中，82.5%的手外科医生认为掌指关节置换术可改善手部功能，而风湿病学家中这一比例为34.1%；分别有93.2%和54.6%的人认为预防性伸肌腱滑膜切除术可预防肌腱断裂；分别有52.5%和12.6%的人认为小关节滑膜切除术可延缓关节破坏。
风湿病学家认为类风湿性手部手术的有效性明显低于手外科医生，这凸显了这两个专业在该临床问题管理上的分歧。
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