Heimkes B, Stotz S
Orthopädische Univ.-Poliklinik Innenstadt, LMU München.
Z Rheumatol. 1992 May-Jun;51(3):132-5.
The aim of this study was to examine the indication for total synovectomy of the hip in juvenile chronic arthritis. For this purpose, five children with six treated hips were followed up. At the time of synovectomy all patients were suffering from therapy resistance and progressive destructive coxitis, as a result of juvenile chronic arthritis. The procedure carried out must, consequently, be regarded as late synovectomy. At the time of the follow-up examination--at least 2 years after the operation--all patients had lasting relief from pain. The range of hip movement could not be improved, despite being accompanied by tenotomies and consistent rehabilitation in the postoperative years. The functional capacity in everyday life also failed to improve. During the post-operative radiographic follow-up the deterioration of the hips proceeded more rapidly than expected for this spontaneous course of treatment. The results lead to the conclusion that the relief of pain due to a late synovectomy of the hip is achieved at the expense of a rapidly progressive destruction of the joints. For this reason, the late synovectomy of the hip in juvenile chronic arthritis should be regarded as the last possibility where resistance to conservative therapy exists.
本研究的目的是探讨青少年慢性关节炎患者行髋关节全滑膜切除术的指征。为此，对5例患儿的6个髋关节进行了随访。行滑膜切除术时，所有患者均因青少年慢性关节炎而出现治疗抵抗和进行性破坏性髋关节炎。因此，所实施的手术应被视为晚期滑膜切除术。在随访检查时（至少在术后2年），所有患者的疼痛均得到持久缓解。尽管术后数年进行了肌腱切断术和持续康复治疗，但髋关节活动范围并未改善。日常生活中的功能能力也未得到改善。在术后影像学随访期间，髋关节的恶化比这种自发治疗过程预期的要快。结果得出结论，晚期髋关节滑膜切除术缓解疼痛是以关节快速进行性破坏为代价的。因此，青少年慢性关节炎患者晚期髋关节滑膜切除术应被视为存在保守治疗抵抗时的最后一种选择。
