Mortazavi S M J, Asadollahi S, Farzan M, Shahriaran S, Aghili M, Izadyar S, Lak M
Imam Hospital Haemophilia Centre, Tehran University of Medical Sciences, Department of Orthopaedic Surgery, Iranian Tissue Bank (Research and Preparation Centre), Tehran, Iran.
Haemophilia. 2007 Mar;13(2):182-8. doi: 10.1111/j.1365-2516.2006.01424.x.
Repeated intra-articular bleeding with subsequent development of chronic synovitis and cartilage changes, leading to haemophilic arthropathy, is one the most debilitating problems in haemophilic patients. Radiosynovectomy is a familiar therapeutic choice in management of chronic synovitis in haemophilia. We report the treatments results of synoviorthesis with (32)P chromic phosphate with emphasis on clinical aspects. Between 2002 and 2006 we performed 66 procedures in 53 patients. Seven patients were excluded. The remaining 46 patients were followed for an average of 31 months. The mean age of patients at the time of injection was 15.9 years (range: 6-28). There were three repeat injections. According to Fernandez-pallazi and Cavilgia clinical classification (Table 1) [23], nine joints were Stage II and 46 were Stage III. In latest follow-up, 77% of patients reported at least a 50% decrease in bleeding frequency after treatment (P < 0.0001). The need for antihaemophilic factor consumption dropped by about 74% postradiosynovectomy (P < 0.0001). In most of the injected joints, the range of motion remained stable or improved. A trend was found for the number of haemarthrosis to increase after a period of considerable improvement. Synoviorthesis using (32)P effectively reduces the intra-articular bleeding rate and factor concentrate use. Durability of the response seems to be unpredictable, perhaps attributable to the late intervention. An early radiosynovectomy might be more helpful in terms of stability of response to treatment.
反复关节内出血，随后发展为慢性滑膜炎和软骨改变，进而导致血友病性关节病，是血友病患者最使人衰弱的问题之一。放射性滑膜切除术是血友病慢性滑膜炎治疗中一种常见的治疗选择。我们报告了用磷酸铬（32）P进行滑膜切除术的治疗结果，重点关注临床方面。在2002年至2006年期间，我们对53例患者进行了66次手术。7例患者被排除。其余46例患者平均随访31个月。注射时患者的平均年龄为15.9岁（范围：6 - 28岁）。有3例重复注射。根据费尔南德斯 - 帕拉齐和卡维尔贾临床分类（表1）[23]，9个关节为II期，46个关节为III期。在最近的随访中，77%的患者报告治疗后出血频率至少降低了50%（P < 0.0001）。放射性滑膜切除术后抗血友病因子的消耗需求下降了约74%（P < 0.0001）。在大多数注射的关节中，活动范围保持稳定或有所改善。在经过一段相当程度的改善后，发现关节积血的数量有增加的趋势。使用磷酸铬（32）P进行滑膜切除术可有效降低关节内出血率和因子浓缩物的使用。反应的持久性似乎不可预测，可能归因于干预较晚。就治疗反应的稳定性而言，早期放射性滑膜切除术可能更有帮助。
