Synovectomy of the hip in patients with juvenile rheumatoid arthritis
Synovectomy of the hip in patients with juvenile rheumatoid arthritis
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DOI：
10.2106/jbjs.f.00657
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发表时间：
2007-09-01
影响因子：
5.3
通讯作者：
Hohenberger, Gerd
中科院分区：
文献类型：
--
作者：
Carl, Hans-Dieter;Schraml, Annemarie;Hohenberger, Gerd
背景资料：开放髋关节滑膜切除术的功能效果，在大量的青少年类风湿性关节炎患者的有效评估tool.Methods：在1985年和1997年之间，67开放髋关节滑膜切除术进行了评估，在五十六例青少年类风湿性关节炎患者的数据缺乏。五十五髋关节（82%）的影像学变化是III期或更高的根据系统的Larsen等。髋关节功能进行了评价术前和术后平均50个月的Merle d 'Aubigne髋关节score.Results：六十五（97%）的六十七髋关节可用于后续。平均总Merle d 'Aubigne髋关节评分（和平均值的标准误）从基线时的9.5 +/- 2.5分显著改善至随访时的16.3 +/- 1.0分（p < 0.001）。疼痛、活动性和行走能力的个体评分也显著增加（所有p < 0.001）。观察到85%的髋关节功能有很大或很大的改善。7个髋关节同时进行软组织松解，9个髋关节需要手术脱位。手术并发症包括2例无需干预的浅表伤口血肿;未观察到股骨头坏死。随访期间，5例髋关节需要全髋关节置换术。因此，生存率为髋关节是94%，平均4年后synovectomy.Conclusions：开放髋关节滑膜切除术的青少年类风湿性关节炎患者是一个安全的程序，可以提高髋关节功能长达5年。
Background: There is a lack of data on the functional effect of open hip synovectomy in a large number of patients with juvenile rheumatoid arthritis evaluated with a validated assessment tool.Methods: Between 1985 and 1997, sixty-seven open hip-joint synovectomies were carried out in fifty-six patients with juvenile rheumatoid arthritis. Fifty-five hips (82%) had radiographic changes that were stage III or higher according to the system of Larsen et al. Hip function was evaluated preoperatively and after a mean of fifty months with the Merle d'Aubigne hip score.Results: Sixty-five (97%) of the sixty-seven hips were available for follow-up. The mean total Merle d'Aubigne hip score (and standard error of the mean) was significantly improved from 9.5 +/- 2.5 points at baseline to 16.3 +/- 1.0 points at the time of follow-up (p < 0.001). The individual scores for pain, mobility, and walking ability were significantly increased as well (all p < 0.001). Eighty-five percent of the hips were observed to have a very great or great improvement in function. A concomitant soft-tissue release was performed in seven hips, and nine hips required surgical dislocation. Surgical complications included two superficial wound hematomas that did not require intervention; osteonecrosis of the femoral head was not observed. Five hips required total hip arthroplasty during the follow-up period. Thus, the survival rate for the hips was 94% at a mean of four years following the synovectomy.Conclusions: Open hip synovectomy in patients with juvenile rheumatoid arthritis is a safe procedure that can improve hip-joint function for up to five years.