关节镜下和/或切开治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎疗效分析  

EFFECTIVENESS OF ARTHROSCOPY AND/OR ARTHROTOMY THERAPY FOR DIFFUSE PIGMENTED VILLONODULAR SYNOVITIS OF THE KNEE

作　　者：刘东[1] 李棋[1] 蒋勰[1] 唐新[1] 李箭[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2012年第5期518-521,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨关节镜下和/或切开手术辅以术后关节外放疗治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis,PVNS)的方法和疗效。方法 2000年9月-2010年8月,收治97例单膝弥漫型PVNS。男38例,女59例;年龄8～75岁,中位年龄33岁。病程1周～30年;复发患者10例。左膝52例,右膝45例。术前膝关节伸直(1.9±2.3)°,屈曲(122.9±5.6)°;Lysholm膝关节评分为(43.2±6.7)分,国际膝关节文献委员会(IKDC)膝关节功能主观评分为(53.2±5.7)分。根据是否合并关节外病变及病变部位,82例采用关节镜下关节前后病变滑膜切除术,3例采用关节镜下关节内病变滑膜切除联合小切口切除关节外病灶,9例采用关节镜下关节内病变滑膜切除及后方关节外软组织内病灶切除术,3例分期切除病灶并植骨。术后76例接受关节外放疗。结果术中1例损伤腘动脉,3例损伤腘静脉分支;术后3 d 1例膝关节血肿形成。其余患者切口均Ⅰ期愈合,无神经损伤等并发症发生。患者均获随访,随访时间1年3个月～11年2个月,中位时间61个月。89例患者随访期间无复发,术后15个月膝关节伸直(0.2±1.3)°,屈曲(135.9±6.6)°,Lysholm膝关节评分为(89.8±5.8)分,IKDC膝关节功能主观评分为(87.8±5.8)分,与术前比较差异均有统计学意义(P<0.05)。8例于术后6个月～8年复发,再次手术后患者膝关节轻度活动受限,无疼痛、肿胀。结论根据膝关节病变范围及程度,选择关节镜下和/或切开手术辅以关节外放疗治疗膝关节弥漫型PVNS可取得较好疗效。术后未接受正规放疗是复发重要因素之一,复发者病变易导致骨质破坏。Objective To investigate the method and the effectiveness of arthroscopy and/or arthrotomy combined with postoperative radiotherapy for diffuse pigmented villonodular synovitis （PVNS） of the knee. Methods Between September 2000 and August 2010, 97 patients with diffuse PVNS of the knee were treated. There were 38 males and 59 females with a median age of 33 years （range, 8-75 years）. The disease duration ranged from 1 week to 30 years, including 52 left knees and 45 right knees. There were 10 recurrent cases. The extention and flexion of the knee joint were （1.9 ± 2.3）° and （122.9 ± 5.6）°, respectively; the Lysholm score was 43.2 ± 6.7; and the International Knee Documentation Committee （IKDC） score was 53.2 ± 5.7, preoperatively. According to the scope and degree of the knee joint lesions, simultaneous anterior and posterior synovectomy was performed under arthroscopy in 82 cases, synovectomy under arthroscopy and removal of posterior extra- articular lesion by arthrotomy in 3 cases, synovectomy and the soft tissue lesions resection under arthroscopy in 9 cases, and staging resection and bone graft in 3 cases. After operation, 76 patients received postoperative radiotherapy. Results Popliteal artery was injuryed in 1 case and the branch of popliteal veins were injuryed in 3 cases during operation. Intra-articular hemorrhage occurred in 1 case at 3 days after operation. The other patients achieved healing of incision by first intention without nerve damage and other complications. All patients were followed up 1 year and 3 months to 11 years and 2 months （median, 61 months） postoperatively. During follow-up, 89 cases had no relapse. At 15 months after operation, the extention and flexion of the knee joint were （0.2 ± 1.3）° and （135.9 ± 6.6）°, respectively; the Lysholm score was 89.8 ± 5.8; and the IKDC score was 87.8 ± 5.8. All indexes were significantly improved when compared with the preoperative ones （P 〈 0.05）. At 6 months to 8 years postoperatively, 8 cases h

关 键 词：膝关节 弥漫型色素沉着绒毛结节性滑膜炎 关节镜 

分 类 号：R687.4[医药卫生—骨科学]