膝关节弥漫性色素沉着绒毛结节性滑膜炎的关节镜治疗

目的探讨采用关节镜技术治疗膝关节弥漫性色素沉着绒毛结节性滑膜炎的方法及其临床效果。方法1999年1月～2001年12月,对32例膝关节弥漫性色素沉着绒毛结节性滑膜炎,在常规关节镜入路的基础上,结合膝关节后内侧、后外侧和跨后纵隔入路,进行滑膜全切。手术时强调对膝关节后内侧室和后外侧室病变滑膜的彻底切除,同时通过辅助切口切除关节外病变组织。术后进行系统的康复训练。通过13～47个月的随访,了解患膝疼痛、肿胀、活动度以及患肢整体功能康复情况。结果术后1年,2例有轻微疼痛,1例有轻度肿胀,均无关节积液;膝关节活动度平均为143°±5.1°。最后随访时,23例行MR检查,1例在内侧半月板后角底面与胫骨平台之间的憩室内发现复发,影像学复发率为4.35%(1/23),但患者无主观症状;其余患者在MRI上无复发现象。术前国际膝关节评分委员会(IKDC)膝关节功能主观评分为(63.4±5.1)分,Lysholm膝关节功能评分为(35.6±4.7)分。最后随访时,IKDC膝关节功能主观评分为(87.9±4.9)分,Lysholm膝关节功能评分为(86.3±5.6)分。3例患者因前十字韧带功能不全,于滑膜切除术后3～5个月进行了前十字韧带重建术。结论通过关节镜能够完成膝关节弥漫性色素沉着绒毛结节性滑膜炎的滑膜彻底切除,有助于滑膜炎的治疗。关节镜手术创伤小,     

关节镜治疗膝关节弥漫色素沉着绒毛结节性滑膜炎

目的探讨关节镜下手术切除膝关节弥漫性色素沉着绒毛结节性滑膜炎的方法与疗效。方法2004年2月至2006年11月，对17例睬关节弥漫性色素沉着绒毛结节性滑膜炎，采用标准膝前内、外侧入路并辅以髌上外侧入路行关节镜下膝前间室滑膜全切，后内、外侧入路行膝后间室滑膜全切，并用射频治疗仪辅助清理十字韧带、关节软骨和半月板表面的滑膜，电凝止血。结果本组17例，4例流动人口失去联系，13例获得14-33个月，平均21．6个月随访。术后2个月，2例有轻度疼痛，2例有轻度肿胀，1例关节置换术后及1例开放手术后复发患者膝关节屈曲小于120°。术后1年，13例均无肿胀及积液，3例有轻度疼痛，2例膝关节屈曲仍小于120°，但不影响日常生活。采用Lysholm评分方法评定膝关节功能，术前Lysholm评分为（38．6±4．5）分。最后随访时，13例无一例复发，Lysholm评分为（87．3±5．6）分。结论关节镜下治疗膝关节弥漫性色素沉着绒毛结节性滑膜炎，具有手术切口小、组织损伤少、术后痛苦少、可早期进行功能锻炼、避免关节黏连引起的功能障碍等优点，且术中病变滑膜切除彻底，术后不易复发。该术式早中期疗效肯定，远期疗效有待进一步观察。     

膝关节色素沉着绒毛结节性滑膜炎的关节镜下治疗

目的观察采用关节镜技术治疗膝关节色素沉着绒毛结节性滑膜炎的早期疗效。方法 2009年4月至2010年4月,收治12例膝关节色素沉着绒毛结节性滑膜炎患者。局限性10例,弥漫性2例;男7例,女5例;年龄12～31岁,平均23岁。主要临床症状为反复膝关节疼痛、肿胀。术前膝关节功能Lysholm评分（64.2±10.3）分。采用关节镜下病灶切除,术中强调对病变滑膜彻底切除,对弥漫性色素沉着绒毛结节性滑膜炎及关节外滑膜病变加用辅助小切口。结果术后病理检查均确诊为色素沉着绒毛结节性滑膜炎。手术后切口均Ⅰ期愈合,无感染及骨筋膜室综合征等并发症发生。全部病例获完整随访,随访时间12～24个月,平均15个月。末次随访未见复发,术后膝关节功能Lysholm评分（92.3±4.5）分。结论采用关节镜技术治疗膝关节色素沉着绒毛结节性滑膜炎创伤小、恢复快、并发症少,是一种可行的方法。     

