关节镜辅助治疗腕关节色素沉着绒毛结节性滑膜炎  

Arthroscopic-assisted treatment for pigmented villonodular synovitis of the wrist

作　　者：郑宇棋 刘波[2] 王新宏 朱瑾[2] 王志新[2] 陈山林[2] ZHENG Yu-qi;LIU Bo;WANG Xin-hong;ZHU Jing;WANG Zhi-xin;CHEN Shan-lin(Department of Hand and Foot Surgery,Xi'an Feng Cheng Hospital,Xi'an,Shaanxi,710016,China)

机构地区：[1]西安凤城医院手足显微外科,陕西省710016 [2]北京积水潭医院手外科,100035

出　　处：《中国骨与关节杂志》2024年第2期81-85,共5页Chinese Journal of Bone and Joint

基　　金：北京市属医院科研培育计划项目(PX2018018);北京积水潭医院高层次人才“学科骨干”培养计划(XKGG201801)。

摘　　要：目的对关节镜辅助治疗腕关节色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis,PVNS)的疗效进行评价,并对这一少见疾患的诊治经验进行总结。方法报告并分析2018至2019年,北京积水潭医院手外科经腕关节镜辅助治疗的2例腕关节PVNS病变累及情况及手术治疗结果。通过术前和术后的腕关节屈伸活动度、握力、改良Mayo腕关节评分、快速上肢功能(quick DASH)评分和患者主观腕关节评价(patient rated wrist evaluation,PRWE)问卷对患者腕部功能恢复情况进行对比评估。通过术前与术后疼痛视觉模拟评分(visual analogue scale,VAS)对患者手术前后腕关节疼痛情况进行对比评估。同时记录手术并发症情况和随访时复发情况。结果本组2例的PVNS病变均同时累及关节内和关节外,均采用腕关节镜手术进行关节内病变切除,切开手术进行关节外病变切除。例1术后随访22个月,末次随访时患侧腕关节屈伸总活动度从术前100度提高到105度,握力从25 kg提高到44 kg,改良Mayo腕关节评分由术前的45分改善到95分,PRWE评分由术前的72分改善到2分,quick DASH评分由术前的82分改善到0分,疼痛VAS评分由术前的5分降至术后的0分。例2术后随访12个月,末次随访时患侧腕关节屈伸总活动度从术前110度提高到130度,握力从40 kg提高到45 kg,改良Mayo评分由术前的65分改善到95分,PRWE评分由术前的70分改善到8分,quick DASH评分由术前的59分改善到16分,疼痛VAS评分由术前的5分降至术后的1分。本组2例,术中、术后均未发生手术并发症,末次复查时临床未见复发。结论关节镜辅助治疗腕关节PVNS是一种可行的微创治疗方法,术后可获得较好的症状缓解与功能改善。Objective To evaluate the results of arthroscopic-assisted treatment for pigmented villonodular synovitis(PVNS)of the wrist,and to review the diagnosis and treatment strategy.Methods Two patients with PVNS of unilateral wrist underwent arthroscopic-assisted treatment between 2018 and 2019 in Beijing Ji Shui Tan Hospital.The characteristics of the disease and outcomes of surgical treatment were reviewed.The two wrists were evaluated with flexion-extension range of motion(F-E ROM),grip power,Modified Mayo Wrist Score(MMWS),Patient Rated Wrist Evaluation(PRWE),quick DASH score and pain Visual Analogue Scale(VAS)scores preoperatively and postoperatively.Recurrence and complications following the surgical procedures were assessed as well.Results There were intraarticular and extraarticular involvement in both wrists.The intraarticular lesions were resected arthroscopically and the extraarticular lesions were resected by open approach.Patient 1 was followed up for 22 months.At the last follow-up,the F-E ROM improved from 100 degree to 105 degree,grip power increased from 25 kg to 44 kg,MMWS improved from 45 to 95,PRWE improved from 72 to 2,quick DASH score improved from 82 to 0,and pain VAS improved from 5 to 0 when compared with preoperative data.Patient 2 was followed up for 12 months.At the last follow-up,the F-E ROM improved from 110 degree to 130 degree,grip power increased from 40 kg to 45 kg,MMWS improved from 65 to 95,PRWE improved from 70 to 8,quick DASH score improved from 59 to 16,and pain VAS improved from 5 to 1 when compared with preoperative data.There was no recurrence or complication observed in both patients.Conclusions Arthroscopic-assisted treatment for PVNS of the wrist is a feasible mini-invasive approach to relieve the symptom and improve the wrist function.

关 键 词：滑膜炎 色素绒毛结节性 腱鞘巨细胞瘤 腕关节 关节镜 

分 类 号：R681.7[医药卫生—骨科学]