全膝关节置换术治疗膝关节色素沉着绒毛结节性滑膜炎的临床效果观察

Study on clinical efficacy of total knee arthroplasty in the treatment of pigmented villonodular synovitis

目的 分析全膝关节置换术、关节镜下滑膜组织切除术对膝关节色素沉着绒毛结节性滑膜炎（PVNS）的临床治疗效果.方法 对2011年3月至2013年3月收治的PVNS行外科治疗患者30例[行关节镜手术者20例（关节镜组）,行全膝关节置换术者10例（全膝关节置换组）]进行回顾性分析,通过分析术前及术后随访结果,比较2组术后关节功能改善情况.结果 关节镜组绒毛型、结节型和混昆合型分别为6、12和2例;全膝关节置换组分别为3、2和5例.关节镜组术后8个月Lysholm评分和关节屈伸活动度均高于术前,差异有统计学意义[分别为（89±11）分比（60±8）分,t=-7.79,P＜0.01;（108±16）.比（72±12）°,t=-3.54,P＜0.01].全膝关节置换组术后的HSS评分和关节屈伸活动度也明显高与术前[分别为（84±11）分比（64±5）分,t=-5.75,P＜0.01;（132±18）°比（69±12）°,t=-3.54,P＜0.01],且全膝关节置换组的关节屈伸活动度术后明显好于关节镜组患者,差异有统计学意义（P＜0.05）.术后8个月关节镜组和全膝关节置换组国际膝关节评分委员会膝关节评估表评分均高于术前[分别为（81 ±11）分比（62±10）,（93±13）分比（58±9）分,均P＜0.01],且全膝关节置换组术后高于关节镜组,差异有统计学意义（P＜0.01）.术后2组患者均未见复发.结论 全膝关节置换术治疗不同程度PVNS的效果好于关节镜下滑膜组织切除术,可有效改善临床症状.

Objective To retrospectively analyze the clinical effects of total knee replacement surgery and arthroscopic resection of the knee joint synovial tissue in pigmentation villonodular synovitis.Methods Patients with pigmented villonodular synovitis treated by surgery pigment from March 2011 to March 2013 were selected and the clinical data was analyzed retrospectively.Results Hair type,nodular type and mixed type in arthroscopy synovectomy group were 6 cases,12 cases,2 cases respectively; those in the total knee replacement group were 3 cases,2 cases and 5 cases respectively.The imaging results were in accordance with Gitelis classification;there were 12 cases of grade 1 change,8 cases of 2 level change in the arthroscopy synovectomy group; 1 case was level 2 change and 9 cases was level 3 changes in the total knee replacement group.The Lysholm score and range of motion in arthroscopy synovectomy group were significantly higher than before [（89 ± 11） vs （60 ± 8）,t =-7.79,P 〈0.01 ; （108 ± 16） ° vs （72 ± 12） °,t =-3.54,P 〈0.01].The HSS score and range of motion in total knee replacement group were significantly higher than before [（84 ± 11） scores vs （64 ± 5） scores,t =-5.75,P 〈 0.01 ;（132 ±18）° vs （69 ± 12）°,t =-3.54,P 〈0.01].Range of motion in the total knee replacement group were clearly better than those in arthroscopy synovectomy group （P 〈 0.05）.The IKDC scores after 8 months in the two group were both significantly higher than before （P 〈 0.05）.IKDC scores in the total knee replacement group were significantly higher than those in arthroscopy synovectomy group and the difference was statistically significant（P 〈0.05）.No recurrence was found in both group.Conclusion Total knee replacement surgery and arthroscopic synovial tissue resection are effective in treating various degrees of knee pigmented villonodular synovitis with low recurrence rate.