关节镜治疗膝关节色素沉着绒毛结节性滑膜炎

目的探讨关节镜下治疗膝关节色素沉着绒毛结节性滑膜炎的临床效果。方法回顾性分析自2005-08—2014-05诊治的42例色素沉着绒毛结节性滑膜炎,行关节镜下滑膜清理,少数结节性色素沉着绒毛结节性滑膜炎患者需辅助小切口取出关节内肿物。结果术后随访1~72个月,平均38个月,术后1例膝关节轻度肿胀,3例有轻微疼痛,其余患者均无交锁、无肿痛,关节功能正常。结论关节镜下治疗膝关节色素沉着绒毛结节性滑膜炎是一种创伤小、治疗相对彻底的有效方法。     

膝关节镜术后再次手术的原因

目的探讨膝关节镜术后再次手术的原因。方法对25例膝关节镜术后再次手术者行膝关节镜术16例,开放性滑膜切除术7例,全膝关节置换术2例。分析其再手术原因。结果软骨剥脱、滑膜病变残留或滑膜炎复发、漏诊半月板或交叉韧带损伤以及关节游离体是再手术中见到的主要病变。随访6个月-2年,16例膝关节镜术后机械性交锁症状均消失,7例行滑膜切除、2例人工全膝关节置换术者术后肿胀疼痛均消失。结论误漏诊、术前查体不细、适应证选择及手术处理不当是膝关节镜术后再次手术的主要原因。提高术前诊断水平、术中关节镜操作技术是减少再手术的关键。     

关节镜下和/或切开治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎疗效分析

目的探讨关节镜下和/或切开手术辅以术后关节外放疗治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis,PVNS)的方法和疗效。方法 2000年9月-2010年8月,收治97例单膝弥漫型PVNS。男38例,女59例;年龄8～75岁,中位年龄33岁。病程1周～30年;复发患者10例。左膝52例,右膝45例。术前膝关节伸直(1.9±2.3)°,屈曲(122.9±5.6)°;Lysholm膝关节评分为(43.2±6.7)分,国际膝关节文献委员会(IKDC)膝关节功能主观评分为(53.2±5.7)分。根据是否合并关节外病变及病变部位,82例采用关节镜下关节前后病变滑膜切除术,3例采用关节镜下关节内病变滑膜切除联合小切口切除关节外病灶,9例采用关节镜下关节内病变滑膜切除及后方关节外软组织内病灶切除术,3例分期切除病灶并植骨。术后76例接受关节外放疗。结果术中1例损伤腘动脉,3例损伤腘静脉分支;术后3 d 1例膝关节血肿形成。其余患者切口均Ⅰ期愈合,无神经损伤等并发症发生。患者均获随访,随访时间1年3个月～11年2个月,中位时间61个月。89例患者随访期间无复发,术后15个月膝关节伸直(0.2±1.3)°,屈曲(135.9±6.6)°,Lysholm膝关节评分为(89.8±5.8)分,IKDC膝关节功能主观评分为(87.8±5.8)分,与术前比较差异均有统计学意义(P<0.05)。8例于术后6个月～8年复发,再次手术后患者膝关节轻度活动受限,无疼痛、肿胀。结论根据膝关节病变范围及程度,选择关节镜下和/或切开手术辅以关节外放疗治疗膝关节弥漫型PVNS可取得较好疗效。术后未接受正规放疗是复发重要因素之一,复发者病变易导致骨质破坏。     

关节镜下滑膜切除术治疗早、中期类风湿性关节炎的疗效

目的探讨关节镜下滑膜切除术治疗早期和中期类风湿性关节炎(类风关)的疗效. 方法对34例早中期的类风关42个膝关节(早期类风关组22例,24个关节;中期类风关组12例,18个关节),在关节镜下施行以滑膜切除术为主处理,其中32个膝关节辅助使用双极射频进行滑膜的清除和止血.术后给予正规抗类风湿药物治疗,对早、中期两组进行随访(平均25月),包括关节功能的评定,检测血沉(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C reaction protein)和类风湿因子(rheumatoid factor,RF ). 结果早期类风关组24个膝关节术后优良率为91.7%(22/24),中期类风关组18个膝关节优良率为66.7%(12/18),二者优良率差异无显著性(χ2=2.705,P=0.100). 结论早期和中期类风关关节镜下滑膜切除术治疗,均可以取得较满意的疗效,二者疗效无差别.双极射频有助于彻底清除病变滑膜、减少关节血肿、利于关节功能康复.     

