Schill S, Biehl C, Thabe H
Orthopädische Universitätsklinik Regensburg, BRK Rheumazentrum, Bad Abbach, Germany.
Orthopade. 2003 Aug;32(8):723-9. doi: 10.1007/s00132-003-0513-3.
We present a comparative study of 120 elbow synovectomies with and without radial head resection performed between 1985 and 1993. Minimal radiological destruction according to Larsen stage 1-2 was present in 38 joints; 28 patients were followed postoperatively for an average period of 8.2 years. Synovectomy was combined with radial head resection in 70 patients (82 joints) where rheumatoid arthritis had radiologically proceeded to Larsen stage 3-4. Fifty patients were available for clinical and radiological follow-up. The follow-up period ranged from 6 to 15 years (average: 9.3 years). All patients in both groups were suffering from rheumatoid arthritis, and the proportion of females dominated. The mean age at the time of operation was 50 and 56 years, respectively. The results according to Inglis and Pellicci (16) were graded as good and excellent in 63.3% (19 joints) after elbow synovectomy. An average postoperative score result of 80.7 points (range: 43-96 points) was obtained. Synovectomy and radial head resection achieved comparable score results (75.7 points), representing 59.4% (35 joints) good and excellent ratings. Complete pain relief was obtained in 51.5%, and 27.1% complained of slight pain after elbow synovectomy. Of the patients who underwent radial head excision, 45.8% were pain free and 27.1% experienced slight pain. The range of motion of combined extension and flexion averaged 113 degrees and 110 degrees, respectively. A comparable improvement concerning pro/supination was maintained at final follow-up with an average gain of 20.4 degrees after synovectomy and 25.3 degrees for the latter group. We routinely noticed a moderate radiographic progression in both groups according to the criteria of the Larsen classification. The radiographic deterioration did not correlate with the clinical outcome. Synovectomy of the rheumatoid elbow is a valuable procedure in early as well as late stages of the disease. Our long-term results after synovectomy of the elbow prove significant pain relief and restoration of elbow function. The radiographic assessment revealed a moderate radiological deterioration. From the clinical viewpoint, the elbow function is maintained for a long time and valuable time is gained before reconstructive surgery may become necessary.
我们对1985年至1993年间进行的120例有或无桡骨头切除术的肘关节滑膜切除术进行了一项对比研究。根据Larsen分期1 - 2期，38个关节存在最小程度的放射学破坏；28例患者术后平均随访8.2年。70例患者（82个关节）因类风湿关节炎在放射学上进展至Larsen 3 - 4期，滑膜切除术联合桡骨头切除术。50例患者可进行临床和放射学随访。随访期为6至15年（平均：9.3年）。两组所有患者均患有类风湿关节炎，女性占主导比例。手术时的平均年龄分别为50岁和56岁。根据Inglis和Pellicci（16）的标准，肘关节滑膜切除术后63.3%（19个关节）的结果评为良好和优秀。术后平均评分为80.7分（范围：43 - 96分）。滑膜切除术和桡骨头切除术取得了相当的评分结果（75.7分），其中59.4%（35个关节）评为良好和优秀。肘关节滑膜切除术后51.5%的患者疼痛完全缓解，27.1%的患者主诉轻微疼痛。在接受桡骨头切除术的患者中，45.8%无疼痛，27.1%有轻微疼痛。伸屈联合活动范围平均分别为113度和110度。在最终随访时，旋前/旋后有类似改善，滑膜切除术后平均增加20.4度，后一组增加25.3度。根据Larsen分类标准，我们在两组中均常规观察到中度的放射学进展。放射学恶化与临床结果无关。类风湿性肘关节滑膜切除术在疾病的早期和晚期都是一种有价值的手术。我们肘关节滑膜切除术后的长期结果证明疼痛得到了显著缓解，肘关节功能得以恢复。放射学评估显示有中度的放射学恶化。从临床角度来看，肘关节功能可长期维持，在可能需要进行重建手术之前赢得了宝贵的时间。
