髋关节色素沉着绒毛结节性滑膜炎的诊治

目的探讨髋关节色素沉着绒毛结节性滑膜炎（PVNS）的诊断方法及治疗措施。方法13例髋关节PVNS患者行关节腔清理术或滑膜广泛清扫术,通过辅助检查、病理检查及手术资料,总结髋关节PVNS的诊断措施及手术经验。结果13例均获随访,时间2～3年。3例局限型未见复发;4例混合型中,1例于2年后复发二次行全髋关节置换术,另3例未复发;6例弥漫型未复发。疗效评定参照日本骨科协会制定的髋关节疗效评定标准：优10例,良3例。结论早期诊断及对症治疗是决定髋关节PVNS疗效的关键;病程长短、病理类型及有无骨侵袭是影响PVNS预后的重要因素。     

色素沉着绒毛结节性滑膜炎

色素沉着绒毛结节性滑膜炎浙江省中医院（３１０００６）潘子毅，朱任东色素沉着绒毛结节性滑膜炎（ＰｉｇｍｅｎｔｅｄＶｉｌｌｏｎｏｄｕｌｌａｒＳｙｎｏｕｉｔｉｓ）为一种少见的慢性关节疾病，多发于青壮年，可发生于关节，腱鞘及滑囊的滑膜。由于本病的病因尚未明确...     

髋关节色素沉着绒毛结节性滑膜炎的研究进展

[目的]对髋关节色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis,PVNS)的相关研究进展进行综述,旨在为临床诊疗提供参考。[方法]广泛查阅近年国内外有关髋关节PVNS的研究文献,并进行综合分析。[结果]髋关节色素沉着绒毛结节性滑膜炎是一种罕见的良性增生性滑膜疾病,起病隐匿,症状缺乏特征性,临床上易于漏诊误诊。病理组织因含铁血黄素沉着而呈灰黄色或红棕色,根据形态可分为局限性和弥漫性。本病发病机理尚未明确,存在炎症、肿瘤、创伤、遗传等多种学说。诊断上需要与多种髋关节疾病相鉴别,X线平片常用于初筛,MRI可定性诊断,病理检查则是金标准。[结论]治疗方面目前尚未形成一套成熟的方案,但完整滑膜切除术已成为标准治疗,可通过开放手术或关节镜进行,对于晚期广泛骨质破坏的病例可考虑全髋关节置换术,放射疗法常用于外科手术的联合治疗。     

右髋关节色素沉着绒毛结节性滑膜炎并周围组织受累1例

1 病例资料 患者,女,36岁,因右髋部疼痛不适4年,加重伴右下肢跛行8个月,于2005年2月15日入院.2001年春无明显诱因开始右髋部疼痛,呈隐痛状,每于行走姿势不当时发作,可忍受,故未予重视.次年10月因X线片及CT扫描示有"股骨头囊性变"就诊,门诊诊断为"股骨头无菌性坏死",予健骨生等中成药服用,自觉症状有所缓解.     

色素沉着绒毛结节性滑膜炎行膝关节置换术后感染1例报告

<正>色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis,PVNS)是一种罕见的滑膜良性增生性病变,膝关节是最常受累的关节,骨结构常受到影响。病变晚期发生骨性关节炎甚至骨破坏后,可选择关节置换术。虽然有报道指出,PVNS患者行TKA术后假体的松动与PVNS的复发有关[1]。但尚无PVNS行TKA术后假体周围感染的文献报道。本科为经病理证实的1例双膝弥漫     

髋关节色素沉着绒毛结节性滑膜炎的诊治

色素沉着绒毛结节性滑膜炎(Pigmented villonodular synovitis，PVS)主要是指关节、滑囊以及腱鞘内的滑膜呈结节状或绒毛状进行性增生。以滑膜增生、棕黄色绒毛结节突出及含铁血黄素沉着为特点。病因不明，以膝关节多发，其次为髋关节。由于其起病隐匿、症状不典型，缺乏特异性辅助检查手段，临床常常漏诊甚至误诊。我科自1996年3月-2002年3月共收治髋关节PVS12例，均经手术及病检确诊，报告如下．     

髋关节色素沉着绒毛结节性滑膜炎的诊断与治疗研究进展

色素沉着绒毛结节性滑膜炎(pigmented villonodular syno-vitis,PVNS)是尚未明确病因的起病隐匿的良性增殖性滑膜疾病,以滑膜绒毛结节状增生肥厚并伴大量含铁血黄素沉积为主要病理生理改变.其最早由Chassaignac于1852年首次报道并形容为异常的肉瘤样滑膜增殖性病变[1].     

