膝关节滑膜炎的病因学诊断及其意义

Etiological diagnosis and its significance of synovitis of the knee joint

膝关节滑膜炎是一种常见的炎症性疾病。主要症状为关节肿胀感,可以伴有或不伴有膝关节疼痛及活动受限。典型体征包括关节肿胀、浮髌试验阳性、可有屈伸受限或股四头肌废用性萎缩,超声或磁共振检查可见明显增生的滑膜组织和多于生理状态的关节积液。根据以上表现,滑膜炎的临床诊断比较容易,但由于病因复杂,有些是系统性疾病如自身免疫性疾病的局部表现,需要长期正规药物治疗;有的滑膜炎如色素沉着绒毛结节性滑膜炎,因治疗后容易复发而需要辅以放射治疗,故不应满足于滑膜炎的临床诊断,更应高度重视其病因学诊断,针对病因进行治疗,这样才有可能持久缓解关节症状并改善关节功能,达到并维持良好的治疗效果。

Knee synovitis is a common inflammatory disorder of the joint.Joint swelling is its main symptom with or without pain and limitation of movement.Typical physical signs include swelling,positive floating patella test,with or without limitation of range of motion and disuse muscular atrophy.Obvious hyperplasia of synovium and abnormal increase of joint effusion can be seen through ultrasound and MRI examination.According to the above manifestations,it is easy to make the clinical diagnosis of synovitis,but the etiological diagnosis is much more difficult and important because of the complexity of the causes of synovitis.Some synovitis caused by autoimmune diseases such as rheumatoid arthritis(RA)or systematic lupus erythematosus(SLE)needs long-term regular medication treatment;some synovitis like pigmented villonodular synovitis(PVNS)needs radiological therapy for its high recurrence rate.Therefore,etiological diagnosis is very critical for lasting relief of the symptom and function and also for better and persistent clinical outcome.