膝关节色素绒毛结节性滑膜炎治疗方法的选择

The Clinical Treatment and Analysis for Different Kinds of Pigmented Villonodular Synovitis on the Knee

目的探讨不同类型膝关节色素绒毛结节性滑膜炎的最佳临床治疗方案选择并对此进行总结。方法回顾性研究2004年8月至2015年8月我科收治的经术后病理证实的膝关节色素绒毛结节性滑膜炎31例;主要临床表现为膝关节的反复肿胀、积液及持续疼痛,关节穿刺液为黄褐色、铁锈色或陈旧血性液,部分患者X线检查可见关节软骨退行性改变或软骨多部位小范围侵蚀样改变;根据病史、临床表现、年龄、影像学表现及对治疗效果期望值综合分析后,26例行关节镜下关节内病变切除(ASR组),5例行人工全膝关节表面置换术(TKA组)。结果 ASR组采用Lysholm膝关节评分,由术前的(44.8±2.5)分增加到术后(85.8±2.8)分,差异有统计学意义(t=55.695,P=0.000);TKA组采用美国特种外科医院评分(HSS评分),由术前(49.4±8.8)分提高到术后的(85.4±11.6)分,差异有统计学意义(t=5.529,P=0.001)。结论对关节色素绒毛结节性滑膜炎,应根据患者年龄、临床症状、疾病分型等个体化治疗,常可获得满意疗效。

Objective To explore and summarize the best clinical treatment options for different types of pigmented villonodular synovitis on the knee.Methods A retrospective study of 31 patients with pigmented villonodular synovitis which were confirmed by postoperative pathology,were treated in our department from August 2004 to August 2015.The clinical manifestationin cluded knee repeated swelling,fluid and persistent pain,yellow brown joint puncture fluid,and rusty or old blood solution.The X-rays of showed articular cartilage had degenerative change or small-scale multi-section erosion change in some patients.There were 26 patients underwent of arthroscopy （ASR group） and 5 patients underwent of total knee arthroplasty（TKA group）,according to history,clinical manifestations,age,imaging performance and expectations of treatment.Results The Lysholm knee score in ASR group increased from preoperative （44.8±2.5） points to postoperative （85.8±2.8） points,the difference was significant（t=55.695,P=0.000）;the HSS in TKA group increased from preoperative （49.4±8.8） points to postoperative （85.4±11.6） points,the difference was significant（t=5.529,P=0.001）.Conclusion For pigmented villonodular synovitis on the knee,should be individualized treated based on the patient age,clinical symptoms,and disease classification.Only in this way can the patient achieve satisfactory outcomes.