强直性脊柱炎并发髋关节色素沉着绒毛结节性滑膜炎1例报告

<正>作者收治1例罕见的强直性脊柱炎(ankylosing spondylitis,AS)并发髋关节色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis,PVNS)患者,现报告如下。1病例报告患者,男,43岁,腰背部疼痛16年,右髋疼痛16年,加重伴活动受限9个月余,左髋疼痛9个月余。13前确诊为AS,经药物治疗后髋部疼痛好转,时有反复。无外伤、酗酒及激素应用史。查体:脊柱     

髋关节色素沉着绒毛结节性滑膜炎31例临床特点分析

目的：探讨髋关节色素沉着绒毛结节性滑膜炎的发病、临床及影像学特点。方法：观察31例髋关节色素沉着绒毛结节性滑膜炎的发病特点，并对X线、CT、MRI检查进行评价。结果：髋关节色素沉着绒毛结节性滑膜炎以青年女性多见，多有外伤史，病程长，症状进行性加重，关节多无明显受限，易出现骨关节破坏。X线、CT、MRI检查有特征性表现，其中MRI是诊断髋关节色素沉着绒毛结节性滑膜炎的敏感性指标，结论：髋关节色素沉着绒毛结节性滑膜炎并不少见，典型者据临床表现及X线可作出诊断，必要时行MRI进一步明确诊断。     

全膝关节置换术在色素沉着绒毛结节性滑膜炎中的应用

目的探讨全膝关节置换术（TKA）治疗色素沉着绒毛结节性滑膜炎（PVNS）的临床效果。方法自2009-06—2012-05对11例PVNS并伴有骨质破坏的患者行滑膜切除及TKA治疗。所有患者手术前后均进行HSS评分及膝关节屈伸度测定,评价其功能恢复情况。结果 11例均获随访14~49个月,平均27个月。术后膝关节屈伸度及HSS评分均较术前明显改善,差异有统计学意义（P〈0.05）。结论对于导致严重骨质破坏或伴发骨性关节炎的PVNS,滑膜切除后行TKA治疗能收到满意的临床效果。     

金属对金属全髋关节表面置换治疗髋关节色素沉着绒毛结节性滑膜炎早期临床效果观察

目的探讨金属对金属全髋关节表面置换术治疗髋关节色素沉着绒毛结节性滑膜炎(PVNS)的可行性及早期临床效果。方法对7例经影像学检查及病理检查确诊的PVNS实施了滑膜切除+全髋关节表面置换术,术后康复锻炼。手术前后行Harris髋关节功能评分。结果7例均获随访,时间12～20(14.6±2.4)个月。患者假体位置良好,无松动、股骨颈骨折及明显骨溶解等并发症,关节活动度90°～130°,可从事日常生活,未出现复发症状。Harris髋关节功能评分由术前(45.2±7.8)分改善至术后(95.8±2.6)分。结论全髋关节表面置换术结合滑膜切除术早期能有效改善髋关节PVNS患者的临床症状、提高生活质量。     

色素沉着绒毛结节性滑膜炎行全髋关节置换术治疗的临床评估

目的回顾性研究全髋关节置换术结合滑膜切除治疗晚期髋关节色素沉着绒毛结节性滑膜炎(PVNS)的临床效果。方法对2000年10月至2010年6月间行髋关节切开滑膜清理加人工髋关节置换术治疗的13例晚期髋关节PVNS感染性患者进行回顾性研究,其中8例为局限型,5例为弥漫型,平均年龄33.7岁(21～65岁)。患者术前活动受限症状明显,术前检查提示关节面破坏,关节间隙狭窄,严重的伴有股骨头变形。术中采用关节切开滑膜广泛清理人工髋关节置换。随访分析患者功能恢复情况,比较术前、术后Harris评分及复发情况。结果 10例患者平均术后随访5.6年(0.5～10.3年),未出现复发,假体稳定,Harris评分从术前的47.6分提高到90.8分,能进行日常活动。3例出现复发,其中1例再次行切开清理术,术后良好;1例目前暂时行放射治疗;1例因复发面积广泛压迫下肢血液循环,减容手术无效最终行髋关节离断术。结论全髋关节置换结合增生滑膜切除是治疗局限型PVNS伴有骨质破坏的合适手术方式,能极大改善临床症状,复发率较低。对于弥漫型的治疗,复发率较高,仍待观察。     

