膝关节滑膜结核误诊为色素沉着绒毛结节性滑膜炎原因及鉴别  

Cause Analysis and Differential Diagnosis of Knee Tuberculosis Masquerading Misdiagnosed as Pigmented Villonodular Synovitis

作　　者：杨接来 胡涂[1] 张智长[1] 杨庆诚[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《临床误诊误治》2016年第3期28-31,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨膝关节结核的临床特征及其与膝关节色素沉着绒毛结节性滑膜炎的鉴别诊断要点。方法对误诊为膝关节色素沉着绒毛结节性滑膜炎的膝关节滑膜结核6例的临床资料进行回顾性分析。结果本组6例均表现为膝关节疼痛、肿胀和活动受限,2例首诊我院,4例曾在外院诊疗后复发而入我院。6例病初均误诊为膝关节色素沉着绒毛结节性滑膜炎,后结合临床、影像学检查及术后病理均确诊为膝关节滑膜结核。行膝关节前、后联合入路病灶清除术5例,后外侧入路病灶清除1例。术后予足疗程抗结核治疗,关节功能均有改善。结论关节滑膜结核临床表现不典型,易误诊,详细了解病史、完善相关检查并注意鉴别诊断是避免误诊误治的关键。Objective To investigate the clinical features and differential diagnosis of knee tuberculosis,in order to reduce the incidence rate of misdiagnosis. Methods The clinical data of 6 tuberculosis patients being initially misdiagnosed as having pigmented villonodular synovitis were analyzed retrospectively. Results All the patients misdiagnosed as having pigmented villonodular synovitis complained of knee pain,swelling and limited mobility. Of the 6 cases of synovial tuberculosis,2 cases were of primary,4 cases were of recurrence with misdiagnosis history in other hospitals. 5 cases received combined synovectomy of both the front and the rear approach; one case received single synovectomy of the rear approach. The clinical,imaging and pathological data confirmed the final diagnosis of synovial tuberculosis. All the misdiagnosed patients underwent postoperative antituberculous therapy and obtained good improvement and rehabilitation of knee function. Conclusion The features of synovial tuberculosis are not typical and the misdiagnosis can be easily made. To avoid misdiagnosis,it is essential to have a detailed medical history,complete relevant examination data and the differential diagnosis of knee tuberculosis.

关 键 词：膝关节 滑膜 结核 误诊 滑膜炎 色素绒毛结节性 

分 类 号：R529.2[医药卫生—内科学]