膝关节滑膜脂肪瘤病的诊断与治疗

The diagnosis and therapy of synovial lipomatosis of the knee joint

目的 探讨膝关节滑膜脂肪瘤病的命名、诊断及关节镜辅助治疗方法，提高对膝关节滑膜脂肪瘤病的认识。方法 回顾性分析2006年2月至2008年2月收治的9例滑膜脂肪瘤病病例资料，男4例，女5例；年龄32-71岁，平均51．1岁。9例均行病灶清理术，其中8例关节镜下手术，1例开放性手术。4例关节镜下表现为膝关节髌上囊滑膜大量、多发球形和绒毛状突起，绒毛饱满，呈浅黄色，严重时累及膝关节内侧室和外侧室；5例关节镜下表现为滑膜簇状增生，呈手指样。MRI显示关节腔积液，滑膜呈树枝状增生、肥厚。组织学检查显示绒毛最外层为两或三层滑膜细胞，绒毛间质由大量成熟的脂肪细胞构成。全部患者随访6-29个月，平均18．2个月。随访内容包括：病情主诉、膝关节活动度测量及膝关节功能Lysholm评分。结果 随访期间均未再发膝关节肿胀、积液。末次随访膝关节活动度111．67°±11．18°，Lysholm评分（72．44±13．93）分，二者与术前比较[101．11°±16．54°，（40．56±19．93）分]差异均有统计学意义（t值分别为3．447和6．728，P值分别为0．009和0．001）。结论 临床上存在对滑膜脂肪瘤病的认识不足，常与膝关节滑膜脂肪瘤混淆。诊断主要依靠特异性的MRI表现、关节镜下特征及病理改变。对膝关节滑膜脂肪瘤病行关节镜下病灶清理术创伤小、恢复快。

Objective To investigate the denomination, diagnosis, and arthroscopic therapy of synovial lipomatosis of knee joint. Methods Nine cases of synovial lipomatosis were retrospectively evaluated. There were 4 males and 5 females, with an average age of 51.1 years （range, 32-71 years）. All patients were treated surgically, including 1 case of open surgery and 8 case of arthroscopy, with a mean follow-up of 18.2 months （range, 6-29 months）. Under arthroscope, patellar bursa was occupied by light yellow, round and villous processes in 4 cases, medial and lateral compartment were also involved. Synovial membrane manifested ＂finger＂ like clustery hyperplasia in 5 cases. MRI showed effusion of joint and ＂tree＂ like synovial membrane. Histology showed outer sphere of villi was formed with two or three layers of synovial cells, and inner part were filled with amount of mature lipocyte. The content of follow-up include： chief complaints, range of motion of knee joint and Lysholm score. Results No swollen nor effusion of the infected knee was found in all patients during the follow-up. Range of motion was 111.67°±11.18° at last follow-up. Lysholm scores was 72.44±13.93. The difference between results was statistically significant （t=3.447, 6.728, P=0.009, 0.001） compared with preoperative data （101.11°±16.54°, 40.56±19.93）. Conclusion Synovial lipomatosis was usually misdiagnosed as synovial lipoma, and a thorough understanding of this disease is required. A clinical diagnosis comes from significant MRI manifestation, arthroseopie feature and histological finding. With the advantage of mini invasion and early recovery, arthroseopic cleaning is preferred to synovial lipomatosis.