Teigland J C, Tjønnfjord G E, Evensen S A, Charania B
Department of Orthopaedic Surgery, Oslo Sanitetsforenings Rheumatism Hospital, Norway.
J Intern Med. 1994 Mar;235(3):239-43. doi: 10.1111/j.1365-2796.1994.tb01066.x.
To assess the efficacy of synovectomy in reducing recurrent haemarthroses and joint pain in patients suffering from haemophilic arthropathy. Moreover, to study whether synovectomy could improve joint mobility or postpone progression of joint destruction.
A retrospective study was conducted addressing joint-related symptoms and findings, and the need of orthopaedic surgery during follow-up.
Oslo Sanitetsforenings Rheumatism Hospital/The National Hospital, the National Centre for Orthopaedic Surgery for approximately 180 Norwegians suffering from severe congenital coagulation deficiencies.
Twelve patients with haemophilia A, two patients with von Willebrand's disease and two patients with factor VII deficiency in which 21 synovectomies (nine knees, six ankles and six elbows) were performed.
Joint pain, joint mobility, frequency of haemarthroses and radiographic joint scores at follow-up were compared to preoperative figures, and the number of joints in need of total joint replacement or arthrodesis was evaluated.
Synovectomy proved efficacious in reducing recurrent haemarthroses and joint pain in all patients. The total range of motion was not improved, but correction of extension deficiency of the knee was accomplished. The progression of arthropathy was not arrested by synovectomy as judged by the radiographic assessment; and in four patients arthroplasty of the knee, and in two patients arthrodesis of the ankle, had been performed. A major wound haemorrhage and subsequent wound rupture was seen in one patient who developed high-titred neutralizing antibodies to factor VIII.
Synovectomy for haemophilic arthropathy is safe and efficacious in reducing recurrent haemarthroses and joint pain. Synovectomy should not be performed to improve joint mobility. The progression of the arthropathy is not arrested, and subsequently many patients will be candidates for arthroplasty or arthrodesis.
评估滑膜切除术对减少血友病性关节病患者复发性关节积血和关节疼痛的疗效。此外，研究滑膜切除术是否能改善关节活动度或延缓关节破坏的进展。
进行一项回顾性研究，关注随访期间与关节相关的症状和发现以及骨科手术需求。
奥斯陆卫生协会风湿医院/国家医院，国家骨科手术中心，约180名患有严重先天性凝血缺陷的挪威人。
12例甲型血友病患者、2例血管性血友病患者和2例因子VII缺乏症患者，共进行了21次滑膜切除术（9个膝关节、6个踝关节和6个肘关节）。
将随访时的关节疼痛、关节活动度、关节积血频率和影像学关节评分与术前数据进行比较，并评估需要进行全关节置换或关节融合术的关节数量。
滑膜切除术在所有患者中均被证明对减少复发性关节积血和关节疼痛有效。总活动范围未得到改善，但膝关节伸直受限得到了纠正。根据影像学评估，滑膜切除术未能阻止关节病的进展；4例患者进行了膝关节置换术，2例患者进行了踝关节融合术。1例对因子VIII产生高滴度中和抗体的患者出现了严重伤口出血及随后的伤口破裂。
血友病性关节病的滑膜切除术在减少复发性关节积血和关节疼痛方面是安全有效的。不应为改善关节活动度而进行滑膜切除术。关节病的进展未被阻止，随后许多患者将成为关节置换术或关节融合术的候选者。
