Trieb Klemens
Klinikum Wels-Grieskirchen, Head of the Orthopaedic Department, Medical Director, Grieskirchnerstr. 42, 4600 Wels,. Australia.
Curr Rheumatol Rev. 2017;13(1):2-4. doi: 10.2174/1573397112666160709030706.
The treatment of metacarpophalangeal destruction by rheumatoid arthritis is an indication for arthroplasty, the swanson spacer is one of the options. The flexible silicone spacer may be implanted with or without titanium guide sleeves ("grommets"). However, the imaginary abrasion protection for the silicone grommets may in turn lead through micro-movements to wear. A 69 years old female patient suffering from rheumatoid arthritis for 30 years is presented. 12 years ago swansen spacers were implanted to metacarpo-phalangeal joints 2 -5 of the right hand. Due to pain, limited movement and swelling at the volar MCP joints she presented at our clinic. Volar synovectomy of the 3rd ray of the right hand was performed, the A2 ring band could be spared. There was massive metallosis induced by wear of the grommets in the third volar tendon sheath, the other flexors were free of metallosis. These results show that in synovitis after swanson spacer implantation using grommets the differential diagnosis of metallosis must be included and complete synovectomy is the treatment of choice.
类风湿关节炎所致掌指关节破坏是关节成形术的指征，斯旺森间隔器是其中一种选择。柔性硅胶间隔器可在有或无钛制导套（“索环”）的情况下植入。然而，硅胶索环的假想耐磨保护可能会因微动而导致磨损。本文介绍了一位69岁的女性患者，患类风湿关节炎30年。12年前，斯旺森间隔器被植入右手第2 - 5掌指关节。因掌侧掌指关节疼痛、活动受限和肿胀，她前来我院就诊。对右手第3指进行了掌侧滑膜切除术，保留了A2环形韧带。在第三掌侧腱鞘中，索环磨损导致大量金属沉着症，其他屈肌未出现金属沉着症。这些结果表明，在植入带有索环的斯旺森间隔器后发生滑膜炎时，必须考虑金属沉着症的鉴别诊断，彻底的滑膜切除术是首选治疗方法。
