关节镜治疗膝关节局限性色素绒毛结节性滑膜炎的临床疗效

CLINICAL RESULTS OF ARTHROSCOPIC TREATMENT FOR LOCALIZED PIGMENTED VILLONODULAR SYNOVITIS OF KNEE

目的探讨采用关节镜技术治疗膝关节局限性色素绒毛结节性滑膜炎的方法及临床效果。方法2006年2月-12月,收治22例膝关节局限性色素绒毛结节性滑膜炎患者。男8例,女14例;年龄16～35岁,平均24岁。8例有膝关节外伤史,其余无明显诱因。病程1～30个月,平均10个月。主要临床症状为反复膝关节绞锁、肿胀及疼痛。术前Lysholm评分为(68.5±8.2)分,国际膝关节评分委员会(International Knee Documentation Committee,IKDC)评分为(72.7±5.2)分。20例术前膝关节MRI检查见明确病灶,2例未见明确病灶。术中采用常规关节镜入路结合病灶旁辅助小切口完整切除病灶,并切除病灶附着处滑膜。结果术后病理检查均确诊为色素绒毛结节性滑膜炎。术后切口均Ⅰ期愈合,无并发症发生。患者术后均获随访,随访时间18～28个月,平均22个月。2例术后6周屈膝<90°,进行手法松解,最终恢复正常膝关节活动范围。末次随访时19例复查膝关节MRI未见复发;Lysholm评分为(94.5±3.5)分,IKDC评分为(92.8±2.4)分,与术前比较差异均有统计学意义(P<0.01)。结论经关节镜下切除病灶及附着处滑膜,能有效治疗膝关节局限性色素绒毛结节性滑膜炎,且创伤小,可最大程度恢复膝关节功能。

Objective To explore the technique of arthroscopic treatment of localized pigmented villonodular synovitis of the knee and to evaluate its clinical results. Methods From February to December 2006, 22 cases of localized pigmented villonodular synovitis of the knee were treated by arthroscopic excision of the focus and partial synovectomy. There were 8 males and 14 females, with an average age of 24 years old （16 to 35 years old）. Eight patients had a trauma history, the others had no obvious inducement. The disease course was from 1 month to 30 months with an average of 10 months. The Lysholm score was 68.5 ± 8.2, and the International Knee Documentation Committee （IKDC） score was 72.7 ± 5.2 before operation. MRI showed that 20 knees had definite focuses and 2 had no ones. In all the cases, routine arthroscopic approach combined with assistant approach adjacent to the focus was used. Results All the patients were diagnosed as having localized pigmented villonodular synovitis of the knee by pathological examination. The incisions healed at stage 1. No complications occurred after operation. All patients were followed up 18-28 months （average 22 months）. The angle of genuflex was less than 90° in 2 cases after 6 weeks, and the range of motion of the knee was recovery after manipulation release. At last followup, MRI showed no recurrence was found in 19 patients. The IKDC score was 92.8 ± 2.4, and the Lysholm score was 94.5 ± 3.5, respectively, indicating significant differences when compered with before operation （P 〈 0.01）. Conclusion Localized pigmented villonodular synovitis of the knee can be effectively treated by arthroscopic excision of the focus along with a rim of surrounding healthy synovium with most minimal invasive and best knee function.