膝关节“隐匿性”滑膜软骨瘤病的关节镜诊治

目的探讨临床症状、体征和影像学表现不典型的膝关节"隐匿性"滑膜软骨瘤病的关节镜诊断和治疗效果。方法 2006年11月至2009年10月本科关节镜诊治4例"隐匿性"膝关节滑膜软骨瘤病,临床表现为膝关节肿胀、疼痛,X线平片和磁共振检查未发现游离体,关节镜检查确诊,并行关节镜下滑膜软骨瘤摘除和病变滑膜切除术。结果膝关节"隐匿性"滑膜软骨瘤病表现为大量微小软骨游离体存在于关节腔、或少量微小软骨游离体局限于滑膜组织内。4例患者均经病理检查证实,全部获得随访,平均随访14个月,所有病例术后功能良好,未见复发,仅1例伴软骨损伤患者残留膝关节轻度疼痛。结论膝关节"隐匿性"滑膜软骨瘤病临床表现不典型,X线平片和磁共振检查常不能确定诊断,关节镜是该病惟一可靠和有效诊断及治疗方法。

Arthroscopic diagnosis and treatment of occult synovial chondrmatosis of the knee

Objective The purpose of this study was to determine the arthroscopic diagnosis and treatment outcomes of occult synovial chondromatosis with atypical clinical symptoms,signs,or imagings.Methods From November 2006 to October 2009,4 cases of occult synovial chondromatosis of the knee were diagnosed and treated with arthroscopy.Clinical picture was characterized by pain and swelling of the involved joint,while the characteristic X-radiograph and magnetic resonance imaging(MRI)findings were negative.All cases were diagnosed and treated with loose body removal and partial synovectomy by arthoscopy.Results Occults synovial chondromatosis of the knee demonstrated a large number of minute loose cartilaginous bodies in joint or a few minute cartilaginous bodies under the surface of the synovial membrane and confirmed by histological examination.Average follow-up was 14 months.All of the patients showed good outcomes,no patients required revision surgery.One case suffered from pain of the involving joint postoperation due to cartilage degeneration.Conclusion The clinical symptoms and signs of occult synovial chondromatosis of the knee are atypical,and conventional radiology and MRI often delay diagnosis.The definitive diagnosis was made on the basis of arthroscopic findings and arthroscopy debridement surgery is the effective treatment for occult synovial chondromatosis.