Siemon B, Schubert T, Grifka J, Borisch N
Orthopädische Klinik der Universität Regensburg im Bayerischen Rheuma- und Orthopädie-Zentrum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany.
Z Rheumatol. 2004 Jun;63(3):230-4. doi: 10.1007/s00393-004-0564-9.
Silicone synovitis is an important clinical entity recognized in rheumatoid patients after arthroplasties with silicone implants. It is a foreign body reaction to particulate material (silicone elastomer) characterized clinically by the re-occurrence of pain, stiffness and swelling at the site of arthroplasty after initial relief of symptoms. Whereas silicone synovitis is a rare complication in metacarpophalangeal implants, it is an important one in the wrist implant. Long-term follow-up studies have revealed that the rates of fracture and subsidence are high and that the implants deteriorate with time necessitating operative revisions in up to 50% of cases. Indications should therefore be restricted to a painful wrist in the elderly, very low demand patient with insufficient bone stock to permit total wrist arthroplasty with a metal-on-plastic design. Severe preoperative deformity and the need for use of ambulatory aids may further limit the indication. The unusual case of direct perforation of silicone particles from the wrist into the tendon sheath of the M. flexor pollicis longus inducing a tumor-like synovitis and a secondary carpal tunnel syndrome is presented. The importance of silicone synovitis and the indication at present for implantation of a silicone wrist spacer in the rheumatoid patient are discussed.
硅胶滑膜炎是类风湿患者在接受硅胶植入关节成形术后被认识到的一种重要临床病症。它是对颗粒物质（硅橡胶弹性体）的异物反应，临床特征为在症状初步缓解后，关节成形术部位再次出现疼痛、僵硬和肿胀。虽然硅胶滑膜炎在掌指关节植入物中是一种罕见并发症，但在腕关节植入物中却是重要的一种。长期随访研究表明，骨折和下沉发生率很高，且植入物会随时间恶化，高达50%的病例需要进行手术翻修。因此，适应症应限于老年、需求极低、骨量不足无法进行金属对塑料设计的全腕关节成形术的疼痛性腕关节患者。严重的术前畸形以及使用助行器的需求可能会进一步限制适应症。本文介绍了硅胶颗粒从腕关节直接穿入拇长屈肌腱鞘导致肿瘤样滑膜炎和继发性腕管综合征这一罕见病例。讨论了硅胶滑膜炎的重要性以及目前类风湿患者植入硅胶腕关节间隔器的适应症。
