关节镜诊治膝关节色素沉着绒毛结节性滑膜炎的初步疗效观察

目的：探讨关节镜微创手术对膝关节色素沉着绒毛结节性滑膜炎的诊断和治疗价值。方法：本组12例,男7例,女5例,年龄18～46岁,平均33岁;病史2～60个月,平均16个月;其中左膝8例,右膝4例;初次就诊11例,外院开放手术后复发1例。所有病例术前均行MRI检查,并行关节镜检,滑膜切除,记录该病在关节镜下的表现形式（局灶型或弥漫型）,样本全部送病理检查。术后加压包扎、局部冰敷并按计划功能锻炼,术后3～4周行患膝放射治疗。结果：本组12例,其中局灶性病例8例,弥漫性4例,术后病理检查确诊;所有病例获得了3～21个月,平均13个月随访,未见复发;术前Lysholm评分（62.3±2.4）分;国际膝关节评分委员会（IKDC）膝关节功能主观评分（56.4±3.1）分;术后3月复查Lysholm评分（82.5±3.2）分;IKDC主观评分（85.3±2.5）分。除1例开放手术后复发病例术后3月膝关节屈曲受限（80°）外,其余患者功能良好。结论：关节镜手术创伤小,显露充分,病灶切除彻底,术后功能恢复理想,辅以放射治疗可有效降低复发率,对膝关节色素沉着绒毛结节性滑膜炎具有较高的诊治价值。

Effect of Arthroscopy to Diagnose and Treat Knee Joint Pigmented Villonodular Synovitis

Objective：To evaluate the role of arthroscopy in the diagnosis and treatment in knee joint pigmented villonodular synovitis.Methods：12 cases of knee joint pigmented villonodular synovitis with the age of 18 to 46 years old were treated with arthroscopical synovectomy with a combined application of postoperative exercise and radiotherapy. The history of disease was 2 to 60 months,with the mean of 16 months.The clinical data were reviewed when followed -up and evaluated by Lysholm score and and IKDC score.Results：12 patients diagnosed by pathologic examination, including 8 localized and 4 diffused,were followed up for 3 to 21 months（13 months on average）with no relapses at the time of follow-up.Lysholm score was（62.3±2.4）points preoperatively,but（82.5±3.2） points 3 months later. The International Knee Documentation Committee（IKDC） score was（56.4±3.1） and（85.3±2.5） respectively before surgery and 3 months later.All patient remained good functions of knee joints except one who relapsed after open operation.Conclusion：In case of pigmented villonodular synovitis of the knee joint,arthroscopical synovectomy combined with postoperative radiotherapy and physical exercise is an effective treatment with less invasion and better function than open operation.