Souter W A
Hand. 1979 Feb;11(1):3-16. doi: 10.1016/s0072-968x(79)80002-9.
A detailed assessment of the patient as a whole is an essential pre-requisite to the successful planning and execution of surgical treatment of the rheumatoid hand. In particular the decision whether or not to operate must emerge from a careful weighing of the severity of the patient's symptoms, signs and physical disability against the benefits which are likely to accrue from surgical treatment assessed in relation to the patient's own individual requirements. The author presents his personal reflections on the relative merits of the commonly used surgical procedures with reference to their ability to relieve pain, restore function, achieve cosmetic improvement, and prevent further damage, while at the same time carrying minimal risk of further damage to the already impaired function of the hand. Finally, the philosophy which should govern the surgeon - patient relationship during the management of a chronic progressive disease is examined. That it is absolutely essential to establish a sound rapport from early in the surgical programme is strongly emphasised. Some guidelines as to the design of the programme are also provided.
对患者进行全面详细的评估是成功规划和实施类风湿性手部手术治疗的必要前提。特别是，是否进行手术的决定必须基于对患者症状、体征和身体残疾的严重程度与手术治疗可能带来的益处进行仔细权衡，而手术治疗的益处是根据患者自身的个体需求来评估的。作者就常用手术方法的相对优点发表了个人看法，这些优点包括缓解疼痛、恢复功能、改善外观以及防止进一步损伤，同时对已经受损的手部功能造成进一步损伤的风险降至最低。最后，探讨了在慢性进行性疾病治疗过程中应指导医患关系的理念。文中强烈强调，从手术方案早期就建立良好的医患关系绝对至关重要。还提供了一些关于手术方案设计的指导原则。
