关节镜联合髌上囊小切口滑膜切除术治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的疗效分析  

Therapeutic effect of synovectomy by arthroscope combined with small incision on suprapatellar bursa for diffuse pigmented villonodular synovitis of knee

作　　者：张紫机[1] 方淑莺[1] 康焱[1] 杨子波[1] 赵潇艺 何爱珊[1] 傅明[1] 廖威明[1] 张志奇[1] 

机构地区：[1]中山大学附属第一医院关节外科,广州510080

出　　处：《中华关节外科杂志（电子版）》2014年第5期24-27,共4页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：国家自然科学基金项目(81301558;81201388)

摘　　要：目的：探讨应用关节镜结合髌上囊小切口切开滑膜切除治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎（ PVNS）患者的疗效。方法本组对2006年1月至2011年12月因膝关节弥漫型PVNS的32例患者进行回顾性分析，该组患者全部采用膝关节镜结合髌上囊局部切开滑膜切除的治疗方法。本研究对患者的基本情况、治疗方法、复发率和症状进展进行的记录，最短随访时间为7个月（平均中位数为49.8个月；范围7～141个月）。结果应用膝关节镜结合髌上囊局部切开滑膜切除方法治疗PVNS的复发率低（6.3％），肿胀和疼痛术后好转，其中明显好转没有疼痛和活动不适的为50％，而关节炎持续进展的为11.1％，但是没有患者在最后随访期内发展进行膝关节置换。最常见的并发症为血肿，发生率为3％，但是没有发现对患者术后疗效产生明显影响。术前KSS临床评分为（62.7±17.7）分；功能评分为（45.0±24.0）分，术后临床KSS评分（85.2±10.9）分；功能评分（79.5±12.3）分，比较均有统计学差异（临床KSS评分：t＝4.456，P＜0.001；功能KSS评分：t＝5.279，P＜0.001）；而Lysholm评分术前（64.7±15.0）分，术后提高到（83.2±8.4）分，二者间比较有统计学差异（ t＝4.451，P＜0.001）。结论结合相关文献报道，膝关节镜结合髌上囊局部切开滑膜切除方法是治疗膝关节弥漫型PVNS的较好方法，有着较低的复发率和并发症。Objective To investigate the effectiveness of arthroscopy and/or arthrotomy combined＆amp;nbsp;with small incision at the suprapatellar bursa in the treatment for diffuse pigmented villonodular synovitis （ PVNS） of the knee.Methods Thirty-two patients with diffuse PVNS of the knee treated between Jan 2006 and Dec 2012 were retrospectively identified. All of these patients were treated by the knee arthroscopy with a small incision at the suprapatellar bursa for synovectomy.The patient demographics, treatment profiles, recurrence rates, complication and progression were recorded.The minimum follow-up time was seven months （median, 49.8 months; range, 7-141 months）.Results The recurrence rate was 6.3%after the knee arthroscopy with the small incision in the suprapatellar bursa for synovectomy. Fifty percent of these patients had no pain or swelling, and the arthritic progression occurred in 11.1%of the total within the follow-up period.The most common complication was hemarthrosis （3%of the total）, but there was no detectable effect on the recovery.The KSS score of the knee and the function score were （62.7±17.7 ） and （ 45.0 ±24.0 ） respectively, and the Lysholm score was （ 64.7 ±15.0 ）, preoperatively;the KSS score of the knee and the function score were （85.2 ±10.9） （t=4.456, P＆lt;0.001） and （79.5 ±12.3） （t=5.279, P〈0.001）, and the Lysholm score was （83.2 ±8.4） （t =4.451, P〈0.001） in the follow-up period.Conclusion Compared with the literature, the arthroscopy with local incision in the suprapatellar bursa for synovectomy is a viable, comprehensive approach for the diffuse PVNS of the knee and provides both low recurrence rates and complication rates.

关 键 词：关节镜 滑膜切除术 弥漫型色素沉着绒毛结节性滑膜炎 膝关节 

分 类 号：R687.4[医药卫生—骨科学]