关节镜下治疗膝关节色素沉着绒毛结节性滑膜炎

目的探讨关节镜下滑膜切除术治疗膝关节色素沉着绒毛结节性滑膜炎（p igm en ted v illonodu lar synov i-tis,PVN S）的临床疗效。方法对18例膝关节色素沉着绒毛结节性滑膜炎患者在关节镜下进行滑膜切除,汽化烧灼创面,1例配合开放手术,术后追踪观察,评定疗效。结果本组18例均获随访,随访时间6个月～5年,平均2年5个月。根据Lysho lm膝关节评分系统,术前评分为（55.6±4.1）分,术后3个月随访时评分为（87.2±5.7）分。根据徐锦森提出的膝关节功能评定标准,优13例,良4例,差1例,优良率94.4%。结论关节镜下可以准确诊断膝关节色素沉着绒毛结节性滑膜炎,彻底切除关节内病变,必要时配合开放手术,可有效减少术后复发,最大程度地恢复膝关节功能。     

关节镜下有限清理术治疗膝关节骨性关节炎 50例报告

目的探讨膝关节骨性关节炎（OA）患者关节镜下有限清理术的疗效。方法在2004年5月．2006年1月对50例患者（男32例，女18例，平均年龄53．8岁）行关节镜外科治疗：关节镜下有限清理包括刨削增生肥厚的滑膜组织，清理关节软骨剥脱区创面和软骨碎片，切除破裂的半月板，取出游离体和磨削骨赘。结果关节镜下选择性、有限化的关节清理术创伤轻和并发症少，关节功能恢复快。随访3个月～1年，术后优良率达80．0％。结论关节镜下有限清理术治疗膝关节骨性关节炎可有效地缓解疼痛和肿胀等症状，改善功能，提高患者生活质量，延缓病程的发展。     

关节镜下清理术治疗膝关节结核性滑膜炎

目的探讨采用关节镜下清理术治疗膝关节结核性滑膜炎的疗效。方法采用关节镜下清理术治疗膝关节结核性滑膜炎16例。结果本组15例获得随访12~41个月,随访患者关节症状均消失,功能良好,术前Lysholm膝关节功能评分为(53.4±10.5)分,术后随访Lysholm膝关节功能评分为(92.3±4.5)分,疗效满意。结论关节镜下清理术是一种治疗膝关节结核性滑膜炎的理想方法。     

Rheumatoid Synovectomy: Does the Surgical Approach Matter?

Background  

Surgical synovectomy relieves pain in patients with rheumatoid arthritis (RA). The comparative effect of arthroscopic versus open synovectomy on pain reduction, recurrence of synovitis, radiographic progression, and need for subsequent total joint arthroplasty (TJA) is unclear. Whether synovectomy relieves pain in patients with advanced degenerative joint changes is also controversial.     

