关节镜手术治疗肩关节滑膜软骨瘤病的疗效评价及复发部位特征分析  

Efficacy evaluation of arthroscopy for synovial chondromatosis of the shoulder and analysis of recurrence site characteristics

作　　者：杜瑞 李强强 陈东阳 蒋青[1,2,3] 秦江辉 DU Rui;LI Qiangqiang;CHEN Dongyang;JIANG Qing;QIN Jianghui(Department of Sports Medicine and Adult Reconstructive Surgery,Nanjing Drum Tower Clinical College of Xuzhou Medical University,Nanjing 210008,China;Department of Sports Medicine and Adult Reconstructive Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospoital of Nanjing University Medical School,Nanjing 210008,China;Branch-center of National Clinical Research Center for Orthopedics,Sports Medicine&Rehabilitation,Nanjing 210008,China)

机构地区：[1]徐州医科大学南京鼓楼临床学院运动医学与成人重建外科,南京210008 [2]南京大学医学院附属鼓楼医院运动医学与成人重建外科,南京210008 [3]国家骨科与运动康复临床医学研究中心分中心,南京210008

出　　处：《中华骨与关节外科杂志》2025年第3期255-260,共6页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金面上项目(81972124);江苏省基础研究计划(自然科学基金)青年基金(20170123)。

摘　　要：目的:评价关节镜手术治疗肩关节滑膜软骨瘤病(SC)的临床疗效,并分析复发部位特征。方法:回顾性分析2022年4月至2023年10月南京大学医学院附属鼓楼医院采用关节镜手术治疗的7例肩关节SC患者的临床资料,包括男2例,女5例,年龄20~61岁,平均(34.8±14.0)岁。症状持续时间为1~24个月,平均(11.8±6.2)个月。2例患者有骨关节炎表现。1例患者合并肱骨头后上方压缩性骨损伤。比较术前与末次随访时患者疼痛视觉模拟评分(VAS)、美国肩肘外科医师协会(ASES)评分、美国加州大学(UCLA)肩关节评分及Constant-Murley评分,以评估患者疼痛和功能恢复情况。结果:7例患者均获得随访,随访时间5~20个月,平均(9.9±6.3)个月。所有患者切口均Ⅰ期愈合,无一例患者发生感染。7例患者末次随访时疼痛VAS评分、ASES评分、UCLA肩关节评分及Constant-Murley评分均较术前明显改善。7例患者中2例复发,1例原发于盂肱关节间隙(GH),复发于结节间沟(ISH);1例原发于肩峰下囊(SAB)、喙突下滑囊(SCB)及三角肌下滑囊(SDB),复发于SAB及SDB。同时,盂肱关节外的SAB、SCB、SDB发病4例,复发1例;GH发病3例,复发1例。1例患者因游离体卡压导致肱骨头软骨损伤。结论:关节镜手术治疗肩关节SC的临床疗效显著。因该病复发率高,术中需完整切除病损部位滑膜组织;对发生在盂肱关节腔的SC,需重点清理ISH区域滑膜组织,以降低复发概率。Objective:To evaluate the clinical efficacy of arthroscopy for synovial chondromatosis(SC)of the shoulder and analyze the characteristics of recurrence sites.Methods:A retrospective analysis was conducted on the clinical data of 7 patients with shoulder joints SC treated by arthroscopy at the Nanjing Drum Tower Hospital,the Affiliated Hospoital of Nanjing University Medical School from April 2022 to October 2023.Two males and five females were included,with an average of 34.8±14.0 years(range:20-61 years).The duration of symptoms ranged from 1 to 24 months,with an average of 11.8±6.2 months.Two patients showed signs of osteoarthritis,and one patient had a concomitant posterosuperior compressive bone injury of the humeral head.At the final follow-up,visual analog scale(VAS)scores for pain,American Shoulder and Elbow Surgeons(ASES)scores,University of California at Los Angeles(UCLA)scores,and Constant-Murley scores were compared with preoperative values to evaluate pain relief and functional recovery.Results:All seven patients were followed up for 5 to 20 months,with an average of 9.9±6.3 months.All Incisions healed by primary intention,with no infections.At the final follow-up,significant improvements were observed in VAS scores,ASES scores,UCLA scores,and Constant-Murley scores,respectively.Among the seven patients,two cases recurred:one initially involved the glenohumeral joint(GH)and recurred in the intertubercular sulcus of humerus(ISH),while the other case originated the subacromial bursa(SAB),subcoracoid bursa(SCB),and subdeltoid bursae(SDB)and recurred SAB and SDB.Meanwhile,four cases involved SAB,SCB,and SDB outside the glenohumeral joint,with one recurrence.Three cases involved GH,with one recurrence.One patient suffered from humeral head cartilage damage due to loose body impingement.Conclusions:Arthroscopy demonstrates significant clinical efficacy for shoulder SC.Given the high recurrence rate,complete synovial resection at the lesion site is necessary during surgery.For SC involving the glenohumera

关 键 词：关节镜手术 滑膜软骨瘤病 游离体 

分 类 号：R684[医药卫生—骨科学]