Martínez-Esteve A, Álvarez-Pérez R M, Núñez-Vázquez R, Tirado-Hospital J L, García-Jiménez R, Povedano-Gómez J, Borrego-Dorado I
Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España.
Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España.
Rev Esp Med Nucl Imagen Mol. 2016 Jan-Feb;35(1):12-6. doi: 10.1016/j.remn.2015.08.008. Epub 2015 Oct 27.
To assess the outcome and adverse-effects of the radioisotope synoviorthesis in paediatric and adolescent patients with haemophilia.
Prospective study of historical cohort was conducted. A total of 20 consecutive haemophiliacs with a mean age of 13.1 years (range 4-17) were included with a mean follow-up of 64.9 months (range 18-109). The diagnosis of synovitis was established on the basis of clinical follow-up including radiological images (radiography and/or MRI). For evaluation, the classification proposed by Fernandez-Palazzi was used.
Patients aged less than 18 years old with haemophilia and more than one haemarthrosis in less than 3 months remaining a chronic synovitis despite prophylactic therapy intensification.
Any contraindication for radionuclide synoviorthesis. Twenty-seven radioisotope synoviorthesis with (90)Y-citrate-colloid and/or (186)Re-sulphide-colloid were done. The effectiveness of the procedure was assessed through pre and posttreatment clinical comparison at 6 months after radioisotope synoviorthesis.
Nineteen of the 27 synoviorthesis (70.3%) had a good or excellent response and 8 joints (29.7%) had partial response. It was necessary to repeat the procedure in 3 joints in 3 different patients, obtaining in all cases a good or excellent response. We appreciated inflammatory reaction after procedure in 4 cases (14.8%), which improved with analgesics and nonsteroidal anti-inflamatory drugs. None of the patients presented malignant or premalignant lesions during the follow-up.
The radionuclide synoviorthesis is a very effective procedure in paediatric and adolescent patients with hemophilia, being a minimally invasive procedure, easy to perform, safe and with minimal side effects.
评估放射性核素滑膜切除术在小儿及青少年血友病患者中的治疗效果及不良反应。
进行前瞻性历史队列研究。共纳入20例连续的血友病患者，平均年龄13.1岁（4 - 17岁），平均随访64.9个月（18 - 109个月）。根据包括影像学图像（X线摄影和/或磁共振成像）在内的临床随访结果确诊滑膜炎。评估采用费尔南德斯 - 帕拉齐提出的分类方法。
年龄小于18岁的血友病患者，在3个月内发生不止一次关节积血，尽管强化了预防性治疗仍存在慢性滑膜炎。
放射性核素滑膜切除术的任何禁忌症。采用（90）Y - 柠檬酸盐胶体和/或（186）Re - 硫化物胶体进行了27次放射性核素滑膜切除术。通过放射性核素滑膜切除术后6个月的治疗前后临床比较评估该手术的有效性。
27次滑膜切除术中19次（70.3%）反应良好或极佳，8个关节（29.7%）部分反应良好。3例不同患者的3个关节需要重复手术，所有病例均获得良好或极佳反应。术后有4例（14.8%）出现炎症反应，使用镇痛药和非甾体抗炎药后有所改善。随访期间所有患者均未出现恶性或癌前病变。
放射性核素滑膜切除术在小儿及青少年血友病患者中是一种非常有效的手术，具有微创、操作简便、安全且副作用极小的特点。
