膝关节内肿物的关节镜检查和手术

Arthroscopic examination and resection of the intra-articular neoplasm of the knee

目的探讨膝关节内肿物的关节镜手术适应证。方法合并关节绞锁症状的膝关节内肿物6例,经CT和或MRI检查,确定肿物位于关节内,遂行关节镜检查和手术。结果诊断分别为腱鞘巨细胞瘤、炎性假瘤、剥脱性骨软骨炎、腱鞘纤维瘤、畸胎瘤和蜡样骨瘤。术后随访1～20个月,症状改善。结论按照肿物来源,可将膝关节内肿物的关节镜检查适应证分为三类:1源于滑膜病变合并关节紊乱者;2怀疑骨骼病变,但有无法解释的关节内症状者;3曾经手术切除的腘窝良性肿瘤,复发症状以关节内症状为主,不接受开放手术者。以上三种情况,经CT和或MRI检查,如肿物位于关节内,可行关节镜检查以进一步诊断。经关节镜检查证实肿物确位于关节内,边界清楚,直径小于5cm者,可行关节镜下肿物切除术。

Objective To disscuss the arthroscopic indications for intra articular neoplasms of the knee joint. Methods Six cases of neoplasms of the knee diagnosed by CT and /or MRI were included in this study. All of the neoplasms were located in the joint cavity and removed by arthroscopy. Results The diagnosis included tenosynovial giant cell tumor, inflammatory neoplasm, osteochondritis dissecans, fibroma of the tendon sheath, dysembryoma and ceroid osteoma, respectively. The symptom was improved during the follow up period from one to twenty months. Conclusion According to the origins of the neoplasm, the indications for arthroscopy included three groups: 1) originate from the synovium that result in derangement of the joint, 2) suspected bone lesion with intra articular symptom, 3) recurrence of benign tumor and the patient does not accept open surgery. If the neoplasm of the knee is located in the joint cavity, clearly demarcated from the adjacent tissue and less than 5 cm in diameter, it may be removed under arthroscopy.