关节镜监视下微创诊治骨关节良性肿瘤的价值

The value of arthroscopic minimally invasive surgery in diagnosis and treatment of benign bone and joint tumors

目的探讨关节镜微创技术在诊断和治疗骨关节良性肿瘤中的价值。方法采用关节镜微创技术诊治骨关节良性肿瘤20例。男9例,女11例,年龄:19～37岁,平均26岁。病变部位:股骨远端9例,膝关节内6例,跟骨4例,胫骨远端表皮样囊肿1例。术前行 X 线平片、MRI 检查和CT 扫描,ECT 检查12例。骨肿瘤采用 C 型臂 X 线透视或 CT 定位,克氏针钻入病灶内,空芯钻沿导针钻入病变部位,在关节镜监视下刮除肿瘤病灶,采用异体冻干骨充填8例,碳酸化羟基磷灰石水泥6例。关节镜下摘除膝关节内软组织肿瘤6例。结果病理报告膝关节内黄色素瘤6例,股骨骨样骨瘤4例,股骨纤维结构不良3例,非骨化性纤维瘤2例,跟骨骨囊肿4例,胫骨远端表皮样囊肿1例。术后随访平均25个月(7个月～4.6年),无复发,关节无肿胀,运动功能正常。结论关节镜监视下微创治疗骨与关节良性肿瘤,定位准确,操作简便,创伤小,有利于早期功能练习。

Objective To approach the values of arthroscopic minimally invnsive surgery （MIS） in diagnosis and treatment of benign bone and joint tumors. Method 20 cases of benign bone and joint tumors were diagnosed and treated by arthroscopie MIS. There were 9 males and 11 females in the group. Their average age was 26 years old （ from 19 to 37 ）. There diseased region ： 9 in distal femurs, 6 in knee joints, 4 in calcanens, 1 in distal tibia. Plain radiographies, MRI examinations and CT scans were performed with all patients preoperatively, among them 12 patients were inspected by ECT. In the treatments of distal femoral and calcaneal benign tumors, firstly, Kirschner wires were drilled into the pathological regions under the monitor of C-arm; then 6 mm diameter hollow drills were drilled follow the guide Kirschner wires and ran-through the opposite side of cortical bone; then the arthroscope was inserted to check-up the pathological regions, then curettes or bite clamps were inserted from the opposite side to clean up tumor tissues; finally, 8 of the 13 were embedded with allograft gelsiccation bone, other 6 were embedded with carbonate hydroxyapatite cement. One case of distal tibia epidermoid cyst were removed under arthroscope and filled with allograft bone. 6 soft connective tissue tumors in knee articular cavities were removed under the monitor of arthroscope. Result According to pathological reports, 6 were yellow pigments tumors in knee articular cavities, 4 were osteoidosteomas of femoral bones, 3 were osteofibrons dysplasins, 2 were nonossifying fivromas, 4 were bone cysts of calcanenses, one was distal tibia epidermoid cyst. All patients were followed up with 7 months to 4.6 years （ average 25 months）. No recurrence occurred, and their joint functions were well. Conclusion It is an accurate, minimally invnsive and easy to manipulate technology to treat benign bone and joint tumors with the monitor of arthroscope.