髋关节镜手术治疗髋关节原发性滑膜软骨瘤病临床疗效  

Clinical Analysis of Hip Arthroscopic Management of Primary Synovial Chondromatosis of the Hip

作　　者：钟名金 欧阳侃[1] 丘志河 梁达强 柳海峰[1] 彭亮权[1] 李阔阔 朱伟民[1,3] 陆伟 王大平[1,3] Zhong Mingjin;Ouyang Kan;Qiu Zhihe;Liang Daqiang;Liu Haifeng;Peng Liangquan;Li Kuokuo;Zhu Weimin;Lu Wei;Wang Daping(Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University/The Second People 's Hospital of Shenzhen , Shen Zhen 518000, China;Shenzhen Key Laboratory of Tissue Engineering, Shenzhen 518035, China;Department of Medicine, Shenzhen University, Shenzhen 518060, China)

机构地区：[1]深圳市第二人民医院深圳大学第一附属医院,深圳518035 [2]深圳大学医学部 [3]深圳市组织工程重点实验室

出　　处：《中国运动医学杂志》2019年第2期92-98,共7页Chinese Journal of Sports Medicine

基　　金：深圳市第二人民医院临床研究项目(20173357201814);深圳市科技计划项目(JCYJ20160226192924528)

摘　　要：目的:探讨髋关节原发性滑膜软骨瘤病的临床特点及髋关节镜手术治疗的效果。方法:回顾性分析2012年7月至2017年7月在我院采用髋关节镜手术治疗髋关节原发性滑膜软骨瘤患者的临床表现、影像学资料及病理特点,对术后疗效进行追踪随访。结果:18例髋关节滑膜软骨瘤患者在我院进行了髋关节镜手术治疗,平均年龄38.2±8.6岁,男性11例,女性7例;右髋10例,左髋8例;病程28.5±8.7个月,术后随访32.2±10.8个月。所有患者术前均有不同程度的疼痛和活动范围受限,4例有捻发感,2例有跛行步态,1例自行可触及肿块感。15例"4"字征阳性,4例前方撞击试验阳性。术前X线能够显示出游离体的有13例;X线阴性而3D-CT能够诊断的有15例;X线和3D-CT阴性而MRI诊断的有3例。所有患者均顺利完成了髋关节镜手术并在关节镜术中及术后病理被最终确诊,术后无并发症发生。术后髋关节活动度、疼痛视觉模拟评分(VAS)、改良髋关节Harris评分(mHHs)、髋关节功能评分-日常生活量表(HOS-ADL)评分均较术前明显改善(P<0.05);髋关节功能评分-体育运动量表(HOS-SSS)评分术前术后无明显差异(P>0.05)。5例(33.3%)患者术后有骨性游离体残留。终末随访时,2例(11.1%)患者复发,3例(16.7%)患者髋关节骨关节炎进行性加重。结论:髋关节镜手术治疗髋关节原发性滑膜软骨瘤病创伤小、并发症少、恢复快,术后短期疗效满意,能显著改善髋关节活动度和功能。但是,髋关节后方及前内侧区域是髋关节镜的操作盲区,增加了游离体残留和复发率的风险。Objective To study the clinical characteristics of the primary synovial chondromatosis of the hip( HPSC) and evaluate the effectiveness of hip cirthroscopic nuinagement. Methods Patients undergoing the hip arthroscopic surgen for HPSC between July 2012 and July 2017 were tissessed retrospectively. The clinical presentations and symptoms, imaging data and pathological findings were recorded. The clinical outcomes after hip arthroscopic surgery y at the final follow-up were also analyzed. Resulte Totally 18 patients with HPSC, 1 1 males and 7 females of 10 right and 8 left hips, were treated unthe hip arthroscopy in our hospikil. The mean agr of the patients was 38.2 ± 8.6 years. The mean preoperative disease course was 28.5 ± 8.7 months, and postoperative follow-up period was 32.2 ± 10.8 months. All patients suffered pain ciiul limited hip range of motion I)efore the treatment, 4 with crepitus, 2 of limp on hip movement, 1 with palpable lumps, 15 showing positive findings in the "4 sign test, and 4 of positive findings in the anterior impingement test. Thirteen patients were found the corpus liberum in the preoperative X-ray. Fifteen patients were diagnosed as HPSC through 3D-CT but not X-ray, while the other 3 were diagnosed according to MRI, but not X-ray or 3D-CT. Hip arthroscopy procedures were successfully performed and all patients were confirmed the diagnosis by arthroscopic findings and ptithological results. No postoperative complications were found among all the patients. The average postoperative range of motion of the hip joint, visual analogue scale score, modified Harris hip score and hip outcome score - activities of daily living score improved significantly compared to those before the operation. However, no significant differences were observed in the average score of the hip outcome score 一 sport-specific subscale before and after the surgery (P>0.05). After the arthroscopic surgery, 5 patients (33.3%) were found loose bodies. Two patients ( 11.1%) suffered from recurrence and another 3 ( 16

关 键 词：髋关节 滑膜软骨瘤 髋关节镜 游离体取出 滑膜切除 

分 类 号：R738.3[医药卫生—肿瘤]