膝关节色素沉着绒毛结节性滑膜炎关节镜下病理学分级——附15例临床病例报告  

The Characteristics of Pathological Grade of Knee Joint Pigmented Villonodular Synovitis under Arthroscopy-Clinical Case Report of 15 Cases

作　　者：田向东[1] 马玉峰[2] 王庆甫[1] 时宗庭[1] 杜春林[1] 黄沪[1] 杨骁侠[1] 杨会敏[3] 宋妍[3] 

机构地区：[1]北京中医药大学第三附属医院脊柱关节科,北京100029 [2]北京中医药大学 [3]北京中医药大学第三附属医院病理科

出　　处：《中国中医骨伤科杂志》2013年第6期11-13,共3页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:探讨膝关节色素沉着绒毛结节性滑膜炎(PVNS)关节镜下病理学分级特征。方法:搜集我院2007年-2012年所有关节镜病例,对18例经病理证实的PVNS患者的病例资料进行回顾性分析,均行X线片、MRI检查。结果:将膝关节X线、MRI等影像学表现以及关节镜术后病理学表现和镜下病变程度、病变范围进行对照,总结膝关节PVNS镜下病理学分级特征:滑膜细胞病理结果均是PVNS.其中,15例关节镜下可见局限或弥漫性、黄褐色滑膜增生、充血、肥厚或软组织结节,增殖的滑膜簇居成团或绒毛样突出,关节内积液明显,未侵犯关节内其他组织,X线(4/15),MRI(15/15);5例可见滑膜增生并侵犯关节内脂肪垫,X线(0/15),MRI(5/15);4例可见滑膜增生并受累半月板或交叉韧带,X线(0/15),MRI(3/15);2例可见滑膜增生并侵犯关节软骨或骨,X线(0/15),MRI(2/15)。结论:(1)膝关节X线、MRI两种检查中,MRI表现和镜下观察最为相符,因而对PVNS诊断特异性较高;(2)膝关节PVNS根据镜下病理学表现,可分为三级,并根据此分级选择不同的治疗方法;(3)关节镜手术治疗是目前治疗PVNS的最佳方法。Objective： To discuss the characteristics of pathological grade of knee joint pigmented villonodular synovitis （PVNS） under arthroscopy. Methods： All the cases were collected who received arthroscopy from 2007 to 2012, among which 18 cases of PVNS confirmed by pathology were retrospectively analyzed. The 18 cases were examined by X-ray and MRI. Results：The imaging findings of knee joint X-ray and MRI, pathological findings after arthroscopy and the severity and the extent of PVNS of 18 cases were compared. The pathological findings of synovial cells were all PVNS. The limited and diffused fulvous synovial hyperplasia, congestion and hypertrophy, or soft tissue nodule and the synovial cluster con- glomerate or villous prominent could be seen under arthroscopy. There was obvious effusion in articular but no invasion to other organizations within the joint. Four cases out of 15 with X-ray showed consistent findings with the above findings. For MRI, all 15 cases had consistent findings. Synovial hyperplasia and invaded intra-articular fat pad were seen in 5 cases, which were confirmed in no patients with X-ray and 5 with MRI. Synovial hyperplasia and invaded meniscus and cruciate ligaments were seen in 4 eases, which were confirmed in no patients with X-ray but 3 with MRI. Synovial hyperplasia and invaded cartilage and bones were seen in 2 cases, which were confirmed in no patient with X-ray but 2 with MRI. Conclu- sion： （1） MRI findings are more consistent with findings of arthroscopy than X-ray findings, so the MRI diagnostic specific- ity of PVNS is higher. （2） Knee joint PVNS can be classified into 3 grades with arthroscopy findings, thus different treat- ments can be selected according to the grades. （3） Arthroscopic surgery is the best treatment for PVNS at present.

关 键 词：色素沉着绒毛结节性滑膜炎 膝关节 关节镜治疗 关节镜下病理学分级 

分 类 号：R684.3[医药卫生—骨科学]