Rodríguez-Merchán E C, Magallón M, Galindo E, López-Cabarcos C
International Hemophilia Treatment and Training Center, La Paz University Hospital, Madrid, Spain.
Clin Orthop Relat Res. 1997 Oct(343):47-53.
A prospective study from 1974 to 1996 was done to determine optimal treatment for chronic hemophilic synovitis of the knee and synovitis of the elbow. Sixty-five patients with synovitis affecting 65 knee joints and 40 patients who had synovitis of the elbow (44 elbows), despite a 3-month trial of prophylactic substitution therapy, were treated by synovectomy. Radiation synovectomies (Au-198 synoviorthesis) were done on 38 knees, open surgical synovectomy on 18, and nine had an arthroscopic procedure. Radioactive gold synoviorthesis was performed on 29 elbows, and 15 had a resection of the radial head and partial open synovectomy. Synovectomy (by any method) significantly reduced bleeding episodes, but did not halt the radiographic deterioration of the joints. It is thought that radiation synovectomy is the best choice for patients with persistent synovitis of the knee and synovitis of the elbow unresponsive to a 3-month trial of prophylactic factor replacement. If two to three consecutive synoviortheses with 3 to 6 months intervals had been ineffective, or when the radiographic score is more than two points, an open synovectomy is indicated.
一项从1974年至1996年开展的前瞻性研究旨在确定膝关节慢性血友病性滑膜炎和肘关节滑膜炎的最佳治疗方法。65例患有滑膜炎的患者累及65个膝关节，40例患有肘关节滑膜炎（44个肘关节），尽管进行了为期3个月的预防性替代治疗试验，但仍接受了滑膜切除术。对38个膝关节进行了放射性滑膜切除术（金-198滑膜切除术），18个进行了开放性手术滑膜切除术，9个进行了关节镜手术。对29个肘关节进行了放射性金滑膜切除术，15个进行了桡骨头切除术和部分开放性滑膜切除术。滑膜切除术（采用任何方法）均显著减少了出血发作，但并未阻止关节的影像学恶化。据认为，对于经过3个月预防性因子替代治疗试验仍无反应的膝关节持续性滑膜炎和肘关节滑膜炎患者，放射性滑膜切除术是最佳选择。如果连续两到三次间隔3至6个月的滑膜切除术无效，或影像学评分超过2分，则应进行开放性滑膜切除术。
