颞下颌关节囊内色素沉着绒毛结节性滑膜炎的关节镜治疗

Arthroscopic management of intra-articular pigmented villonodular synovitis of temporomandibular joint

目的探讨关节镜在颞下颌关节囊内色素沉着绒毛结节性滑膜炎诊断和治疗中的应用。方法回顾性分析在2002至2009年间接受过关节镜治疗局限于关节囊内经病理确诊为颞下颌关节色素沉着绒毛结节性滑膜炎的4例患者。结果 4例患者中,3例为女性,1例为男性,诊断时平均年龄46岁,共同症状是张口难和疼痛,均无耳前区肿胀或肿块。磁共振成像(MRI)和关节腔造影检查显示关节盘前移位、关节盘穿孔、髁突骨赘形成或关节腔积液。关节镜下观:1例可见关节上腔内一黄色结节和数枚软骨样游离体,其余3例患者可见上腔滑膜局部或全部呈黄色或棕色病理性增生,2例患者可见关节软骨呈退行性变。每例患者均采用局部滑膜切除术和关节面修整术,其中2例年轻患者同时进行关节盘复位缝合固定术。术后病理检查确诊为颞下颌关节色素沉着绒毛结节性滑膜炎。平均随访时间为57.4个月,未见复发。结论本研究提示关节镜是诊断和治疗局限于关节囊内的色素沉着绒毛结节性滑膜炎的一种有效方法。

Objective The objective of this study is to discuss the application of arthroscopy in diagnosis and treatment of intra-articular pigmented villonodular synovitis. Methods This retrospective study reports on four patients with intra-artieular pigmented villonodular synovitis （PVNS） of the temporomandibular joint （TMJ） who were managed with arthroscopy between 2002 and 2009. Results There were three females and one male, with a mean age of 46 years at diagnosis. The common symptoms were trismus and pain. No pre-aurieular swelling or mass was detected. Magnetic resonance imaging （MRI） and arthrography showed an anteriorly displaced disc, disc perforation, osteophyte of the condyle, or increased joint effusion. No neoplasm was suspected radiologically. Under arthroseopy, a yellow nodule and loose bodies were found in one patient, and yellow or brown hyperplasia of the synovial membrane was noted in the other three patients. Degeneration of the articular cartilage was detected in two patients. The arthroscopic procedures used for every patient were partial synovectomy and debridement of articular surfaces. Arthroscopic disc repositioning was performed for the two young patients. Postoperative histological examination verified the diagnosis of PVNS of the TMJ. The average follow-up period was 57.4 months, and no recurrence was found. Conclusions Arthroscopy has proved to be a useful method for the management of intra-articular PVNS of the TMJ.