Objective: To observe the therapeutic response of radiosynovectomy with p-32 colloid on hemophilic arthropathy, and to assess the effects of radiosynovectomy with Denver Score on hemophilic arthritis staging. Methods: Radiosynovectomy with p-32 colloid was performed on 326 hemophilic arthritis patients (405 joints) , and recorded bleeding before and after treatment. The MRI performance of 102 joints was evaluated by using Denver scoring system, then was divided into 0-6 and 7-10 groups. Finally, the differences between 2 groups were analyzed. Results: Average pain score of all hemophilic arthritis patients at 6 months, 1, 2 and 3 years post treatment decreased from 3.2±2.4 (n=326) to 1.2±0.6 (n=285, P=0.021) , 1.7±0.5 (n=242, P=0.032) , 2.1±1.1 (n=212, P=0.030) and 2.2±1.6 (n=176, P=0.037) , respectively. The frequency of bleeding in 405 joints at 1, 2 and 3 years post treatment decreased from 15.1±3.6 to 2.1±0.7, 4.3±0.6, and 4.8±0.8 times per year (P<0.01) , respectively; Meanwhile, the proportions of significantly ameliorated joints' activities were observed as of 68.50% (248/362) , 58.39% (181/310) , 55.67% (162/239) and 42.61% (75/176) , respectively. The frequencies of haemarthrosis at 1 and 2 years post treatment in patients with 0-6 Denver Score (45 target joints) reduced from 13.0±1.9 to 1.3±0.6 (P=0.002) and 3.1±0.9 (P=0.009) times per year, respectively, which also decreased in 7-10 group (57 target joints) from 16.6±2.1 to 3.1±0.9 (P=0.008) and 5.7±1.1 (P=0.004) times per year, respectively. There was no statistical difference between 0-6 and 7-10 groups before treatment in the terms of haemarthrosis frequency (P=0.773) . However, 7-10 group had higher haemarthrosis frequency at 1 and 2 years post treatment compare with 0-6 group (P=0.028 and 0.042, respectively) . Synovial volumes in 29 joints reduced after 6 month when compared with baseline [ (2 362.15±32.41) mm(3) vs (3 012.40±39.78) mm(3), t=7.621, P<0.001]. Conclusion: Radiosynovectomy with p-32 colloid on haemophilic synovitis was a safe and effective procedure. The patients with Denver Score of 0-7 had lower frequency of haemarthrosis.
目的：观察(32)P-胶体滑膜切除术治疗血友病性关节病的疗效，并评估MRI Denver评分对血友病性关节病进行分期的临床意义。 方法：对326例血友病患者的405个关节进行(32)P-胶体滑膜切除术治疗，根据MRI表现对102个关节进行Denver评分并比较0~6分和7~10分组临床疗效的差异，观察29个膝关节治疗前后滑膜体积变化。 结果： ①全部326例血友病性关节病患者治疗前的疼痛评分为（3.2±2.4）分，治疗后6个月及1、2、3年分别为（1.2±0.6）分（285例）、（1.7±0.5）分（242例）、（2.1±1.1）分（212例）、（2.2±1.6）分（176例），均低于治疗前（P值分别为0.021、0.032、0.030、0.037）。②全部326例血友病患者治疗前的出血频次为（15.1±3.6）次/年，治疗后1、2、3年分别为（2.1±0.7）、（4.3±0.6）、（4.8±0.8）次/年，均低于治疗前（P值分别为0.016、0.011、0.025）。③治疗后6个月及1、2、3年靶关节活动度明显改善的比例分别为68.50%（248/362）、58.39%（181/310）、55.67%（162/239），42.61%（75/176）；Denver评分0~6分组治疗后6个月、1年和2年的HSS评分均高于7~10分组（P值分别为0.011、0.007、0.026）。④Denver评分0~6分组（45个靶关节）治疗前出血频次为（13.0±1.9）次/年，治疗后1、2年分别为（1.3±0.6）、（3.1±0.9）次/年，均低于治疗前（P值分别为0.002、0.009）；Denver评分7~10分组（57个靶关节）治疗前出血频次为（16.6±2.1）次/年，治疗后1、2年分别为（3.1±0.9）、（5.7±1.1）次/年，均低于治疗前（P值分别为0.008、0.004）。Denver评分7~10分组治疗前出血频次与0~6分组差异无统计学意义（P=0.773），治疗后1、2年均高于0~6分组（P值分别为0.028、0.042）。⑤29个膝关节治疗后6个月滑膜体积小于治疗前[（2 362.15±32.41）mm(3)对（3 012.40±39.78）mm(3)，t=7.621，P<0.001]。 结论： (32)P-胶体滑膜切除术治疗血友病性关节病安全有效。Denver评分0~6分的患者行滑膜切除术治疗效果更佳。.
Keywords: Hemophilia A; Hemophilia B; Magnetic resonance imaging; Phosphorus radioisotopes; Synovitis.