Fernández-Palazzi F, Caviglia H A, Salazar J R, López J, Aoun R
Orthopaedic Unit, National Hemophilia Treatment Center, Hospital San Juán de Dios, Caracas, Venezuela.
Clin Orthop Relat Res. 1997 Oct(343):25-9.
From 1988 to 1966, 34 patients with advanced chronic hemophilic synovitis (25 Grade III and nine Grade IV) were treated with intraarticular injections of long acting dexamethasone (sodium phosphate of dexamethasone plus acetate of dexamethasone) in cycles of three injections with 3-week intervals between each injection with 6-month rest intervals between cycles for as many as three cycles, depending on the evolution of each case. All patients had chronic severe synovitis, axial deformity, muscular atrophy, and diminution of range of movement. There were 31 knees, two ankles, and two shoulders. Subjective and objective evaluations were done grouping the results in good, fair, and poor according to grade of patient satisfaction, presence of synovitis and pain, range of movement, and limitation of activities of daily living. In the subjective results there were 19 good results, 12 fair results, and four poor results, and in the objective evaluation there were 22 good results, nine fair results, and four poor results at an average followup of 1.5 years. The use of intraarticular dexamethasone as an alternative in the short to medium term for treatment of advanced chronic hemophilic synovitis with pain and limitation of function before doing an invasive surgical treatment is proposed.
1988年至1966年期间，对34例晚期慢性血友病性滑膜炎患者（25例为Ⅲ级，9例为Ⅳ级）进行了关节腔内注射长效地塞米松（地塞米松磷酸钠加地塞米松醋酸酯）治疗，每3周注射1次，共注射3次为1个周期，周期之间休息6个月，根据具体病情最多进行3个周期。所有患者均患有慢性重度滑膜炎、关节畸形、肌肉萎缩以及活动范围减小。受累关节包括31个膝关节、2个踝关节和2个肩关节。根据患者满意度、滑膜炎及疼痛情况、活动范围以及日常生活活动受限程度，将主观和客观评估结果分为优、良、差三组。主观评估结果显示，优19例，良12例，差4例；客观评估结果显示，优22例，良9例，差4例，平均随访时间为1.5年。本文提出，在进行侵入性手术治疗之前，关节腔内注射地塞米松可作为中短期治疗晚期慢性血友病性滑膜炎伴疼痛和功能受限的一种替代方法。
