Comparison of Swanson and Sutter metacarpophalangeal arthroplasties in patients with rheumatoid arthritis: a prospective and randomized trial

PURPOSE: To perform a prospective and randomized comparison of the clinical outcome of patients with rheumatoid arthritis who had Swanson or Sutter implant replacement arthroplasty of the metacarpophalangeal joints. METHODS: There were 45 patients (3 men, 42 women) and 49 hands; a total of 75 Swanson and 99 Sutter implants were inserted. The mean time between surgery and the final follow-up control visit was 58 months (range, 37-80 mo). Preoperative and postoperative measurements were performed including active extension and flexion, correction of ulnar deviation, and strength. RESULTS: There was no statistically significant difference between groups with regard to active extension deficit correction. Mean active flexion decreased less in the Sutter group than in the Swanson group but difference between the groups was statistically significant in only the index finger. At the final follow-up examination no significant differences existed between the groups in the correction of ulnar deviation or arc of motion. Grip strengths, chuck pinch, and thump-to-fingertip grip strengths did not improve in either of the groups. CONCLUSIONS: In this study clinical results showed no significant difference between the groups with the single exception of the amount of index finger metacarpophalangeal joint flexion.     

Survival and complications are similar after Swanson and Sutter implant replacement of metacarpophalangeal joints in patients with rheumatoid arthritis.

We compared the survival, fracture, and deformation rates of Swanson and Sutter implants in a prospective series of 53 patients with rheumatoid arthritis (RA). Fifty-eight hands were operated on with 215 silastic implants. The Swanson group comprised 25 hands and 89 implants, and the Sutter group 33 and 126, respectively. Follow up was 58 (37-80) months. During a period of 48 months the survival of Swanson and Sutter prostheses did not differ significantly: 92% (95% CI 84% to 96%) and 97% (95% CI 92% to 99%), respectively. The fracture rate was high in both groups: 26 (34%) in the Swanson and 25 (26%) in the Sutter group. There was no significant difference between the groups in definite fracture rates of implants. The Sutter prosthesis appears to be at least as durable an implant in rheumatoid patients' metacarpophalangeal arthroplasty as the Swanson.     

掌指关节置换术治疗类风湿关节炎尺偏畸形的疗效

目的总结掌指关节置换术治疗类风湿关节炎(RA)尺偏畸形的临床疗效。方法对40例RA尺偏畸形患者采用Swanson假体掌指关节置换术。评价患者术后尺偏角度、握力、关节活动度及关节功能等指标。结果患者切口均一期愈合,无感染或坏死等早期并发症。患者均获得随访,时间4~6个月。术后3个月,尺偏角度明显纠正,掌指关节活动度及握力明显增加,MHQ评分、AIMS2评分明显改善,各项指标与术前比较差异均有统计学意义(P<0.05)。无假体断裂、脱位及假体周围骨折等并发症。结论掌指关节置换术治疗RA尺偏畸形安全有效,可有效改善手的外观,减轻疼痛,改善关节功能。     

Swanson人工关节置换治疗创伤后掌指关节僵硬近期疗效

目的探讨Swanson人工关节置换治疗创伤后掌指关节僵硬的近期疗效。方法 2007年8月-2010年5月,对11例13指创伤后掌指关节僵硬伴不同程度软组织缺损患者行Swanson人工关节置换术。男7例9指,女4例4指;年龄43～65岁,平均49岁。其中拇指4指,示指4指,中指3指,环指2指。损伤类别:手部开放性压轧伤8指,掌指关节骨折3指,掌指关节离断2指。发生关节僵硬至入院时间为12～48周,平均24周。术前关节活动度为(136.82±28.96)°,根据关节主动活动度(TAM)系统评定,其中良1指,可6指,差6指。采用Sollerman等手功能评定标准评定手功能为(45.64±11.04)分。X线片、CT检查示掌指关节创伤性关节炎。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间12～34个月,平均24.1个月。末次随访时关节活动度为(194.64±28.86)°,与术前比较差异有统计学意义(t=25.214,P=0.000);采用TAM评定获优1指,良4指,可7指,差1指。采用Sollerman等的手功能评定标准评定手功能为(67.45±8.20)分,与术前比较差异有统计学意义(t=10.470,P=0.000)。末次随访时,X线片检查示均无假体断裂、假体周围骨折、关节明显脱位等并发症发生。结论 Swanson人工关节置换治疗创伤后掌指关节僵硬,术后关节活动度改善明显,近期疗效满意,但应注意适应证的选择及软组织缺损处理技巧。     

