Artroskopska sinoviektomija lakta u bolesnika s reumatoidnim artritisom

master's thesis

• Title (english): Arthroscopic synovectomy in patients with rheumatoid arthritis
• Author: Filip Anton Božinović
• Mentor: Ivan Bojanić (mentor)
• Committee member: Damjan Dimnjaković (predsjednik povjerenstva)
• Committee member: Tomislav Đapić (član povjerenstva)
• Committee member: Ivan Bojanić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Orthopedics); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Orthopedics

Abstract

Reumatoidni artritis (u daljnjem tekstu RA) najčešća je upalna bolest zglobova i zahvaća oko 1% populacije, a lakat je zahvaćen u 20% - 65% slučajeva. Sinovijalna ovojnica prvenstveno je zahvaćena upalnim procesom što dovodi do nepovratnog oštećenja priležeće hrskavice i kosti ako se ne liječi. Bolesnici kod kojih se perzistentni sinovitis lakta praćen bolovima tijekom 6 mjeseci ne povlači na primjenu odgovarajuće medikamentozne terapije kandidati su za artroskopsku sinoviektomiju lakta. Glavni ciljevi ovog istraživanja bili su usporediti rezultate MEPS upitnika dobivene prije i nakon učinjene artroskopske sinoviektomije lakta kod bolesnika s RA, kao i analizirati ishod artroskopske sinoviektomije lakta kod bolesnika s RA s obzirom na radiološku klasifikaciju prema utvrđenim promjenama na rendgenskim snimkama lakta te ih usporediti s rezultatima drugih istraživanja. Hipoteza istraživanja je da će rezultat u MEPS upitniku nakon artroskopske sinoviektomije biti statistički značajno bolji od rezultata dobivenog tim upitnikom prije zahvata. Pretraživanjem operacijskih protokola Klinike za ortopediju Kliničkog bolničkog centra Zagreb i Medicinskog fakulteta Sveučilišta u Zagrebu pronađena je serija od 22 uzastopno liječenih bolesnika oboljelih od RA kojima je u Klinici u razdoblju od 1.1.2008. do 1.1.2020. učinjeno sveukupno 26 artroskopskih sinoviektomija lakta. 20 bolesnika kojima su učinjene sveukupno 24 artroskopske sinoviektomije odazvali se na poziv na sudjelovanje u istraživanju. Duljina praćenja ispitanika izračunata kao razdoblje od dana operacije do dana pregleda provedenog za potrebe ovog istraživanja prosječno je iznosila 102,04 mjeseca (raspon 26 - 169). Ispitanici su u MEPS upitniku provedenom prije zahvata ostvarili prosječno 60,00 bodova (raspon 40 - 70), a nakon zahvata prosječno 78,70 bodova (raspon 45 - 100) što se pokazalo statistički značajnim (P<0.05) te je hipoteza istraživanja potvrđena. Ispitanici su u 60,87% slučajeva imali odličan ili dobar rezultat prema MEPS upitniku, a u 86,96% slučajeva izrazili su zadovoljstvo ishodom učinjenog zahvata. Nakon jednog zahvata (4,34%) došlo je do komplikacije u smislu prolaznog ispada osjeta u području ulnarnog živca nakon kojeg je tijekom praćenja došlo do spontanog oporavka te je nakon jednog zahvata (4,34%) zbog povrata boli i otekline u operiranom laktu bilo potrebno ponovno učiniti artroskopsku sinoviektomiju 47 mjeseci nakon prvotnog zahvata. Ovo istraživanje pokazalo je kako je artroskopska sinoviektomija lakta kod bolesnika s RA siguran i učinkovit zahvat kojim je moguće postići dugoročno zadovoljavajuće rezultate čak i kod bolesnika s visokim radiološkim stupnjem zahvaćenosti lakta prema Larsenovoj radiološkoj klasifikaciji.

Abstract (english)

Rheumatoid arthritis (in further text RA) is the most common inflammatory joint disease and affects around 1% of the population with the elbow being affected in 20% - 65% of patients. The synovium is the primary site of the inflammatory process, which if untreated leads to irreversible damage to the adjacent cartilage and bone. Patients with a persistent, painful synovitis which does not resolve after 6 months of adequate pharmacological treatment are candidates for arthroscopic synovectomy of the elbow. This study aimed to compare the MEPS scores obtained before and after arthroscopic synovectomy of the elbow in patients with RA, as well as to analyze the outcome of arthroscopic synovectomy of the elbow in patients with RA based on radiographic changes on elbow X-rays and compare it to the results of other studies. Hypothesis of the study was that the MEPS score obtained after arthroscopic synovectomy will be statistically significantly better than the MEPS score obtained before the procedure. A hand search of operating room logs from the Department of Orthopaedic Surgery University Hospital Centre Zagreb was performed and it was found that 26 consecutive arthroscopic synovectomies of the elbow were performed in 22 patients with RA between January 1, 2008 and January 1, 2020. 20 patients in which 24 arthroscopic synovectomies were performed agreed to participate in the study. Duration of follow-up, calculated as the period from the day of surgery until the day of the examination performed for the purpose of this study, averaged at 102,04 months (range 26 - 169) The MEPS score before the procedure averaged at 60.00 points (range 40 - 70) and after the procedrue it averaged at 78.70 points (range 45 - 100), which was shown to be statistically significant (P<0.05), confirming the hypothesis of the study. The patients had excellent or good results based on the MEPS score in 60,87% of cases and expressed satisfaction with the outcome of the procedure in 86,96% of the cases. There was a complication after one procedure (4,34%), a transient sensory neuropathy of the ulnar nerve which resolved spontaneously. Also, one patient (4,34%) required a repeat arthroscopic synovectomy 47 months after the initial procedure due to the return of pain and swelling of the operated elbow. This study has shown that arthroscopic synovectomy of the elbow in patients with RA is a safe and effective procedure with which it is possible to achieve long-term satisfactory results, even in patients with a high radiographic grade of elbow affliction according to the Larsen grading system.

• Keywords: artroskopija; sinoviektomija; lakat; reumatoidni artritis
• Keywords (english): arthroscopy; synovectomy; elbow; rheumatoid arthritis
• Language: croatian
• URN:NBN: urn:nbn:hr:105:824054
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-01-04 09:44:27