Langfristige Ergebnisse nach Synovektomien am oberen Sprunggelenk des Rheumatikers

S. Anders; J. Schaumburger; S. Kerl; S. Schill; J. Grifka
November 2007
Zeitschrift für Rheumatologie;Nov2007, Vol. 66 Issue 7, p595
Academic Journal
Zusammenfassung  Entz�ndlich rheumatische Ver�nderungen am R�ckfu� des Rheumatikers gef�hrden dessen Mobilit�t durch Schmerz und Funktionsverlust. In unserem Patientengut erfolgte bei 29 Patienten nach 14,3 Jahren Rheumatoide-Arthritis- (RA-)Dauer und durchschnittlich 7,6 Jahre nach lokaler Manifestation eine Synovektomie des oberen Sprunggelenks (OSG) mit fakultativer Begleittenosynovektomie. Erkrankungsdauer und das Vorherrschen definitiver radiologischer Ver�nderungen (81% Larsen, Dale, Eek/LDE 2–3) charakterisieren die durchgef�hrten Eingriffe als Sp�tsynovektomien. Der hohe Anteil an Begleittenosynovektomien (93%) sowie die hohe Inzidenz radiologischer Ver�nderungen der Anschlussgelenke des R�ckfu�es (Kalkaneokuboidalgelenk/CC-Gelenk, Talonavikulargelenk/TN-Gelenk, unteres Sprunggelenk/USG) deuten auf eine gelenk�bergreifende Pathologie durch die RA hin. Eine radiologische Progression der LDE-Klasse fand sich bei 62% der Gelenke. Der signifikante Anstieg des Kofoed-Scores von 42,4 auf 55,9 Punkte (p=0,042) war ma�geblich durch die Schmerzreduktion und geringer auch durch einen Funktionszuwachs begr�ndet, w�hrend bei der Rubrik Mobilit�t Einbu�en zu verzeichnen waren. Die durchschnittliche Schmerzintensit�t auf der visuellen Analogskala (VAS) sank signifikant von 7,6 auf 3,3 (p


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