Bilateral hip and knee replacement in rheumatoid arthritis

A series of 20 patients who had bilateral hip and knee replacement are reviewed and analyzed. Early surgical opinion should be sought before all four joints are irreparably destroyed and the patient is nonambulant so that the joints can be replaced one at a time, as necessary to maintain mobility. This considerably reduces stress to the patient, the surgeon, the nursing staff, and the rehabilitation team. The follow-up period ranged from 2 to 13 years. The early postoperative complications were few and the reoperation rate for aseptic loosening in this study was 3.75%.     

类风湿性关节炎肩关节病变的影像学测量

[目的]调查类风湿性关节炎( rheumatoid arthritis,RA)患者的肩关节功能及影像学改变,了解该类人群中肩关节病变现状,分析肩关节破坏的相关因素,为RA肩部疾病的预防和治疗提供临床依据.[方法]随机选择RA患者,记录发病年龄、病程,采用ASES肩关节评分量表评测肩关节功能;拍摄肩关节正位X线片,进行Larson分期,测量肩关节内侧距离(MD)、肩关节上移指数(UI)、肩关节内移指数(MI)、大结节关节面间距(GA),分析Larson分期与上述数据间的相关性.[结果]2010年3月～2010年11月,60人入选本研究,平均年龄(51.34±14.14)岁,男6人,女54人.ASES评分(72.69±24.76)分;完成116肩摄X线片,无明显骨性破坏的肩关节(Larson 0 ～1期)MD为(7.55±0.55) cm,UI为1.38±0.10,MI为1.04±0.29,GA为(0.60±0.22) cm.Larson 分期与ASES评分呈显著负相关(r=-0.028 3,P=0.001),与反映肩关节内移的MD、MI呈显著负相关(r=-0.177,P=0.029和r=-0.438,P＜0.001);与UI无显著相关性(r=-0.062,P=0.253);与GA呈显著负相关(r=-0.369,P＜0.001).与病程和年龄呈显著正相关(r=0.534和r=0.390,P＜0.001),与患病年龄无显著相关性(r =0.091,P=0.165).[结论]肩关节受累在RA患者中广泛存在,其受累程度随着病程增加而增加,随着破坏程度的加剧肩关节旋转中心发生内移,但是尚不明确旋转中心上移与骨性破坏是否同步发展.     

Temporomandibular joint disorders in patients with rheumatoid arthritis

ObjectivesThe aim of this study is to draw the attention of patients, doctors and therapists to the importance of temporomandibular joint (TMJ) problems in rheumatoid arthritis (RA).Material and methodsThe research was conducted at the National Institute of Geriatrics Rheumatology and Rehabilitation in Warsaw. The study involved 60 subjects. The test group consists of 30 patients with diagnosed RA. The control group (n = 30) consisted of healthy participants of similar age. The study analyzed the occurrence of problems in TMJ joints, acoustic phenomena and the level of pain. Masseter muscle development, range of abduction motion and pain during palpation of soft tissues were assessed on the basis of the joint pain map of Prof. Mariano Rocabado.ResultsIn the RA group, more than half (56.7%) had problems with the TMJ, 70% of them had masseter hypertrophy and clicks in the TMJ, and 46.7% had tinnitus (in the control group: 10%, 30%, and 30%, respectively). Patients also had a limited range of abduction movement in the TMJ (38.0 ±6.1 mm). Analysis of the pain map of Prof. Mariano Rocabado in RA patients indicates a significantly greater number of pain structures. In the control group no pain was observed in structures such as the posterosuperior synovial and bilaminar zone, posterior ligament, or retrodiscal area.ConclusionsTemporomandibular joint problems in RA patients were more serious than in the control group and these differences were statistically significant for most tests. The awareness of the problem with the TMJ in RA patients is very low; participants of our study were 100% unaware that the function of the TMJ could be improved. Additionally, there are no guidelines for the treatment and rehabilitation of these joints.     

