关节镜对诊断单膝关节炎病因的意义

目的 探讨关节镜检查对病因不明的单膝关节炎的诊断价值.方法 对74例病因不明的单膝关节炎患者进行关节镜手术探查,每位患者术前均行MRI检查.结合临床表现及术中镜下所见的滑膜形态特征、活检组织病理及其他实验室检查和影像学资料,对单膝关节炎作出病因诊断.结果 74例患者中71例经关节镜检查后诊断明确,3例诊断未明,关节镜诊断率为95.9%.其中诊断类风湿关节炎(RA)39例(52.9%),血清阴性脊柱关节病、化脓性关节炎各7例(各占9.5%),RA合并痛风性关节炎6例(8.1%),痛风性关节炎、膝关节结核各5例(各占6.5%),色素沉着绒毛结节性滑膜炎1例,多中心网状组织细胞增多症1例.结论 关节镜检查对病因不明的单膝关节炎的有较高的诊断价值;病因不明的单膝关节炎以RA最常见;关节镜下所见特征性改变可辅助诊断单膝关节炎.

Significance of arthroscopy in the diagnosis of unilateral knee arthritis

Objective To investigate the role of arthroscopy in the diagnosis of unilateral knee arthritis of unknown causes.Methods During December 2005 to February 2008,74 patients of unilateral knee arthritis of unknown origins were treated with arthroscopy.And magnetic resonance imaging(MRI) scans were performed for all of them before knee arthroscopy.The diagnosis was made by the synovial appearance in gross examination in arthroscopy combined with synovial pathology,synodal fluid analysis and clinical manifestations.Results Among these patients,71 cases were definitely diagnosed and 3 cases had unknown causes.Thirty-nine cases(52.9%)were of rheumatoid arthritis(RA),7(9.5%) of seronegative spondyloarthropathy(SPA),7 patients(9.5%) of septic arthritis,6 patients(8.1%)of RA coexisting gout arthritis,5 patients(6.5%) of gout arthritis,5 patients (6.5%) of tuberculosis of knee joint,1 patient(1.3%)of pigmented villonodular synovitis and l patient(1.3%) of multicentric reticulohistiocytosis.Conclusion Arthroscopy provides valuable diagnostic information in unilateral knee arthritis of unknown causes.RA is the major cause of unilateral knee arthritis of unknown causes.Synovial appearance in gross examination in arthroscopy,synovial pathology and crystals are helpful to make a diagnosis.