膝关节置换与关节镜治疗膝关节色素沉着绒毛结节性滑膜炎  

Total knee replacement and arthroscopic treatment for pigmented villonodular synovitis of the knee joint

作　　者：雷鹏飞[1] 谢杰[1] 文霆[1] 钟达[1] 汪龙[1] 杨序程[1] 胡懿郃[1] 

机构地区：[1]中南大学湘雅医院骨科,湖南省长沙市410008

出　　处：《中国组织工程研究》2013年第52期9077-9082,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:外科治疗色素沉着绒毛结节性滑膜炎能够最大程度的切除病变滑膜,最大限度的恢复关节功能。目的:探讨人工全膝关节置换与关节镜下滑膜切除治疗膝关节色素沉着绒毛结节性滑膜炎的膝关节功能和复发率。方法:回顾性分析中南大学湘雅医院骨科2006年12月至2011年12月收治的34例膝关节色素沉着绒毛结节性滑膜炎行手术治疗患者,治疗后病检均为弥漫性色素沉着绒毛结节性滑膜炎,其中24例患者行膝关节镜下滑膜切除,10例色素沉着绒毛结节性滑膜炎患者行人工全膝关节置换,治疗后根据病情行辅助放疗。膝关节镜下滑膜切除组采用Lysholm功能评分,人工全膝关节置换组采用美国膝关节协会评分,比较两组患者治疗前后膝关节功能,随访观察比较两组间的膝关节功能恢复情况及复发率。结果与结论:34例膝关节色素沉着绒毛结节性滑膜炎患者均获有效随访,随访时间12-66个月,平均41.3个月。统计学分析结果表明关节镜下滑膜切除组治疗后膝关节Lysholm功能评分为(86.3±10.3)分,明显高于治疗前的(55.5±13.2)分(t=3.81,P=0.016,P<0.05)。人工全膝关节置换组美国膝关节协会评分由治疗前的(40.7±2.2)分提高到(90.2±1.1)分(t=6.27,P<0.01);关节镜下滑膜切除组美国膝关节协会评分由治疗前的(34.2±3.9)分提高到(80.8±1.9)分(t=16.58,P<0.01)。证实,关节镜下滑膜切除结合辅助放疗治疗膝关节色素沉着绒毛结节性滑膜炎可取得较好效果,人工全膝关节置换治疗晚期膝关节弥漫型色素沉着绒毛结节性滑膜炎可较好恢复膝关节功能,且复发率较低。BACKGROUND：Surgical treatment for pigmented vil onodular synovitis can maximize the excision of synovial lesions and recovery of joint function. OBJECTIVE：To investigate the knee joint function and relapse rate fol owing treatment of pigmented vil onodular synovitis with total knee replacement and arthroscopic synovectomy. METHODS：We retrospectively analyzed 34 cases of knee pigmented vil onodular synovitis admitted for surgical treatment in the Department of Orthopedics, Xiangya Hospital of Central South University, China from December 2006 to December 2011. In these cases, 24 patients received arthroscopic synovectomy and 10 patients were subjected to total knee replacement. Adjuvant radiotherapy was conducted according to postoperative patient’s conditions. Lysholm scoring was employed in the arthroscopic synovectomy group, and American Knee Society scoring was used in the total knee replacement group. Knee function in two groups was compared before and after treatment. Fol ow-up observation was performed to compare knee function recovery and relapse rate between two groups. RESULTS AND CONCLUSION：Thirty-four patients were effectively fol owed up for 12-66 months, mean 41.3 months. Statistical analysis showed that in the arthroscopic synovectomy group, the postoperative Lysholm score was （86.3± 10.3） points, significantly higher than the preoperative score which was （55.5±13.2） points （t=3.81, P=0.016, P〈0.05）. In the total knee arthroplasty group, the American Knee Society score was increased from （40.7±2.2） points preoperatively to （90.2±1.1） points postoperatively （t=6.27, P〈0.01）. In the arthroscopic synovectomy group, the American Knee Society score was increased from （34.2±3.9） points preoperatively to （80.8±1.9） points postoperatively （t=16.58, P〈0.01）. Arthroscopic synovectomy combined with adjuvant radiotherapy can achieve better outcomes in pigmented vil onodular synovitis patients, while the total knee replacement for advanced with advanced k

关 键 词：骨关节植入物 骨与关节学术探讨 膝关节 色素沉着绒毛结节性滑膜炎 全膝关节置换 关节镜 滑膜切除 关节功能 膝关节功能评分 复发率 

分 类 号：R318[医药卫生—生物医学工程]