掌指关节置换术治疗类风湿关节炎

目的 探讨应用掌指关节置换术治疗类风湿关节炎的方法和临床疗效.方法 2002年1月-2007年1月,对8例13指类风湿关节炎的患者,采用Swanson假体行掌指关节置换术.结果 术后伤口均Ⅰ期愈合,随访时间为9～24个月,平均15.8个月.掌指关节置换后按李庆泰等的疗效评定标准评价:优9指,良4指.结论 掌指关节置换术治疗类风湿关节炎疗效可靠,是一种较好的治疗方法.     

Results of revision metacarpophalangeal joint surgery in rheumatoid patients following previous silicone arthroplasty

PURPOSE: Primary silicone metacarpophalangeal (MCP) joint arthroplasties have good results that deteriorate with time. The purpose of this study was to assess indications, patient satisfaction, and clinical and radiographic results following revision surgery in rheumatoid patients who had previously undergone silicone MCP arthroplasty. METHODS: Twenty hands in 18 patients (62 implants) had revision silicone MCP arthroplasties between 1986 and 2005 and had a greater than 1-year follow-up period (mean 5 y). A retrospective chart review was performed to collect preoperative and intraoperative data. Patients were then re-examined and administered a questionnaire addressing subjective outcome and satisfaction. RESULTS: Intraoperatively, 76% of the implants were fractured. Thirteen of 17 synovial biopsies revealed giant cell foreign body reaction. Preoperatively, the average arc of motion was from 16 degrees to 50 degrees , and ulnar drift was 24 degrees . Postoperatively, the average arc of motion was from 20 degrees to 54 degrees , and ulnar drift was 13 degrees . X-rays of 14 hands revealed that 15 of 44 revised implants had fractured. Sixteen patients (18 hands) were available to complete questionnaires. Twelve patients (14 hands) were satisfied and 3 were dissatisfied. Five of 16 patients would not have the revision again. These patients had worse average postoperative ulnar drift (30 degrees vs 9 degrees ) than the other 11 patients. All patients except one who had preoperative pain had at least moderate pain relief, and of the 6 patients who had revision surgery because of pain, 5 were satisfied. CONCLUSIONS: Revision silicone arthroplasty provides excellent pain relief, and the majority of patients were pleased with their results. Objective results, however, were generally poor. Soft tissue reconstruction is more difficult to achieve than the primary procedure, as evidenced by minimal improvement in ulnar drift, a high rate of implant fracture, and no change in arc of motion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

Ultrasound remission in patients with rheumatoid arthritis in clinical remission

ObjectivesThe aim of the study was to assess ultrasound (US) remission in patients with rheumatoid arthritis (RA) in clinical remission using different definitions.Material and methodsThis was a cross-sectional study including patients with RA in clinical remission defined by disease activity score (DAS28)-erythrocyte rate (ESR) ≤ 2.6 for at least 6 months. Each patient underwent B-mode and power Doppler (PD) assessments of 42 joints and 20 tendons. B-mode and PD signal for synovitis and tenosynovitis (TS) were defined and graded semi-quantitatively (0–3) according to the outcome measures in rheumatology clinical trials (OMERACT). Several different definitions of US remission were examined: the absence of synovial hypertrophy (SH), TS on B-mode and PD signal, the absence of SH and PD signal, a grade ≤ 1 of SH and the absence of PD, a grade ≤ 1 of SH and PD, the absence of PD, or a grade of PD ≤ 1. The DAS28, clinical disease activity index (CDAI), simple disease activity index (SDAI), and the Boolean American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were compared.ResultsThirty-seven patients were enrolled. The rate of remission according to the different composite indices was 70.2% for the SDAI, 64.8% for the CDAI, and 54% for the ACR/EULAR Boolean criteria. Synovial hypertrophy and TS in B-mode were detected in 94.6% and 40.5% of patients, respectively. Synovitis with PD signal was found in 59.5% and 13.5% of patients had TS with PD, respectively. Ultrasound remission at joints and tendons was found in 5.4–62.2% of patients. For the other remission criteria: CDAI, SDAI, and ACR/EULAR Boolean criteria, 7.7–60% of patients showed US remission at joints and tendons.ConclusionsClinical remission, even classified by strict composite indices, does not seem to be the closest method to the concept of absence of inflammatory activity; hence the interest of integrating US in assessing remission in practice.     