Arthroscopic and open synovectomy of the elbow in rheumatoid arthritis

BACKGROUND: Synovectomy has been advocated for early treatment of the rheumatoid elbow. It has not been determined whether arthroscopic or open synovectomy is better and whether a preoperative arc of flexion of >90 degrees is an important prognostic factor. METHODS: Arthroscopic or open synovectomy was performed in fifty-eight elbows in fifty-three patients with rheumatoid arthritis and radiographic changes in the joint of Larsen grade 2 or less. Clinical symptoms, recurrent synovitis, postoperative complications, and radiographic changes were assessed ten to eighteen years (average, thirteen years) postoperatively. RESULTS: Eleven (48%) of twenty-three elbows in which arthroscopic synovectomy had been performed and sixteen (70%) of twenty-three elbows in which open synovectomy had been performed were mildly or not painful at the latest follow-up evaluation. However, no significant difference was detected between the overall clinical results of arthroscopic synovectomy and those of open synovectomy. In elbows with a preoperative arc of flexion of <90 degrees , the clinical results of the two procedures were comparable. In elbows with a preoperative arc of flexion of <90 degrees , arthroscopic synovectomy provided significantly (p < 0.05) better function than open surgery after mid-term follow-up, and motion and function continued to be better in those patients at the most recent follow-up evaluation. Recurrent synovitis was observed in six elbows that had arthroscopic synovectomy and in three that had open synovectomy, and the Larsen grade increased in both groups. Three elbows with a preoperative arc of flexion of <90 degrees underwent a total elbow arthroplasty to treat ankylosis after open synovectomy. Surgical complications were uncommon and not severe. CONCLUSIONS: Arthroscopic synovectomy of the elbow is a reliable procedure. One of the most favorable indications for either arthroscopic or open synovectomy is a preoperative arc of elbow flexion of >/=90 degrees in patients with early rheumatoid arthritis.     

Surgical management of the rheumatoid elbow

Many patients with rheumatoid arthritis demonstrate elbow involvement that may limit upper extremity function, usually within 5 years of disease onset. Initial management consists of nonsurgical measures that address synovitis and capsular inflammation in an effort to diminish pain and maintain elbow range of motion. Disease progression may result in articular damage and ligamentous compromise, causing increased symptoms, elbow instability, and functional debilitation. For patients unresponsive to nonsurgical management, open or arthroscopic synovectomy may provide relief of symptoms. For those with more advanced disease, elbow arthroplasty is a reasonable alternative. Advancements in prosthetic technology and surgical techniques allow elbow arthroplasty to be reliably performed in patients with severe rheumatoid arthritis of the elbow.     

Long-term results of arthroscopic synovectomy for seropositive rheumatoid arthritis: 6-16 year review

We prospectively studied a consecutive series of 25 knees (21 patients) treated with arthroscopic synovectomy for seropositive rheumatoid arthritis. All patients had pain and swelling and were in the early stages of the disease process (Larsen grade 2 or less). Three patients were lost to follow-up. At a mean of 8 years from operation two knees underwent total knee replacement with another two knees required a further arthroscopic synovectomy. One patient continued to experience intermittent mild synovitis. The range of movement was maintained or improved by surgery in 73% of cases but radiological evidence of degenerative change was seen in all knees. We discuss the technical difficulties associated with arthroscopic synovectomy that were associated with a small complication rate. In appropriately selected patients unresponsive to medical therapy, arthroscopic synovectomy can give safe and reliable results.     

Arthroscopic synovectomy of the elbow in rheumatoid arthritis

BACKGROUND: The purpose of this study was to investigate the results of arthroscopic synovectomy for the treatment of elbows affected by rheumatoid arthritis. METHODS: Arthroscopic synovectomy was performed on twenty-nine elbows (twenty-seven patients) between 1984 and 1996. Twenty-one elbows (twenty patients), followed for a minimum of forty-two months, were evaluated clinically with use of the Mayo elbow performance score and radiographic findings. The mean duration of follow-up was ninety-seven months. With use of the system of Larsen et al., we classified all elbows into three groups--Grades 1 and 2, Grade 3, and Grade 4--according to the preoperative radiographic findings. These groups were then compared. RESULTS: The mean Mayo elbow performance score improved from 48.3 points preoperatively to 77.5 points (an excellent result in two elbows, a good result in thirteen, a fair result in six, and a poor result in none) at two years after the operation and 69.8 points (an excellent result in two elbows, a good result in seven, a fair result in seven, and a poor result in five) at the final follow-up evaluation. The mean score for pain improved from 9.3 points preoperatively to 31.4 points at two years after the operation and 27.9 points at the final follow-up evaluation. Clinically apparent synovitis recurred in five of the twenty-one elbows, and two of the five required total elbow arthroplasty. Among the three groups, only elbows with Larsen Grade-1 or 2 arthritis had a favorable long-term result with regard to total function. The postoperative results were unsatisfactory for Larsen Grade-4 elbows. CONCLUSIONS: Arthroscopic synovectomy in an elbow affected by rheumatoid arthritis is a reliable procedure that can alleviate pain. Our results suggest that one of the most favorable indications for arthroscopic synovectomy is a preoperative radiographic rating of Grade 1 or 2.     