全髋表面置换与金属对金属大直径股骨头全髋置换术后的步态分析比较

目的 比较全髋关节表面置换术与金属对金属大直径股骨头全髋关节置换术患者术后1年的步态有无差异.方法 选择2006年6月至2009年3月期间行全髋关节表面置换术与金属对金属大直径股骨头全髋关节置换术的连续病例各30例,利用Vicon步态分析仪测得两组患者术后平均1年左右的步态参数和步态周期中的髋、膝关节活动度,计算自身患侧/健侧比值进行比较分析.结果 两组患者术后平均1年左右步频、单腿支撑时间等比值和美国特种外科医院评分及加州大学洛杉矶分校评分比较差异无统计学意义,但全髋关节表面置换组患者步态周期中的髋屈伸度、收展度、旋转度及膝关节屈伸度患/健比分别为1.0323、0.9747、1.0558、1.0027,明显高于大直径股骨头全髋关节置换组(患/健比分别为0.8615、0.7824、0.8162、0.9472),P值分别为0.007、0.005、0.006、0.037.结论 (1)全髋关节表面置换术与金属对金属大直径股骨头全髋关节置换术患者术后1年的步态参数接近正常;(2)全髋关节表面置换术后患者行走时的关节活动度优于金属对金属大直径股骨头全髋关节置换术患者;(3)采用全髋关节表面置换除了能够保留骨量,还能最大程度恢复患者的关节功能.     

Complications after metal-on-metal hip resurfacing arthroplasty

This article determines the incidence and cause of the complications commonly associated with metal-on-metal hip resurfacing implants and the proposed methods to prevent these complications. The literature available in PubMed was reviewed. Complication rates after hip resurfacing are low, and the procedure has shown both safety and efficacy in the hands of surgeons trained in specialized centers. Proper surgical technique can further reduce the incidence of femoral neck fracture, component loosening, and abnormal wear of the prosthesis. A more systematic detection of adverse local tissue reactions is needed to provide accurate assessments of their prevalence.     

金属对金属髋关节表面置换术的短期随访研究

目的探讨金属对金属(MOM)混合固定型髋关节表面置换术(HRA)的近期疗效,分析手术技术要点。方法 2004年10月至2008年6月,对52例(58髋)股骨头缺血性坏死、骨关节炎、髋关节发育不良、强直性脊柱炎患者行MOM-HRA。其中男32例,女20例;年龄16～65岁,平均42.6岁。手术方法按照K.De.Smet标准方法进行,术后对Harris评分、关节活动度和X线片进行随访。结果失访7例(8髋),45例(50髋)获得随访,随访时间平均22个月(12～54个月)。术前平均Harris评分(37.0±1.2)分,术后22个月平均(93.0±1.0)分;术前屈髋度平均(25.3±1.6)°,术后22个月平均(105.0±1.8)°;术前外展度平均(18.8±0.8)°,术后22个月平均(40.6±1.0)°。评价:46髋优,3髋良,1髋差。无股骨颈骨折,无松动,无脱位,无感染,无翻修,1例异位骨化BrookerⅢ型。结论 HRA具有保留股骨头骨量、术后关节活动度恢复快、近期结果好等优点,对于获得优良的术后结果,严格的患者选择和精确的手术技术至关重要。     

Surgical treatment of pigmented villonodular synovitis of the hip

BACKGROUND: Pigmented villonodular synovitis of the hip is a rare disease. Synovectomy is generally accepted as the only surgical treatment for the disorder, but there have been few studies with a sufficient sample size and duration of follow-up to allow the evaluation of long-term outcomes. The aim of this study was to determine the long-term outcome of the treatment in sixteen patients. METHODS: Sixteen patients (nine men and seven women), with a mean age of 35.5 years at the time of surgery, were treated between 1970 and 1996. Complete synovectomy was performed in all patients; in addition, three had a cup arthroplasty, four had a total hip arthroplasty, and one had a monopolar arthroplasty. Clinical and radiographic outcomes were evaluated retrospectively at a mean of 16.7 years postoperatively. Only one patient was followed for less than eight years. RESULTS: Nine patients needed repeat surgery, but only one had recurrent synovitis, as detected with pathological examination fourteen years after treatment with synovectomy and cup arthroplasty. Secondary osteoarthritis developed in all eight patients who had been treated with synovectomy alone, and four of them required a total hip arthroplasty within the follow-up period. CONCLUSIONS: These results support earlier data indicating that osteoarthritis consistently develops in patients with pigmented villonodular synovitis of the hip. Complete synovectomy seems to be effective in preventing recurrence of the synovitis, but it does not appear to prevent the development of secondary osteoarthritis.     

