人工膝关节表面置换术治疗晚期膝关节弥漫型色素绒毛结节性滑膜炎临床疗效

EFFECTIVENESS OF KNEE RESURFACING ARTHROPLASTY IN TREATING LATE-STAGED DIFFUSE PIGMENTED VILLONODULAR SYNOVITIS

目的探讨人工膝关节表面置换术治疗晚期膝关节弥漫型色素绒毛结节性滑膜炎(pigmented villonodular synovitis,PVNS)的方法和疗效。方法 2002年11月-2009年5月,收治11例晚期膝关节弥漫型PVNS患者。男3例,女8例;年龄42～63岁,平均51.2岁。病程2.5～10.0年,平均5.2年。均为单膝发病,左膝7例,右膝4例。9例有膝关节外伤史,2例无明显诱因。术前关节活动度为(90.1±17.2)°。膝关节功能按照美国特种外科医院(HSS)评分为(68.9±8.7)分。患者均于滑膜清除术后行人工膝关节表面置换术。结果 1例术后6d切口皮下浅部感染,经清创后切口愈合;其余切口均Ⅰ期愈合。术后1例膝关节屈伸受限,1例腓总神经出现不完全麻痹,1例患侧小腿深静脉血栓形成,经对症处理后症状消失。患者均获随访,随访时间13～102个月,中位时间38个月。2例自觉膝关节慢性疼痛,对日常生活无明显影响,未作处理。术后12个月1例复发,二次手术后未见复发。X线片检查示未见假体周围透亮线、假体松动、下沉及骨溶解等迹象。末次随访时,关节活动度为(109.1±18.6)°,HSS评分为(86.7±9.3)分,与术前比较差异均有统计学意义(P<0.05);获优6例,良3例,可1例,差1例,优良率为81.8%。结论人工膝关节表面置换同时行滑膜彻底切除术治疗晚期膝关节弥漫型PVNS,可较好恢复膝关节功能,复发率较低,临床疗效可靠。

Objective To explore the method and outcome of knee resurfacing arthroplasty in treating late-staged diffuse pigmented villonodular synovitis（PVNS）.Methods Between November 2002 and May 2009,11 cases of late-staged diffuse PVNS were treated,including 3 males and 8 females with an average age of 51.2 years（range,42-63 years）.The disease duration was 2.5-10.0 years（mean,5.2 years）.Unilateral knee was involved in all patients,including 7 left knees and 4 right knees.Nine patients had a history of trauma and 2 cases had no obvious inducing factors.The range of motion was（90.1 ± 17.2）° and Hospital for Special Surgery Knee Score（HSS） was 68.9 ± 8.7.After synovectomy,knee resurfacing arthroplasty was performed in all patients.Results Superficial infection of the incision occurred in 1 case at 6 days postoperatively and was cured after debridement;other incisions healed by first intention.Limited flexion and extension,incomplete palsy of common peroneal nerve,and deep venous thrombosis occurred in 1 case respectively,and were cured or improved after symptomatic treatment.All the 11 cases were followed up 38 months on median（range,13 to 102 months）.Two cases developed chronic pain and were not given treatment.Recurrence occurred in 1 case 12 months postoperatively and recovered after synovectomy again.X-ray films showed no signs of loosening,sinking,and bone destruction.At last follow-up,the range of motion was（109.1 ± 18.6）° and HSS score was 86.7 ± 9.3,showing significant differences when compared with those before operation（P 0.05）.According to the HSS score system,the results were excellent in 6 cases,good in 3,fair in 1,bad in 1,and the excellent and good rate was 81.8%.Conclusion A combination of knee resurfacing arthroplasty and synovectomy for the treatment of late-staged diffuse PVNS is able to get a good clinical results in restoration of function,improvememt of the life quality,and decrease of recurrence rate.