Summary
Synovectomy of the wrist was done on 77 patients (97 wrists) during 1968–1981. The age of the patients at the time of operation ranged from 18 to 77 years, mean 44.9 yrs. Clinical and radiological follow-up examinations (90 wrists) or follow-up evaluation by questionnaire (7 wrists) were made by the authors in 1982. The mean length of the follow-up period was 8.5 years. Clinical symptoms of pain, swelling, restricted motion, instability and deformity of the wrist joint were evaluated and graded according to a special score. Radiological changes due to rheumatoid arthritis and osteoarthrosis were graded and analysed. Eight wrists were arthrodesed during the follow-up. Among the remaining wrists (89 cases) pain was absent or almost absent in 39%, was less than before the operation in 49% and was unchanged or worse in 12% of cases. The respective percentages for the presence of swelling were 47%, 36%, and 17%. The range of dorsiflexion was between 0 and 70°, with an average of 27.9°. The range of volar flexion was between 0 and 75°, the mean being 28.2°. The average ulnar and radial side motions were 12.9° and 5.4°, respectively. The radiological grading of RA remained about the same in 10 wrists and did not improve in a single wrist. In the other wrists the X-ray changes progressed. The results (patient's opinion) were subjectively good in 53%, fair in 32%, and poor in 15%. The result of the synovectomy must be evaluated as poor in the wrists that were arthrodesed (8 cases). The overall objective results of the 90 wrists examined personally were: good in 54 cases (60%), fair in 17 (19%) and poor in 19 (21%). In conclusion, we recommend surgical synovectomy of the wrist for alleviation of pain and swelling in RA, despite the deterioration shown by the X-ray.
Zusammenfassung
Von 1968 bis 1981 wurde bei 77 Patienten (97 Gelenke) eine Synovektomie des Handgelenkes durchgeführt. Das Alter der Patienten zum Zeitpunkt der Operation betrug 18 bis 77 Jahre ∅ 44,9 Jahre). Die Beurteilung der Resultate durch die Autoren erfolgte mittels klinischer and röntgenologischer Untersuchung (90 Gelenke) bzw. Fragebogen (7 Gelenke) nach einer durchschnittlichen Beobachtungszeit von 8,5 Jahren. Die klinischen Symptome (Schmerz, Schwellung, Bewegungseinschränkung, Instabilität, Handgelenksdeformierung) wurden nach einer speziellen Bewertungsskala beurteilt. Radiologische Veränderungen wurden analysiert. Acht Handgelenke wurden während der Beobachtungszeit arthrodesiert. Von den bleibenden 89 Gelenken waren 39% schmerzfrei bzw. nahezu schmerzfrei, 49% hatten geringere Schmerzen als präoperativ, 12% waren unverändert oder verschlechtert. Die entsprechenden Prozentzahlen für die Bewertung der Gelenkschwellung betrugen 47%, 36% and 17%. Die Dorsalflexion betrug p. op. 0 bis 70 Grad ∅ 27,9 Grad), die Volarflexion 0 bis 75 Grad (∅ 28,2 Grad). Die durchschnittliche ulnar- und radialabduktion betrug 12,9 Grad bzw. 5,4 Grad. Der radiologische Schweregrad war bei 10 Gelenken unverändert, bei den übrigen Gelenken progressiv. Die subjektive Bewertung durch die Patienten war gut in 53%, befriedigend in 32% sowie schlecht in 15% der Fälle. Alle arthrodesierten Gelenke wurden als schlecht angesehen. Die objektive Beurteilung der 90 persönlich nachuntersuchten Gelenke ergab: gut 54 Fälle (60%), befriedigend 17 Fälle (19%) und schlecht 19 Fälle (21%). Zusammenfassend wird die Synovektomie des Handgelenkes bei Rheumatoidarthritis zur Verminderung von Schmerz und Schwellung trotz der beobachteten radiologischen Verschlechterung empfohlen.
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Vahvanen, V., Pätiälä, H. Synovectomy of the wrist in rheumatoid arthritis and related diseases. Arch. Orth. Traum. Surg. 102, 230–237 (1984). https://doi.org/10.1007/BF00436135
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DOI: https://doi.org/10.1007/BF00436135