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DOI: 10.1055/s-0037-1618134
Dringlichkeit von operativen Eingriffen in der Rheumatologie
Urgency of surgical interventions in rheumatologyPublication History
Publication Date:
20 December 2017 (online)
Zusammenfassung
Die Planung von Operationen bei Patienten mit entzündlich rheumatischen Erkrankungen stellt eine große Herausforderung dar. Neben den unterschiedlichen zugrundeliegenden rheumatischen Erkrankungen, deren Aktivität und Befallsmuster und nicht zuletzt deren begleitende medikamentöse Therapie, muss großen Wert auf die richtige Terminierung der Operation gelegt werden. Bei Weitem nicht alle rheumaorthopädischen Eingriffe sind als elektive Eingriffe einzustufen. Die Schwierigkeit der richtigen Terminierung besteht auch darin, dass aus einem bestehendem Funktionsdefizit oder einer Schmerz situation nur sehr eingeschränkt auf die Dringlichkeit der anstehenden Operation zu schließen ist: Eine zervikale Myelopathie muss nicht zwingend mit einer fulminanten klinischen Symptomatik einhergehen, die grobe Endoprothesenlockerung an Hüft- und Kniegelenk ist nicht selten schmerzarm, aber mit fatalen Folgen bei zu später operativer Intervention. Dieser Beitrag soll einen Überblick über die Krankheitsbilder beim Rheumapatienten geben, die eine rasche operative Intervention erfordern.
Summary
The planning of surgery in patients with inflammatory rheumatic diseases presents a major challenge. In addition to the different underlying rheumatic diseases, their activity and infection pattern and not least their adjuvant drug therapy, great importance must be attached to the correct timing of the operation. By no means can all rheumatic orthopaedic operations be classed as elective surgery. The problem with correct timing is that conclusions as to the urgency of the imminent operation can only be drawn to a limited extent from an existing functional deficit or pain situation. Cervical myelopathy need not necessarily be associated with fulminant clinical symptoms, a gross endoprosthetic loosening at the hip and knee joint is not infrequently almost painless, but the consequences are disastrous if surgical intervention is too late. This article is intended to provide an overview of the clinical symptoms in rheumatic patients who require urgent surgical intervention.
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