关节镜下滑膜全切术治疗膝关节慢性滑膜炎

Arthroscopic total synovectomy for treatment of chronic synovitis in the knee

[目的]探讨关节镜下膝关节滑膜全切术的手术方法及临床疗效。[方法]自2007年6月～2010年8月,收治各种原因导致的膝关节反复积液的患者共32例,男18例,女14例;年龄12～64岁,平均36.5岁,病程3个月～5年,平均8.4个月。膝关节慢性感染8例,类风湿性关节炎10例,色素沉着绒毛结节性滑膜炎8例,膝关节滑膜结核3例,不明原因3例。所有患者行关节镜下膝关节滑膜全切术,在常规前内、前外入路的基础上,结合后内侧、后外侧及髌上外侧入路,6例色素沉着绒毛结节性滑膜炎患者采用跨后纵隔入路。术后配合相应的药物治疗。[结果]所有患者均获得随访,随访时间24～46个月,平均30.5个月。2例色素沉着绒毛结节性滑膜炎患者手术24个月后膝关节肿胀复发,余患者关节肿胀消退,浮髌试验阴性。末次随访时膝关节屈曲由术前的(36.25±7.93)°增加到术后(120.00±13.20)°,Lysholm评分由术前的(34.84±7.04)分提高到术后(85.00±5.75)分,优良率87.50%。[结论]通过关节镜技术能彻底切除膝关节滑膜,创伤小,能最大程度的恢复膝关节功能。

[ Objective] To explore the technique of total synovectomy in the knee under arthroscope and to evaluate its clinical results. [ Methods] From June 2007 to August 2010, 32 cases of recurrent knee effusion were treated by arthroscopic surgery, including 18 males and 14 females with an average age of 36. 5 years （ 12 to 64 years） . The average preoperative histo- ry was 8.4 months （ 3 months to 5 years） . All patients complained knee pain, limitation of motion and repeated swelling. There were 8 cases of chronic infection of knee, 10 cases of rheumatic arthritis, 8 cases of pigmented villonodular synovitis, 3 cases of synovium tuberculosis, and the last 3 cases were uncertain even after surgery. All patients were treated by total synovectomy un- der arthroscopy using routine anterior approach, combined with posteromedial, posterolateral and superolateral of patella ap- proach. Additional trans - septal approach was used in 6 cases of pigmented villonodular synovitis. Suitable drugs were used after surgery. [ Results] All patients were followed up for 24 - 46 months with an average of 30. 5 months. Knee swelling recurred in 2 cases of pigmented villonodular synovitis 24 months after surgery, but it was relatively slight compared with preoperation and relieved after joint puncture and expectant treatment continued till now. Knee swelling subsided with negative floating patella test in other patients. The range of knee flextion improved from （ 36. 25 ±7.93 ） °preoperatively to （ 120. 00 ± 13.20 ） ° （ P 〈 0. 01 ） at the last follow - up. The Lysholm score improved from （ 34. 84 ± 7.04） preoperatively to （ 85. 00 ± 5.75 ） （ P 〈 0. 01 ） at the last follow -up with an excellent and good result rate of 87.50% （6 cases as being excellent, 22 good and 4 fair） . [ Conclu- sion ] Total synovectomy under arthroscopy is easy to obtain a thorough debridement of the knee, the procedure is minimally in- vasive and useful to restore knee function.