关节镜诊治滑膜软骨瘤病的近期疗效

目的:全面分析关节镜手术对滑膜软骨瘤病的诊疗疗效.方法:2011年1月至2016年12月,中国人民解放军兰州总医院骨科中心运动医学科明确诊治了膝滑膜软骨瘤病共17例,术前负重行走时疼痛视觉模拟评分(Visual Analogue Scale,VAS)为3.81±2.02;Lysholm评分为43.27±7.91.完善术前相关检查及检验后采用关节镜对患者进行诊断及治疗,并将关节内的软骨样游离体送致病例检查以明确诊断,同时行关节镜下探查清理术.术后给予玻璃酸钠+曲安奈德注射液腔内注射.结果:术后病理检查结果均为滑膜软骨瘤病,患者随访4～24(平均12.7)个月,患者术后体征缓解,膝关节屈曲活动度较术前改善,无其他并发症,我科随访期间未见滑膜软骨瘤病复发患者.行VAS评分下降至末次随访时的2.5±0.4,差异有统计学意义(P＜0.05);Lysholm评分提升至近期随访时的86.5±4.2,差异有统计学意义(P＜0.05).结论:滑膜软骨瘤病具有较强的隐匿性,采用关节镜手术对滑膜软骨瘤病可明确诊断,结合局部封闭镇痛治疗是目前治疗滑膜软骨瘤病的可行性办法.

Effect of arthroscope on the diagnosis and treatment of knee synovial chondromatosis

Objective:To analyze and evaluate the diagnosis and treatment of synovial cartilage tumors by arthroscopic surgery.Methods:From January 2011 to December 2016,17 cases of knee synovial chondromatosis were diagnosed and treated in our department,the visual analogue scale (VAS) for preoperative weight-bearing walking pain was 3.81±2.02;Lysholm score was 43.27±7.91.We improved the preoperative diagnosis and examination of the patients after arthroscopic diagnosis and treatment,The cartilage free body in the joint was sent for examination to make a definite diagnosis and arthroscopic debridement was obtained at the same time.After surgery,sodium hyaluronate + triamcinolone acetonide injection was injected into the cavity.Results:The postoperative pathological results were synovial chondromatosis,patients were followed up for 4-24 months (average 12.7 months),signs of patients was in remission,knee flexion improved compared with preoperative,and without other complications.During the follow-up period,no recurrence of synovial chondromatosis appeared.The VAS score dropped to 2.5±0.4 at the last follow-up,with a statistically significant difference (P＜0.05);the Lysholm score increased to 86.5±4.2 at the recent follow-up,with a statistically significant difference (P＜0.05).Conclusion:Synovial chondromatosis has strong concealment,the use of arthroscopic surgery can confirm the diagnosis of synovial chondromatosis,and further combined the locally closed analgesia in the treatment of synovial chondromatosis is a feasible approach,which is worth referencing for clinicians.