臨床整形外科54巻12号

2019年12月発行

誌上シンポジウム 患者の満足度を高める関節リウマチ手術

関節リウマチの肘関節手術の現状と展望

著者： 那須義久¹ 西田圭一郎²

所属機関： ¹岡山大学病院整形外科 ²岡山大学大学院医歯薬学総合研究科生体機能再生・再建学講座(整形外科)

ページ範囲：P.1213 - P.1219

　人工肘関節置換術(TEA)をはじめ，関節リウマチ(RA)では肘関節の障害に対して手術が必要となる例が以前は多くみられていた．薬物療法の進歩により減少はしているものの，手術適応症例がなくなることはない．本邦では優れた非連結型人工関節が開発され，特に最近いくつかの機種において10年以上にわたって90％を大きく上回るインプラント生存率など，優れた臨床成績が相次いで報告されている．今後は多関節罹患例や高度関節破壊例の減少と，インプラント性能・術式が改善されることでRA肘の手術成績はさらに向上するものと期待される．

参考文献

1) Young BL, Watson SL, Perez JL, et al. Trends in joint replacement surgery in patients with rheumatoid arthritis. J Rheumatol 2018;45(2):158-64.

2) Viveen J, van den Bekerom MPJ, Doornberg JN, et al. Use and outcome of 1,220 primary total elbow arthroplasties from the Australian Orthopaedic Association National Joint Arthroplasty Replacement Registry 2008-2018. Acta Orthop 2019:1-6.

3) Krukhaug Y, Hallan G, Dybvik E, et al. A survivorship study of 838 total elbow replacements:a report from the Norwegian Arthroplasty Register 1994-2016. J Shoulder Elbow Surg 2018;27(2):260-9.

4) Matsumoto T, Nishino J, Izawa N, et al. Trends in treatment, outcomes, and incidence of orthopedic surgery in patients with rheumatoid arthritis:an observational cohort study using the Japanese National Database of Rheumatic Diseases. J Rheumatol 2017;44(11):1575-82.

5) Momohara S, Inoue E, Ikari K, et al. Recent trends in orthopedic surgery aiming to improve quality of life for those with rheumatoid arthritis:data from a large observational cohort. J Rheumatol 2014;41(5):862-6.

6) Momohara S, Yano K, Sakuma Y, et al. Recent orthopedic surgeries aiming to improve quality of life for patients with rheumatoid arthritis. J Rheumatol 2016;43(1):245.

7) Saeki Y, Matsui T, Saisho K, et al. Current treatments of rheumatoid arthritis:from the ‘NinJa’ registry. Expert Rev Clin Immunol 2012;8(5):455-65.

8) 森　俊仁，岩澤三康，高群浩司・他．関節リウマチに対する工藤式type-5の長期成績．日本人工関節学会誌2016；46：469-70．

9) Nishida K, Hashizume K, Nasu Y, et al. A 5-22-year follow-up study of stemmed alumina ceramic total elbow arthroplasties with cement fixation for patients with rheumatoid arthritis. J Orthop Sci 2014;19(1):55-63.

10) Nishida K, Hashizume K, Ozawa M, et al. Results of total elbow arthroplasty with cementless implantation of an alumina ceramic elbow prosthesis for patients with rheumatoid arthritis. Acta Med Okayama 2017;71(1):41-7.

11) Nishida K, Hashizume K, Nasu Y, et al. Mid-term results of alumina ceramic unlinked total elbow arthroplasty with cement fixation for patients with rheumatoid arthritis. Bone Joint J 2018;100-B(8):1066-73.

12) Kondo N, Arai K, Fujisawa J, et al. Clinical outcome of Niigata-Senami-Kyocera modular unconstrained total elbow arthroplasty for destructive elbow in patients with rheumatoid arthritis. J Shoulder Elbow Surg 2019;28(5):915-24.

13) Welsink CL, Lambers KTA, van Deurzen DFP, et al. Total elbow arthroplasty:a systematic review. JBJS Rev 2017;5(7):e4.

14) Ikävalko M, Tiihonen R, Skytta ET, et al. Long-term survival of the Souter-Strathclyde total elbow replacement in patients with rheumatoid arthritis. J Bone Joint Surg Br 2010;92(5):656-60.

15) van der Lugt JC, Geskus RB, Rozing PM. Primary Souter-Strathclyde total elbow prosthesis in rheumatoid arthritis. J Bone Joint Surg Am 2004;86(3):465-73.

16) Hänninen P, Niinimaki T, Flinkkila T, et al. Discovery elbow system:clinical and radiological results after 2- to 10-year follow-up. Eur J Orthop Surg Traumatol 2017;27(7):901-7.

17) Nishida K, Hashizume K, Nakahara R, et al. Short-term results of the PROSNAP linked elbow prosthesis with a snap-in structure and modular flange for the reconstruction of severely damaged rheumatoid elbows. J Shoulder Elbow Surg 2014;23(6):837-42.

18) Ishii K, Inaba Y, Mochida Y, et al. Good long-term outcome of synovectomy in advanced stages of the rheumatoid elbow. Acta Orthop 2012;83(4):374-8.

19) Ishikawa H, Abe A, Kojima T, et al. Overall benefits provided by orthopedic surgical intervention in patients with rheumatoid arthritis. Mod Rheumatol 2019;29(2):335-43.