摘要:目的:探討關(guān)節(jié)鏡微創(chuàng)手術(shù)對膝關(guān)節(jié)色素沉著絨毛結(jié)節(jié)性滑膜炎的診斷和治療價值。方法:本組12例,男7例,女5例,年齡18～46歲,平均33歲;病史2～60個月,平均16個月;其中左膝8例,右膝4例;初次就診11例,外院開放手術(shù)后復(fù)發(fā)1例。所有病例術(shù)前均行MRI檢查,并行關(guān)節(jié)鏡檢,滑膜切除,記錄該病在關(guān)節(jié)鏡下的表現(xiàn)形式(局灶型或彌漫型),樣本全部送病理檢查。術(shù)后加壓包扎、局部冰敷并按計劃功能鍛煉,術(shù)后3～4周行患膝放射治療。結(jié)果:本組12例,其中局灶性病例8例,彌漫性4例,術(shù)后病理檢查確診;所有病例獲得了3~21個月,平均13個月隨訪,未見復(fù)發(fā);術(shù)前Lysholm評分(62.3±2.4)分;國際膝關(guān)節(jié)評分委員會(IKDC)膝關(guān)節(jié)功能主觀評分(56.4±31)分;術(shù)后3月復(fù)查Lysholm評分(82.5±3.2)分;IKDC主觀評分(85.3±2.5)分。除1例開放手術(shù)后復(fù)發(fā)病例術(shù)后3月膝關(guān)節(jié)屈曲受限(80°)外,其余患者功能良好。結(jié)論:關(guān)節(jié)鏡手術(shù)創(chuàng)傷小,顯露充分,病灶切除徹底,術(shù)后功能恢復(fù)理想,輔以放射治療可有效降低復(fù)發(fā)率,對膝關(guān)節(jié)色素沉著絨毛結(jié)節(jié)性滑膜炎具有較高的診治價值。
Abstract: Objective: To evaluate the role of arthroscopy in the diagnosis and treatment in knee joint pigmented villonodular synovitis. Methods: 12 cases of knee joint pigmented villonodular synovitis with the age of 18 to 46 years old were treated with arthroscopical synovectomy with a combined application of postoperative exercise and radiotherapy. The history of disease was 2 to 60 months, with the mean of 16 months. The clinical data were reviewed when followedup and evaluated by Lysholm score and and IKDC score. Results: 12 patients diagnosed by pathologic examination,including 8 localized and 4 diffused, were followed up for 3 to 21 months(13 months on average)with no relapses at the time of followup. Lysholm score was (62.3±2.4)points preoperatively, but (82.5±3.2) points 3 months later.The International Knee Documentation Committee (IKDC) score was (56.4±3.1) and (85.3±2.5) respectively before surgery and 3 months later. All patient remained good functions of knee joints except one who relapsed after open operation. Conclusion:In case of pigmented villonodular synovitis of the knee joint, arthroscopical synovectomy combined with postoperative radiotherapy and physical exercise is an effective treatment with less invasion and better function than open operation.

引用本文： 陳剛,葉永杰,陽波,羅斌,銀毅,冉俊輝,張曉. 關(guān)節(jié)鏡診治膝關(guān)節(jié)色素沉著絨毛結(jié)節(jié)性滑膜炎的初步療效觀察. 華西醫(yī)學(xué), 2009, 24(11): 2954-2956. doi: 復(fù)制