关节镜对膝关节滑膜血管瘤的诊断和治疗价值

Arthroscopic diagnosis and treatment on the knee synovial hemangioma

目的探讨关节镜在膝关节滑膜血管瘤的诊断和治疗中的价值。方法通过对5例经关节镜检查并经病理证实为膝关节滑膜血管瘤患者的随访观察,分析其临床表现、彩色超声检查及核磁共振成像的特点,并观察关节镜在滑膜血管瘤的诊断和治疗中的作用。结果疼痛是膝关节滑膜血管瘤的主要表现,但由于疼痛无特异性,临床诊断困难。彩色多普勒检查及核磁共振检查均可发现膝关节内血流丰富的肿块,关节镜下肿瘤表现为增生、扩张、迂曲的血管团。关节镜下肿瘤切除术后随访6～24个月,疼痛症状消失,关节功能恢复良好。结论彩色多普勒超声和核磁共振检查有助于滑膜血管瘤的术前诊断,关节镜检查结合组织活检是确诊本病的重要手段。但要提高早期诊断率,加强对本病的认识是关键,关节镜下肿瘤切除是滑膜血管瘤治疗的有效方法,且镜下手术具有创伤小、并发症少、不影响关节活动等优点。

Objective To discuss the clinical characteristics of synovial hemangioma and evaluate the the usefulness of arthroscopy in the diagnosis and treatment of synovial hemangioma. Methods 5 cases with synovial hemangioma of the knee who underwent arthroscopic tumour resection in our department were followed up. Clinical manifestation, imaging features of colour Doppler and MRI and clinical outcome of those patients were studied. Results Since synovial hemangioma has no specific clinic manifestation, early diagnosis was very difficult. Both MRI and color Doppler yielded specific findings to indicate synovial hemangioma. The diagnosis of all cases was confirmed by arthroscopy and tumor biopsy. The specific finding was masses that made of dilated and circuitous blood vessels on the synovium. The results of all cases showed excellent after arthroscopic excision of the tumor. The pain disappeared and joint function was restored after operation. Conclusions MRI and color Doppler were helpful in the preoperative diagnosis of synovial hemangioma. Arthrosopy was a useful and effective method in the diagnosis and treatment of synovial hemangioma. Comparing to open surgery arthroscopy has many advantages such as less injury, less complications and no affect on joint motion.