Menchaca-Tapia Victor M, Rodríguez Elizabeth M, Contreras-Yáñez Irazú, Iglesias-Morales Martin, Pascual-Ramos Virginia
Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Department of Plastic Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Plast Surg (Oakv). 2016 Summer;24(2):67-72. Epub 2016 May 27.
Up to 70% of patients with long-standing rheumatoid arthritis (RA) may present with rheumatic hand disease and benefit from hand surgical procedures (HSPs).
Through retrospective review, the present study aimed to report HSPs in RA patients at a tertiary care centre to identify patient adverse outcomes (AOs) and their predictors.
From 1989 to 2013, 96 patients who underwent ≥1 HSP(s) were identified from two local registries; their clinical records were independently reviewed by two trained physicians (surgeon and clinical) who used a standardized format. AOs were defined by consensus; data abstracter agreement was found in 90% of cases. Descriptive statistics were used in addition to Kaplan-Meier curves to determine the time to each AO, while logistic regression models were used to determine predictors of AOs.
At first HSP, 89.6% of patients were female, had a mean (± SD) age of 49.1±12 years, a disease duration of 12.2±7.2 years, 93.6% were positive for rheumatoid factor and 24% were receiving intensive treatment. A total of 130 HSPs were performed: the most frequent interventions were arthrodesis (25.4%), resection of the ulnar head (15.4%) and tenorrhaphy (14.6%). During follow-up, 33 AOs were reported in 27 (28.1%) patients, 87% of which occurred after the first HSP. The most frequent AO subsets were impaired wound healing (18.2%) and exposed pin (15.2%). Longer disease duration at first HSP (OR 3.07 [95% CI 1.04 to 9.08]; P=0.04) and intensive treatment (OR 1.08 [95% CI 1.002 to 1.156]; P=0.045) were predictors of AOs. The optimal disease duration cut-off to predict AOs was 20.1 years.
Early referral of long-standing RA patients for hand surgery, along with less aggressive treatment, favoured improved surgical outcomes.
高达70%的长期类风湿关节炎（RA）患者可能出现风湿性手部疾病，并能从手部外科手术（HSPs）中获益。
通过回顾性研究，本研究旨在报告一家三级医疗中心RA患者的手部外科手术情况，以确定患者的不良结局（AOs）及其预测因素。
从1989年至2013年，从两个本地登记处确定了96例接受过≥1次手部外科手术的患者；他们的临床记录由两名经过培训的医生（外科医生和临床医生）独立审查，审查采用标准化格式。不良结局通过共识定义；在90%的病例中发现数据提取者意见一致。除了使用Kaplan-Meier曲线来确定每个不良结局的发生时间外，还使用逻辑回归模型来确定不良结局的预测因素。
在首次进行手部外科手术时，89.6%的患者为女性，平均（±标准差）年龄为49.1±12岁，病程为12.2±7.2年，93.6%的患者类风湿因子呈阳性，24%的患者正在接受强化治疗。共进行了130次手部外科手术：最常见的手术是关节融合术（25.4%）、尺骨头切除术（15.4%）和肌腱缝合术（14.6%）。在随访期间，27例（28.1%）患者报告了33例不良结局，其中87%发生在首次手部外科手术后。最常见的不良结局亚组是伤口愈合受损（18.2%）和钢针外露（15.2%）。首次手部外科手术时病程较长（比值比3.07 [95%置信区间1.04至9.08]；P = 0.04）和强化治疗（比值比1.08 [95%置信区间1.002至1.156]；P = 0.045）是不良结局的预测因素。预测不良结局的最佳病程临界值为20.1年。
长期RA患者早期转诊进行手部手术，同时采用不太激进的治疗方法，有利于改善手术结局。
