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著者: Kiwamu Horiuchi, Shigeki Momohara, Taisuke Tomatsu, Kazuhiko Inoue, Yoshiaki Toyama
雑誌名: J Bone Joint Surg Am. 2002 Mar;84(3):342-7. doi: 10.2106/00004623-200203000-00002.
Abstract/Text
BACKGROUND: The purpose of this study was to investigate the results of arthroscopic synovectomy for the treatment of elbows affected by rheumatoid arthritis.
METHODS: Arthroscopic synovectomy was performed on twenty-nine elbows (twenty-seven patients) between 1984 and 1996. Twenty-one elbows (twenty patients), followed for a minimum of forty-two months, were evaluated clinically with use of the Mayo elbow performance score and radiographic findings. The mean duration of follow-up was ninety-seven months. With use of the system of Larsen et al., we classified all elbows into three groups--Grades 1 and 2, Grade 3, and Grade 4--according to the preoperative radiographic findings. These groups were then compared.
RESULTS: The mean Mayo elbow performance score improved from 48.3 points preoperatively to 77.5 points (an excellent result in two elbows, a good result in thirteen, a fair result in six, and a poor result in none) at two years after the operation and 69.8 points (an excellent result in two elbows, a good result in seven, a fair result in seven, and a poor result in five) at the final follow-up evaluation. The mean score for pain improved from 9.3 points preoperatively to 31.4 points at two years after the operation and 27.9 points at the final follow-up evaluation. Clinically apparent synovitis recurred in five of the twenty-one elbows, and two of the five required total elbow arthroplasty. Among the three groups, only elbows with Larsen Grade-1 or 2 arthritis had a favorable long-term result with regard to total function. The postoperative results were unsatisfactory for Larsen Grade-4 elbows.
CONCLUSIONS: Arthroscopic synovectomy in an elbow affected by rheumatoid arthritis is a reliable procedure that can alleviate pain. Our results suggest that one of the most favorable indications for arthroscopic synovectomy is a preoperative radiographic rating of Grade 1 or 2.
PMID 11886901 J Bone Joint Surg Am. 2002 Mar;84(3):342-7. doi: 10.2106/00004623-200203000-00002.
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