Kerschbaumer F
Universitätsklinik für Orthopädie, Innsbruck.
Orthopade. 1988 Aug;17(4):359-65.
The natural history of rheumatoid arthritis of the elbow often includes impairment of the function of the upper extremity in advanced stages of the disease. Synovectomy performed by a large radial incision is considered a worthwhile procedure for stages 1-3 according to the classification of Larsen et al. Radiosynoviorthesis is possible in stages 0 and 1. In the authors' opinion, resection- and interposition arthroplasty remains the procedure of choice for advanced stages 4 and 5. For elbows with severe instability alloarthroplasty may be considered. The radial head should generally not be resected. Entrapment neuropathy of the ulnar and the posterior interosseus nerves is possible in rheumatoid arthritis patients. The surgical treatment consists in decompression, if necessary with transposition and synovectomy of the elbow joint.
肘关节类风湿关节炎的自然病程在疾病晚期常包括上肢功能受损。根据Larsen等人的分类，经大的桡侧切口进行滑膜切除术被认为是1-3期值得采用的手术。0期和1期可行放射性滑膜切除。作者认为，切除及间置关节成形术仍是4期和5期晚期的首选手术。对于严重不稳定的肘关节可考虑采用全关节成形术。一般不应切除桡骨头。类风湿关节炎患者可能发生尺神经和骨间后神经卡压性神经病变。手术治疗包括减压，必要时进行移位及肘关节滑膜切除术。
