膝关节色素沉着绒毛结节性滑膜炎的微创治疗

目的探讨单独或联合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2002年1月～2006年4月，对38例关节镜下诊断膝关节色素沉着绒毛结节性滑膜炎（其中5例为院外手术后复发病例）常规行滑膜切除术，囊外病灶较大者辅助小切口开放手术完整切除病灶。样本全部送病理检查。术后常规放置引流管、局部冰敷和按计划功能锻炼。结果38例均为单膝手术，关节镜下滑膜明显增生呈特征性棕黄色，术后病理确诊，其中局灶性病灶20例，弥漫性滑膜炎18例；6例胭窝部位病灶较大而辅助开放手术。术前国际膝关节评分委员会（IKDC）膝关节功能主观评分为（60．4±6．1）分，术后1年时评分为（89．3±7．2）分。38例随访1～4年（平均2．1年），症状无复发，除2例院外开放手术后复发病例膝关节屈曲仅90。外，其余患者屈伸功能正常。结论关节镜手术对膝关节色素沉着绒毛结节性滑膜炎具有较高的诊断价值，还可非常有效地处理关节内病变，对囊外病灶较大时应辅助小切口开放手术完整切除病灶以避免症状复发。

Microsurgical Management of Pigmented Villonodular Synovitis of the Knee

Objective To investigate the value of microsurgical management for the diagnosis and treatment of pigmented villonodular synovitis （PVNS） of the knee. Methods Thirty-eight patients with PVNS of the knee that were confirmed by arthroscopy were treated in our unit between January 2002 and April 2006. Among the patients, 5 were referred from other hospitals because of postoperative recurrence. Villusectomy was performed in each of the patients by using arthroscopy. In the cases with larage extra-articular lesions, small auxiliary incision was made for complete resection. All the resected masses were examined pathologically after the surgery, and the patients received intra-anticular drainage, local ice therapy, and functional exercises afterwards. Results Unilateral surgery was performed on this group of patients. Under an arthroscope, the synovium showed characteristic yellow-brown color. Patholgocial examination confirmed PVNS in all the cases, including 20 cases of local PVNS and 18 diffused lesions. Open surgery was performed on 6 patients owing to large lesion at the popliteal fossa. According to the International Knee Documentation Committee （IKDC） Scoring Forms, the mean IKDC score increased from 60.4 ± 6.1 to 89.3 ± 7.2 in one year after the operation. The 38 patients were followed up for 1 to 4 years （mean 2.1 years） , none of them had recurrence during this period. Two of the patients, who had been treated by open surgery and then were referred to our hospital, could not flex their knees to 90~ after the microsurgery. Whereas, all the others achieved normal knee flexion. Conclusions Arthroscopy is reliable for the diagnosis and treatment of PVNS. For large extra-articular lesions, open surgery using small auxiliary incision is necessary for complete resection and avoidance of recurrence.