Magalhães Andréa Fernandes, de Oliveira Luciana Correa O, Pitella Felipe Arriva, Wichert-Ana Lauro, Engel Edgard Eduard, Barbieri Cláudio Henrique
Department of Health Sciences Applied to the Locomotor System (Orthopaedics/Traumatology), Ribeirão Preto Medical School ,University of São Paulo, São Paulo, Brazil.
Department of Medical Imaging, Hematology, and Clinical Oncology, Ribeirão Preto Medical School ,University of São Paulo, São Paulo, Brazil.
Hematol Transfus Cell Ther. 2021 Jan-Mar;43(1):15-20. doi: 10.1016/j.htct.2019.11.001. Epub 2020 Jan 30.
The radiosynovectomy (RS) is one treatment option for recurrent hemarthrosis in patients with hemophilia (PWH). A prospective cohort study was designed to evaluate the effects of the RS on the synovial membrane volume in the ankles and knees of PWH and patient characteristics related to the RS outcome.
In a one-year follow-up, 25 joints of 22 PWH who presented 3 bleeds or more in the same joint over the last 6 months (target joints) were subjected to the RS. Two groups were compared: those who retained target joints following the RS and those who did not (less than 3 bleeds/6 months after the RS). The groups were analyzed according to age, hemophilia type/severity, joint, body mass index (BMI), inhibitor and Hemophilia Joint Health Score 2.1 (HJHS). The magnetic resonance images (MRI) of six ankles and six knees were acquired prior to, and 6 months after, the RS. The synovial membrane volume and arthropathy MRI scale were accessed and volumes were compared and correlated with the Yttrium-90 dose injected.
Patients with a mean age of 12 years and a mean HJHS of 6.7 (p < 0.05) retained target joints after the RS. The inhibitor, joint, type/severity of disease and BMI showed no significant differences between groups. The synovial membrane volume had a significant reduction after the RS (p = 0.03), but no correlation with the Yttrium-90 dose. In proportion to the synovial membrane volume, doses injected to the ankles were larger than those injected to the knees.
The synovial membrane volume is reduced after the RS, regardless of the effective 90Y dose.
放射性滑膜切除术（RS）是血友病患者（PWH）复发性关节积血的一种治疗选择。一项前瞻性队列研究旨在评估RS对PWH踝关节和膝关节滑膜体积的影响以及与RS结果相关的患者特征。
在为期一年的随访中，对22例PWH的25个关节进行了RS，这些关节在过去6个月内在同一关节出现3次或更多次出血（靶关节）。比较了两组：RS后保留靶关节的患者和未保留靶关节的患者（RS后6个月内出血少于3次）。根据年龄、血友病类型/严重程度、关节、体重指数（BMI）、抑制剂和血友病关节健康评分2.1（HJHS）对两组进行分析。在RS前和RS后6个月获取了6个踝关节和6个膝关节的磁共振图像（MRI）。评估滑膜体积和关节病MRI量表，并比较体积，并与注射的钇-90剂量相关联。
平均年龄为12岁、平均HJHS为6.7的患者（p<0.05）在RS后保留了靶关节。两组之间抑制剂、关节、疾病类型/严重程度和BMI无显著差异。RS后滑膜体积显著减少（p=0.03），但与钇-90剂量无关。与滑膜体积成比例，注入踝关节的剂量大于注入膝关节的剂量。
无论有效90Y剂量如何，RS后滑膜体积都会减少。
