膝色素沉着绒毛结节性滑膜炎的手术治疗

PIGMENTED VILLO-NODULAR SYNOVITIS OF THE KNEE

对12例膝色素沉着绒毛结节性滑膜炎病例的临床观察表明:关节镜检查有助于本病的诊断;局限型可采取单纯结节切除术,而弥漫型应采取综合治疗措施。作者指出,这是防止复发、保持关节正常活动范围行之有效的方法。

Pigmented villonodular synovitis is a kind of chrouic synovitis without definite etiology, characterizedby marked proliferation of synovium with dark red and brownish colour. Pathologically, it can be dividedinto three types: villi type, nodular type and mixed type. On microscopic examination the villi of the syno-vium present a structure of multiple nucleated macrocytes and hemosiderin molecular deposits are usuallyfound in it. However, in nodular type, dense networks of collagenous fibers, crowded synovial cells andspindle-shaped fibroblasts are usually prominent. In this article 12 cases of the knee joint involved were reported. Among them nine were diffuse in natureand three were simple nodular type, male 9 and female 3. The age range is 20-40. Six cases had a definit his-tory of knee injury or surgical operation. The main complaint was recurrent knee pain with marked jointeffusion. The synovial fluid was usually of yellowish or brownish colour. An irregular wavy outline of thesuprapatellar pouch with a number of round shape soft tissue shadows could be demonstrated by X-ray pneu-arthrogram. In this series three cases of nodular type were treated by local excision. In cases of diffuse type, partialsynovectomy was done, followed by X-ray therapy (1200-3000) roentgen and manipulation under general anes-thesia one month after operation. In six cases, a small piece of silicone membrane was put into the supra-patellar pouch during the operation of synovectomy in order to prevent joint adhesion. After 1-23 years follow-up, the results showed that 10 cases have regained a normal range of kneemovement. 1 case could only flex her knee to 95 degrees because of severe osteoarthritic changs of the kneeand heavy reaction of radiotherapy. No case of recurrence was found in this series. Based upon what mentioned above, we believe that in treatment of this kind of disease particularly incase of diffuse type, partial synovectomy with interposing silicone membrane, radiotherapy and manipulation,if necessary, may be the best way of choice.