开放手术与关节镜下滑膜切除治疗膝关节绒毛结节性滑膜炎的比较

Comparison of open and arthroscopic synovectomy methods in treatment of pigmented villonodular synovitis

目的比较开放滑膜切除(OG)与关节镜下滑膜切除(AG)两种方法治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎(PVNS)的复发率、复发时间、Lysholm和IKDC膝关节评分。方法 46例术后病理证实为PVNS患者分别行OG(19例)和AG(27例)治疗。OG组采用膝关节前后联合入路进行滑膜切除,AG组通过高位前外侧、标准前内侧、后内外侧以及髌上外侧的关节镜入路完成滑膜切除。结果 46例均获12个月以上随访:OG组为12～60(31±14.7)个月,AG组为12～72(35±17.8)个月。复发率:OG组为15.8%(3/19),AG组为18.5%(5/27)(P>0.05)。复发时间:OG组为2～4年,AG组为0.5～4年。两组的膝关节活动度、Lysholm和IKDC膝关节评分:OG组分别为(134.2±22.1)°、(79.8±8.4)分、(81.9±9.3)分,AG组分别为(139.2±17.9)°、(81.6±9.3)分、(85.2±7.6)分,两组各项比较差异均无统计学意义(P值分别为0.397、0.504、0.193)。除AG组1例复发于术后6个月外,余复发病例均>2年。结论两种方案的复发率相当,膝关节评分也无明显差异,均可作为弥漫型PVNS的治疗选择。

Objective To compared the ratio and time of recurrence and Lysholm and International Knee Documenta- tion Committee（IKDC） knee score of diffuse pigmented villonodular synovitis （PVNS）of knee in both open operation group（OG） and arthroscopic group（AG）. Methods 46 cases postoperatively diagnosed as PVNS by pathological examination were operated in open or arthroscopic methods. Among them 19 and 27 cases were divided into OG and AG. Recurrence,range of motion, Lysholm and IKDC knee score were analyzed and compared in both groups. Combined anterior and posterior knee approach was applied to complete synovectomy in OG,while high anterolateral, standard anteromedial, posterolateral, posteromedial and superpatellar portal were applied to complete synovectomy in AG. Results All of 46 cases had been followed up for more than 12 months. Averaged follow-up in OG and AG were respective 12 -60（31 ± 14. 7） and 12 ~72（35±17. 8） months;recurrence rate were 15.8% and 18.5% in OG and AG（P 〉 0. 05 ）. While postoperative range of motion, Lysholm and IKDC knee score were 134. 2° ± 22. l °,79.8 ± 8.4 and 81.9 _ 9.3 in OG, and 139.2° ＋ 17. 9°,81.6± 9. 3 and 85.2 ± 7.6 in AG（ P = 0. 397,0. 504 and 0. 193 ）. The time of recurrence ranged respectively from 0. 5 -4 and 2 -4 years in AG and OG. There were no statistical difference in Lyshohn and IKDC score, range of motion,recurrenee rate. All cases relapsed postoperatively more than 2 years except one case postoperatively relapsed at half one year in AG. Conclusions Recurrence and knee evaluation score of knee were similar in PVNS treated by arthroscopic and open operation. Both of them were available for PVNS.