局麻下关节镜术治疗膝关节滑膜软骨瘤

Arthroscopic treatment of knee synovial chondromatosis under local anesthesia

[目的]观察局麻下关节镜手术治疗膝关节滑膜软骨瘤的疗效。[方法]对2010年8月~2015年2月共67例膝关节滑膜软骨瘤的患者在关节镜监视行清除手术,其中男41例,女26例;平均年龄45.2岁(26~67岁);右膝36例,左膝31例;67例患者均在术前明确诊断为膝关节滑膜软骨瘤病;术前主要临床表现为膝关节疼痛、肿胀、关节绞锁等症状。术后立即拍摄X线片,术后4、8和24周,及之后的每6个月均在门诊进行复查随访,末次随访时,对患者进行活动度的测量,以及疼痛视觉模拟评分(VAS)、Lysholm评分和国际膝关节评分委员会IKDC 2000评分。[结果]所有患者术后切口均I期愈合,无相关并发症。67例患者均获得随访,随访时间29.6个月(22~47个月)。末次随访时,术前术后比较,VAS评分由(5.13±1.42)分提高到(1.26±0.54)分(t=5.761,P=0.021),活动度由(68.83±9.23)°提高到(96.62±8.71)°(t=10.283,P=0.008),Lysholm评分由(50.22±6.23)分提高到(78.19±7.15)分(t=-12.372,P<0.001),IKDC 2000评分由(61.36±6.14)分提高到中期(80.07±5.32)分(t=-15.172,P<0.001)。[结论]关节镜下治疗膝关节滑膜软骨瘤创伤小、清理彻底、术后恢复快、中期随访效果确切。

[Objective] To evaluate the clinical outcome of knee synovial chondromatosis treated arthroscopically with local anesthesia. [Methods] From August 2010 to February 2015, 67 patients with knee joint synovial chondromatosis were arthroscopically treated under local anesthesia in our hospital. The patients included 41 males and 26 females with average age of 45.2 years old ranged from 26 to 67 years, with the lesion involving right knees in 36 and left knees in 31patients. Before operation, all the 67 patients were clearly diagnosed as knee joint synovial chondromatosis, associated with clinical manisfestration of knee pain, swelling and locking. X-ray film was taken immediately after operation and at 4, 8, 24 weeks postoperatively. VAS, Lysholm score, IKDC 2000 score as well as range of motion were determined before the operation and at the last follow-up for evaluation of the clinical outcomes. [Results] All the patientswere followed up for an average of 29.6 months ranged from 22 to 47 months. All the patients had primary healing of the incisions without complications. Compared with the preoperative da- ta, VAS （5.1＋ 1.4 versus 1.2~0.5, P=O.021） , Lysholm score （50.22~6.23 versus 78.19＋7.15, P〈0.001） , IKDC score （61.36±6.14 versus 80.07±5.32, P〈0.001） and range of motion （68.8±9.2 versus 96.6±8.7, P=0.008） statistically improved at the latest follow-up. [Conclusion] Arthroscopic surgery for treatment of knee synovial chondromatosis with local anesthesia does achieve satisfactory median-term outcome, with advantages of minimized surgical trauma, thorough resection of the lesion and early functional recovery.