金属对金属全髋关节表面置换术的近期疗效

 目的 分析金属对金属全髋关节表面置换术的近期疗效, 探讨其适应证选择和技术要点。方法 2006 年1 月至2010 年10 月因股骨头坏死、髋关节骨关节炎、髋关节发育不良、强直性脊柱炎接受全髋关节表面置换术104 例(116 髋), 其中男59 例(66 髋), 女45 例(50 髋);年龄16~67 岁, 平均39.7 岁。均采用Conserve Plus 假体, 依据比利时技术标准完成全髋关节表面置换术。术后1 个月、3个月、6 个月、1 年及之后每年随访一次, 摄X 线片并统计Harris 髋关节评分。结果 101 例(112 髋)获得随访, 随访率97.1豫。随访时间9~66 个月, 平均33个月。Harris髋关节评分由术前平均(37.6±6.3)分提高至末次随访时(91.3±5.3)分, 其中优104 髋、良7 髋、差1 髋, 优良率99.1%(111/112)。末次随访时, 髋臼假体外展角36°~55°, 平均42.7°;股骨假体柄干角132°~146°, 平均138.5°。随访期间出现异位骨化2 例(2.0豫, 2/101), 分别为Brooker III型1 例及Brooker II型1 例, 均无症状, 未予处理。术后并发假体脱位1 例(1.0%, 1/101), 经手法复位及卧床1 个月治愈, 未再发生脱位。无股骨颈骨折、假体松动、感染及翻修病例。结论 严格选择手术适应证, 配合精确的手术技术, 金属对金属髋关节表面置换术可获得良好的近期疗效。     

Femoral revision in hip resurfacing compared with large-bearing metal-on-metal hip arthroplasty

It has been suggested that revision of the femoral component of hip resurfacing after femoral failure would be straightforward and have an outcome comparable to primary total hip arthroplasty (THA). We have compared the outcome of femoral side-only revision resurfacings to the results of primary modular large-bearing metal-on-metal THA. Fourteen consecutive patients underwent revision surgery of the failed femoral component, to a cemented tapered stem (CPT, Zimmer, Warsaw, Indiana) with a large modular metal head (Smith and Nephew Orthopaedics Ltd, Memphis, Tennessee, or Adept, Finsbury Orthopaedics, Surrey, England). The acetabular component was found to be well fixed, well orientated, and was left in situ. The 14 matched patients in the primary THA group received the same components. At a mean follow-up of 49 months (range, 30-60 months), clinical outcome measured using the Oxford and Harris Hip Scores showed no significant difference (P = .11, P = .45, respectively). Operative time and blood loss were comparable for both groups. We conclude that revision of the failed femoral resurfacing component gives excellent results.     

One- or two-stage bilateral metal-on-metal hip resurfacing arthroplasty

Patients considered suitable for total hip resurfacing arthroplasty often have bilateral disease. The peri-operative complications, transfusion requirements, hospital stay, outcome and costs in patients undergoing one-stage bilateral total hip resurfacing were compared with a group of patients undergoing a two-stage procedure. A total of 92 patients were included in the study, of which 37 (40%) had a one-stage and 55 (60%) had a two-stage resurfacing. There were no significant differences in age, gender, or American Society of Anaesthesiologists grade between the groups (p = 0.31, p = 0.23, p = 0.13, respectively). There were three systemic complications in the one-stage group (8.1%) and one in the two-stage group (1.8% of patients; 0.9% of procedures). There was no significant difference in the complication rate (p = 0.72) or the transfusion requirements (p = 0.32) between the two groups. The one-stage group had a reduced total hospital stay of five days (95% confidence interval 4.0 to 6.9; p < 0.001), reduced length of time to completion of all surgery of five months (95% confidence interval 2.6 to 8.3; p < 0.001), and the reduced cost was 35% less than that of a two-stage procedure. However, the total anaesthetic time was significantly longer for the one-stage group (p < 0.001; 95% confidence interval 31 to 52). This study demonstrates that consideration should be given to one-stage surgery for patients with bilateral symptomatic disease suitable for metal-on-metal hip resurfacing. A one-stage procedure appears to have benefits for both the patient and the hospital without additional complications.