关节镜下诊治膝关节弥漫性色素沉着绒毛结节性滑膜炎

Diagnosis and treatment of diffuse pigmented villonodular synovitis of knee joint under arthroscopy.

目的探讨采用关节镜技术诊治膝关节弥漫性色素沉着绒毛结节性滑膜炎的临床疗效。方法自2009年3月至2011年5月关节镜下诊治膝关节弥漫性色素沉着绒毛结节性滑膜炎7例,先行后内、后外侧间室的清理,然后清理髁间窝,交叉韧带表面,前内、外侧间室,内、外侧沟,最后行髌上囊清理,病变组织均送病检。术后常规放置引流管,按计划指导功能训练。结果本组7例患者有4例MRI发现结节病变,诊断为弥漫性绒毛结节性滑膜炎;3例镜检发现术前穿刺液为鲜血或淡黄色液或褐色液。1例伴外侧半月板复杂撕裂;2例合并不同程度的骨关节炎。无一例发生膝关节感染。术后2例行放疗。全部患者获得随访,随访时间12.0～32.0个月,平均21.4月,无膝关节活动受限,未见复发病例。所有患者对术后疗效表示满意。Lysholm膝关节的功能评分由术前的50.7分增加到86.6分。结论关节镜技术诊治膝关节弥漫性色素沉着绒毛结节性滑膜炎是一种创伤小,恢复快,病灶切除彻底,能有效地避免复发的治疗方法。

Objective To investigate the clinical effectiveness of arthroscopic technique in the treatment of diffuse pig mented villonodular synovitis of knee joint. Methods From March 2009 to May 2011, 7 cases of diffuse pigmented villonodular synovitis of knee joint were treated under arthroscopy, including four males and three females with age ranging from 18 to 80 years （mean, 42. I years）. All patients were subjected to arthroscopic resection with synovectomy according to priority from the posterior medial and lateral compartment, to the intercondylar fossa, the surface of cruciate ligament, the medial and lateral compartment, and finally to the surprapatellar bursa. All the resected masses were examined pathologically after the surgery, and the patients received intra-anticular drainage, and functional exercises were done afterwards. Results MR1 showed characteristic nodular lesions in the synovium of four cases, and in the three cases, arthroscopy revealed the characteristic blood or light yellow liquid or brown liquid of the joint. There was one case of lateral meniscus complex tear, and two cases of different degrees of osteoarthritis. No knee joint infection occurred. The radiotherapy was performed on 2 cases after operation. Seven patients were followed up for 12 to 32 months （mean 21.4 months）. There was no limitation of the knee joint movement. There were no recurrent cases during the follow-up period. All patients were satisfied with the treatment. The Lysholm Knee Scoring was increased form 50. 7 to 86. 6. Conclusion Arthroscopy is effective in the diagnosis of diffuse pigmented villonodu- lar synovitis and complete arthroscopic excision can be considered the effective treatment for diffuse pigmented villonodular synovitis. Arthroscopic synovectomy, with its advantage of minor invasiveness and rapid function recovery, and complete resection, and avoidance of recurrence, can be the first choice for the treatment of diffuse pigmented villonodular synovitis of the knee joint.