Psoriatic arthritis and arthroplasty: a review of the literature

Psoriatic arthritis is an inflammatory arthropathy as- sociated with the characteristic dermatologic lesions of psoriasis. The diagnosis of psoriatic arthritis is quite difficult, due to the overlap of patients with osteoarthritis (OA) or rheumatoid arthritis (RA) with concomitant non-associated psoriasis. A nonspecific elevation in inflammatory markers (erythrocyte sedimentation rate, ESR; antinuclear antibodies, ANA; or rheumatoid factor, RF) and characteristic radiographic features are often present in these patients. The mainstay of treatment is medical management, using NSAIDs, various immunosuppressants, and anti-TNF agents, for both pain control and possibly as disease modifying agents. Only a minority of patients require surgical intervention, leading to the limited amount of literature concerning total joint arthroplasty and psoriatic arthritis. While past literature has yielded high infection rates post-arthroplasty, newer studies have found more promising results. Alternative surgical options for treating destructive arthritis include open or arthroscopic synovectomy. While early results are promising, recurrence rates and long-term outcomes are not yet available.     

Early failure of silicone radial head implants in the rheumatoid elbow. A complication of silicone radial head implant arthroplasty

Three cases of early recurrent synovitis of the rheumatoid elbow following silicone radial head implant arthroplasty are presented. All three patients underwent synovectomy with silicone radial head implant for pain and loss of function due to rheumatoid synovitis. All three implants failed within 4-9 months after surgery. This failure was associated with radiographic medial joint space widening. At reexploration, recurrent synovitis with hemosiderin pigmentation was noted. Patterns of prosthetic failure included fracture, fraying, and compressive deformation or rotary wear ("motar and pestle") of the silicone radial head; a prosthetic stem fracture was also present. Histologic examination of the synovium revealed evidence of silicone-induced synovitis; particulate, refractile silicone debris was associated with inflammatory and foreign body giant cells. The presence of rheumatoid destruction of the joint surface may have accelerated this process and may be a relative contraindication to silicone radial head implant arthroplasty.     

Pigmented villonodular synovitis of the knee. The results of total arthroscopic synovectomy, partial, arthroscopic synovectomy, and arthroscopic local excision.

Twenty-five patients who had had a diagnosis of pigmented villonodular synovitis of the knee were followed for an average of four and one-half years (range, two to ten years) after arthroscopic treatment. Five patients had had localized lesions and had been managed with local resection; all five had improvement, with no apparent recurrence. The remaining twenty patients had had diffuse disease. Of these twenty, eleven had had a complete arthroscopic synovectomy. All eleven had definite improvement in pain and function, and almost all had a decrease in synovitis and an increase in the range of motion of the knee; the disease recurred in only one. The other nine patients had had a partial arthroscopic synovectomy. Although most had some improvement in function and range of motion and a decrease in pain and synovitis, the disease recurred in five of the nine. Thus, in the patients who had had diffuse pigmented villonodular synovitis, the rate of recurrence was lower in those who had had a complete arthroscopic synovectomy than in those who had had a partial arthroscopic synovectomy (p = 0.01).     

关节镜治疗膝关节早中期类风湿性关节炎

目的探讨膝关节类风湿性关节炎关节镜下滑膜切除术的治疗方法以及疗效评价。方法在关节镜下对33例（39个关节）膝关节类风湿性关节炎患者进行滑膜切除术,其中早期类风湿性关节炎7例,8个关节;中期类风湿性关节炎26例,31个关节。术后给予正规严格的抗类风湿药物治疗。术后随访分别按照Lysholm评分、ESR、CRP以及Ishikawa疗效评定标准进行评价。结果 33例患者平均随访时间为5.77年。采用Lysholm评分、ESR、CRP差异均具有统计学意义（P〈0.05）。Ishikawa评分：39个关节优良率为76.9%（30/39）,早期8个关节的优良率为87.5%（7/8）,中期31个关节的优良率为74.2%（23/31）,二者差异不具有统计学意义（P〉0.05）。结论膝关节早、中期类风湿性关节炎关节镜下滑膜切除术联合术后正规的抗类风湿药物治疗,均可以获得较满意的疗效。