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腕关节镜检查在青少年特发性关节炎中的作用

Role of Wrist Arthroscopy in Juvenile Inflammatory Arthritis.

作者信息

Ishwar Mahalakshmi, Lindau Tommy R, Johnson Karl, Pidgeon Claire, Jester Andrea, Coles William, Oestreich Kerstin

机构信息

Department of Plastic Surgery, Hand & Upper Limb Service, Birmingham Children's Hospital, Birmingham, United Kingdom.

Pulvertaft Hand Center, Royal Derby Hospital, Derby, United Kingdom.

出版信息

J Wrist Surg. 2022 Mar 8;11(5):376-382. doi: 10.1055/s-0042-1743448. eCollection 2022 Oct.

Abstract

The wrist is the fourth most common joint to be involved in juvenile inflammatory arthritis (JIA), which is a common rheumatological condition affecting children. Wrist arthroscopy is well established in rheumatoid arthritis, but remains unexplored in JIA. The aim of this study is to investigate the role of wrist arthroscopy in JIA, with focus on those who are refractory to medical management.  This is a prospective observational study, including consecutive patients with JIA undergoing arthroscopy between January 2016 and December 2020. Those over the age of 18 years and those with other rheumatological diagnoses were excluded. Data including pre-, intra-, and postoperative variables, demographics, and patient-reported outcomes were collated and are reported using standard measures.  A total of 15 patients underwent arthroscopy (  = 20 wrists). Synovitis was noted in all wrists on arthroscopy and synovectomy was performed in all cases. Other procedures were performed as indicated during the procedure. The median follow-up duration was 11.3 (interquartile range [IQR] 8.1-24.2) months. Median reduction of 4 (IQR 2.25-6) points on the Visual Analogue Score for pain on loading was noted postoperatively. Grip strength was improved in  = 11/20 wrists and functional improvement was noted in  = 18/20 wrists. Restriction of range of motion was achieved with a shrinkage procedure in patients with hypermobile joints. There were no postoperative complications, and no patients were lost to follow-up.  In experienced hands, wrist arthroscopy is feasible, safe, and efficacious in the management of JIA, among patients who are refractory to medical management.  This is a Level II study.

摘要

手腕是青少年特发性关节炎(JIA)中第四常见的受累关节,青少年特发性关节炎是一种影响儿童的常见风湿性疾病。手腕关节镜检查在类风湿性关节炎中已得到广泛应用,但在青少年特发性关节炎中仍未得到充分探索。本研究的目的是探讨手腕关节镜检查在青少年特发性关节炎中的作用,重点关注那些对药物治疗无效的患者。

这是一项前瞻性观察性研究,纳入了2016年1月至2020年12月期间连续接受关节镜检查的青少年特发性关节炎患者。排除18岁以上患者和其他风湿性疾病诊断患者。收集包括术前、术中和术后变量、人口统计学数据以及患者报告结局的数据,并使用标准测量方法进行报告。

共有15例患者接受了关节镜检查(共20个手腕)。关节镜检查发现所有手腕均存在滑膜炎,所有病例均进行了滑膜切除术。根据手术过程中的指示进行了其他操作。中位随访时间为11.3(四分位间距[IQR]8.1 - 24.2)个月。术后在负重时疼痛的视觉模拟评分中位数降低了4(IQR 2.25 - 6)分。20个手腕中有11个握力得到改善,20个手腕中有18个功能得到改善。对于关节活动过度的患者,通过收缩手术实现了活动范围的限制。没有术后并发症,也没有患者失访。

在经验丰富的医生手中,手腕关节镜检查对于药物治疗无效的青少年特发性关节炎患者的管理是可行、安全且有效的。

这是一项II级研究。

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