Takenaka R, Fukatsu A, Matsuo S, Ishikawa K, Toriyama T, Kawahara H
Nagoya Kyoritsu Hospital, Japan.
Clin Nephrol. 1992 Oct;38(4):224-30.
Thirteen patients with hemodialysis-related shoulder arthropathy were treated either with arthroscopic synovectomy or with open surgery. Arthroscopic synovectomy was performed in eight patients who had shoulder pain, shoulder immobility or both but did not have cystic bone lesions. The therapy was effective for pain relief and improvement of shoulder function for six months but in 12 months the shoulder pain reappeared in most of the patients. Open surgery was done in 5 patients who, in addition to shoulder pain and immobility, had humeral head bone cysts. Resection of the deposited mass on the biceps tendon sheath, of hypertrophied synovium and bursa as well as curettage of cysts and calcium hydroxyapatite ceramic implantation were performed. The therapy was effective for pain relief throughout the follow-up period (12 months). No adverse effects were noted for either procedure. Resected specimens of the synovia contained amyloid as indicated by a positive Congo-red stain by light microscopy and the presence of amyloid fibrils by electron microscopy. Deposition of amyloid in the biceps tendon sheath, synovium and bursa and invasion of the humeral head by amyloid were observed upon open surgery. The results suggest that the resection of deposited material induces the improvement of the shoulder arthropathy.
13例血液透析相关性肩关节病患者接受了关节镜下滑膜切除术或开放手术治疗。8例有肩部疼痛、肩部活动受限或两者皆有的患者接受了关节镜下滑膜切除术，这些患者没有囊性骨病变。该治疗方法在6个月内对缓解疼痛和改善肩部功能有效，但在12个月时，大多数患者的肩部疼痛再次出现。5例除肩部疼痛和活动受限外还伴有肱骨头骨囊肿的患者接受了开放手术。手术切除了肱二头肌腱鞘上的沉积肿物、肥厚的滑膜和滑囊，并刮除囊肿，植入羟基磷灰石陶瓷。在整个随访期（12个月）内，该治疗方法对缓解疼痛有效。两种手术均未观察到不良反应。滑膜切除标本经光学显微镜刚果红染色阳性及电子显微镜观察到淀粉样纤维，提示滑膜中含有淀粉样物质。开放手术时观察到肱二头肌腱鞘、滑膜和滑囊中淀粉样物质沉积以及淀粉样物质侵入肱骨头。结果表明，切除沉积物质可改善肩关节病。
