关节镜下诊疗膝关节滑膜血管瘤病八例报告

Diagnosis and treatment of intraarticular synovial hemangioma of the knee under arthroscope:8 cases report

目的：对8例膝关节内滑膜血管瘤病例进行回顾性分析，探讨膝关节内滑膜血管瘤的临床特点及关节镜下治疗体会。方法回顾性分析自2008年7月至2013年1月，收治的8例膝关节滑膜血管瘤患者，男3例，女5例，年龄11～39岁，平均24.1岁，左膝5例，右膝3例。所有病例均采用关节镜下手术治疗。随访术后膝关节功能恢复情况，采用改良HSS评分进行膝关节功能评定。结果术后8例均获随访，随访12～45个月，平均29个月。术后4周时，所有患者症状明显改善或消失，较术前关节功能明显改善，术前HSS评分：38±6.9，术后4周HSS评分，97±1.7，差异有高度统计学意义（ P＜0.001）。术后6个月、1年、2年、4年较术后4周时关节功能无统计学意义。所有患者至末次复诊均未见复发。结论血管瘤极易漏诊误诊，术前仔细查体，结合磁共振及彩超检查有助于提高膝关节滑膜血管瘤的诊断准确率。关节镜诊治本病疗效确切，关节功能得以早期恢复。

Objective To retrospectively analyze 8 cases of intraarticular synovial hemangioma of the knee and to investigate its clinical features and the experience of arthroscopic treatment.Methods From July 2008 to January 2013, 8 patients with intraarticular synovial hemangioma of the knee were adopted, including 3 males and 5 females. Their average age was 24.1 years old （ range： 11-39 years ）. Lesions were found in the left knee （n=5 ） and in the right knee （n=3 ）. Arthroscopic surgery was performed on all the patients. The improved Hematological Scoring System （ HSS ） was used to evaluate the postoperative recovery of the knee.Results All the 8 patients were followed up for an average period of 29 months （ range： 12-45 months ）. At 4 weeks after the operation, the symptoms of all the patients were obviously relieved or disappeared, which were greatly improved when compared with that before the operation. The preoperative HSS score was 38±6.9 points, which was 97±1.7 points at 4 weeks after the operation. The differences between them were statistically signiifcant （P〈0.001 ）. No statistically signiifcant differences existed in the joint functional recovery at 6, 12, 24 and 48 months after the operation, when compared with that at 4 weeks after the operation. No recurrence was found in all the patients until the latest subsequent visit.Conclusions The missed diagnosis and misdiagnosis frequently occur in the treatment of intraarticular synovial hemangioma of the knee. The diagnostic accuracy rate can be improved with careful physical examination, Magnetic Resonance Imaging （ MRI ） and color Doppler ultrasound. The curative effects of arthroscopic surgery are satisfactory, and the joint function will recover earlier.