水中抗阻训练对类风湿关节炎居家患者手足关节功能康复的影响

目的 探讨水中抗阻训练对类风湿关节炎居家患者手足关节功能康复的影响.方法 将风湿免疫科门诊就诊的类风涅关节炎患者71例根据就诊日期单双日分为观察组(n=35)和对照组(n=36).对照组接受常规护理及关节功能训练;观察组在对照组基础上实施水中抗阻训练,每天训练30～60 min,每周至少训练3d.比较两组干预前后双手握...     

类风湿关节炎合并骨质疏松与7关节超声评分相关性及预测模型

目的 探讨类风湿关节炎（rheumatoid arthritis,RA）合并骨质疏松与7关节超声评分（7-joint ultrasound score ,US7）相关性并建立骨质疏松预测模型。方法 123例RA患者根据骨密度检测结果分为骨质疏松组、低骨量组和骨量正常组,进行病史记录、血清学检测、US7超声评分,通过多元logistic回归分析建立预测模型。结果 多元Logistic回归分析显示：年龄、病程、DAS28、抗环瓜氨酸抗体（CCP）是骨质疏松组与骨量正常组、低骨量组与骨量正常组的危险因子（P<0.001）。预测模型总符合率78.0 %,骨质疏松模型符合率87.5 %、低骨量模型53.3 %、正常模型82.8 %。结论 年龄、病程、DAS28、CCP是RA患者骨量异常的危险因子,建立的骨质疏松模型可为预测RA患者骨质疏松提供重要参考。     

Long-term results of silicone wrist arthroplasty in patients with rheumatoid arthritis

PURPOSE: The surgical treatment of the rheumatoid wrist is key in managing the affected hand. Wrist fusion is often the treatment of choice in cases of severe destruction and deformation although most patients would prefer a motion-preserving procedure. The implantation of a wrist prosthesis might be an alternative to partial arthrodesis for selected cases. In this series we analyzed the long-term results (minimum follow-up period, 10 y) of the Swanson silicone spacer for the wrist in patients with rheumatoid arthritis. METHODS: Sixteen patients with rheumatoid arthritis with 18 silicone spacers for the wrists were reviewed after a minimum follow-up period of 10 years (average, 15 y). Subjective evaluation, clinical examination, and radiographic analysis were included. An additional 9 patients (9 wrists) were interviewed by telephone. RESULTS: In 12 of the patients the subjective result was good or very good, mostly because of adequate pain relief. The average range of motion for flexion (average, 28 degrees )/extension (average, 15 degrees ) was 43 degrees with a wide variation within the series. Radiologically all wrists had diminished residual carpal height at follow-up evaluation and 9 of the wrists had evidence of osteolysis and foreign-body granuloma. The initial good correction of the ulnar translation of the wrist was lost partially in the follow-up period (1.1 vs 4.0 mm). Three of the patients needed surgical revision within the follow-up period; all were converted to wrist fusion. CONCLUSIONS: These long-term results suggest that the silicone wrist spacer still may be considered as an alternative to wrist fusion or more complex wrist joint prostheses in patients with rheumatoid arthritis, especially in severe cases and in patients with low demands. In the long term osteolysis caused by foreign-body granulation is to be expected and has to be considered.     

Anxiety and depression are common in rheumatoid arthritis and correlate with poor quality of life in Indian patients

