Mäenpää Heikki M, Kuusela Pekko P, Kaarela Kalevi, Kautiainen Hannu J, Lehtinen Janne T, Belt Eero A
Department of Orthopaedics, Rheumatism Foundation Hospital, Heinola, Finland.
J Shoulder Elbow Surg. 2003 Sep-Oct;12(5):480-3. doi: 10.1016/s1058-2746(03)00167-8.
The purpose of this study was to evaluate the reoperation rate of elbow synovectomy in patients with rheumatoid arthritis. A total of 103 synovectomies were performed in 88 patients (61 women) with rheumatoid factor-positive rheumatoid arthritis with a mean follow-up of 5.2 years (range, 1-8 years). The survival rate after elbow synovectomy (free from reoperation) was 77% (95% confidence interval, 66%-85%) at 5 years. Eight resynovectomies and fourteen total elbow replacements were performed during the follow-up. No significant improvement in range of motion was detected after synovectomy, but pain relief and patient satisfaction were favorable. Elbows were classified preoperatively (before primary synovectomy) with the Larsen system. All resynovectomies were performed for elbows of grade 0-2 destruction. A significant difference was found between early (Larsen grade 0-2) and late (Larsen grade 3) synovectomies in relation to elbow replacement (P =.002) during the follow-up. Late synovectomy yielded more temporary pain relief with a high rate of elbow arthroplasties.
本研究的目的是评估类风湿性关节炎患者肘关节滑膜切除术的再次手术率。对88例（61例女性）类风湿因子阳性的类风湿性关节炎患者共进行了103次滑膜切除术，平均随访5.2年（范围1 - 8年）。肘关节滑膜切除术后（无需再次手术）5年的生存率为77%（95%置信区间，66% - 85%）。随访期间进行了8次再次滑膜切除术和14次全肘关节置换术。滑膜切除术后未发现活动范围有显著改善，但疼痛缓解和患者满意度良好。术前（初次滑膜切除术之前）用拉森系统对肘关节进行分类。所有再次滑膜切除术均针对0 - 2级破坏的肘关节进行。随访期间，早期（拉森0 - 2级）和晚期（拉森3级）滑膜切除术在肘关节置换方面存在显著差异（P = 0.002）。晚期滑膜切除术能带来更多的短期疼痛缓解，但肘关节成形术的发生率较高。