ObjectivesWe planned this study to assess the prevalence of anxiety and depression in rheumatoid arthritis (RA) patients and its correlation with quality of life (QOL) in these patients.Material and methodsEighty-eight patients (76 females) were included in this cross-sectional study. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. Quality of life was measured using the World Health Organization WHOQOL-BREF. The severity of pain was measured by 100-millimetre-long Visual Analogue Scale (VAS), and functional disability was measured by using the Indian version of the Health Assessment Questionnaire (HAQ). The disease activity was measured by Disease Activity Score for 28 joints with 3 variables.ResultsProbable anxiety and depression were seen in 61 (69%) and 68 (77%) of the patients, respectively. Patients with anxiety had more severe pain (VAS 53.8 ±26.4 vs. 39.7 ±26.1, p < 0.05), and significantly lower scores in all the 4 domains of the WHOQOL-BREF. Patients with depression had more pain (VAS 54.2 ±25.2 vs. 33.5 ±27.3, p < 0.01), higher HAQ scores (1.0 ±0.7 vs. 0.5 ±0.7, p < 0.01), and lower QOL scores. Both anxiety and depression scores had a negative correlation with all the 4 domains of the WHOQOL-BREF. Anxiety had a significant negative effect on psychological (β = –0.58, p < 0.001) and environmental domains (β = –0.39, p < 0.001), while depression had a significant negative effect on psychological (β = –0.57, p < 0.001) and environmental domains (β = –0.53, p < 0.001). Both anxiety and depression predicted more pain in RA patients (β = 0.24, p < 0.001 and β = 0.44, p < 0.001, respectively).ConclusionsAnxiety and depression correlated with poor QOL in all 4 domains of the WHOQOL-BREF. Higher HADS scores had a negative effect on all the domains of the WHOQOL-BREF and predicted more severe pain in RA patients. Thus, patients with RA need to be screened and treated for underlying anxiety and depression to improve their QOL, pain, and functional status.     

硅橡胶假体置换治疗类风湿性跖趾关节病

目的 :探寻类风湿性前足病损的外科治疗方法及效果。方法 :对女性患者 6例 9足 13个RA跖趾关节进行Swan son双柄铰链式硅橡胶假体置换成形术 ,其中 9个第 1跖趾关节 ,第 2及第 3跖趾关节各 2个 ,同期合并手术 3 0多项。手术时平均年龄 47岁 (3 0～ 63岁 ) ,RA病程平均 18年 (13～ 2 8年 )。术后平均随访 2年 (1～ 3年 )。采用美国风湿病学会的足百分评分系统进行术前术后评分 ,包括疼痛、行走能力 (含穿鞋情况 )、畸形 ,以及X线片观察等。结果 :外翻术前平均 42 5° (3 0～ 60°) ,术后平均 15° (10～ 2 5°) ;跖趾关节脱位术前 6个 ,其中 4个行假体置换 ,全部矫正 ;跖趾关节活动度术前平均 2 6° (0～ 45°) ,术后平均 46° (3 5～ 60°) ;疼痛全部解除或缓解 ,行走能力增强 ,穿普通鞋。X线片无关节脱位、假体断裂及骨痂过度生长。病人满意度 10 0 %。综合评分术前平均 45分 (2 0～ 5 5分 ) ,术后平均 90分 (65～ 10 0分 )。优良率 89%。结论 :应用Swanson双柄铰链式硅橡胶假体置换成形术治疗RA跖趾关节病损 ,手术操作简单 ,并发症少 ,临床疗效满意     

Value of dynamic splinting after replacement of the metacarpophalangeal joint in patients with rheumatoid arthritis.

In a retrospective study, we compared a group of 13 patients (41 joints) treated with dynamic splints after replacement of the metacarpophalangeal (MCP) joints with a group of 9 patients (29 joints) not so treated. We failed to confirm our hypothesis, that the range of movement in the joints would be less in the group treated with dynamic splints. Furthermore, residual extension lag was significantly less (p = 0.002) in the treated group. We conclude that postoperative dynamic splinting seems to be useful after replacement of MCP joints with silastic implants.     

云克治疗类风湿关节炎患者合并骨质疏松的临床疗效观察

目的分析云克治疗类风湿关节炎(rheumatoid arthritis,RA)患者合并骨质疏松的临床疗效。方法选取我院2019年1月1日至2019年3月31日住院接受云克治疗的RA患者49名及未接受云克治疗的RA门诊患者30名并随访一年,收集患者临床资料。结果两组患者基线临床资料年龄、病程、体质量指数、晨僵时间、疼痛评分、ESR、CRP、RF、骨密度、关节肿胀及压痛数目差异无统计学意义(P0.05)。使用云克治疗的研究组患者在治疗1年后各项临床指标均低于对照组(P0.05)。研究组经云克治疗后12个月骨密度有所改善(P0.05),而对照组治疗前后腰椎及髋部BMD对比差异无统计学意义(P0.05)。结论云克治疗类风湿关节炎合并骨质疏松不仅有良好的抗炎效果,亦可增加骨密度、抗骨质疏松。