关节镜手术辅助放射治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的疗效分析

目的分析采用关节镜手术辅助放射治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的疗效。方法 10例膝关节弥漫型色素沉着绒毛结节性滑膜炎患者,采用关节镜下病变切除,术后辅助放疗,通过12~36个月的随访,观察治疗效果。结果 10例随访患者,术前Lysholm膝关节功能评分为（53.5±11.6）分,术后随访Lysholm膝关节功能评分为（85.7±10.7）分。结论关节镜手术辅助放射治疗对弥漫型膝关节色素沉着绒毛结节性滑膜炎是一种有效的方法。     

关节镜治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的短期临床疗效分析

目的：探讨关节镜治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的短期临床疗效。方法自2007年1月～2011年1月对7例弥漫型色素沉着绒毛结节性滑膜炎患者进行了全滑膜切除术,并进行了2～5年的临床随访。结果7例患者均完全获得随访,平均随访时间32月。6例患者术后症状、功能得以明显改善,1例患者术后2月出现复发,再次进行关节镜下全滑膜切除术,术后联合局部放疗,截止末次随访为止,未见复发。 Ly－sholm关节功能评分由术前（41．21±12．32）分提高到（83．25±5．10）分（P＜0．05）,较术前关节功能评分具有显著性差异。结论关节镜治疗弥漫型色素沉着绒毛结节性滑膜炎损伤少、恢复快,复发率低,短期临床疗效满意。     

弥漫性色素绒毛结节性滑膜炎1例

色素沉着绒毛结节性滑膜炎（pigmented Villonodular synovitis．PVNS）临床上甚为少见，是发生在关节滑囊或腱鞘、滑膜内的滑膜呈结节状或绒毛状增生的一种病变。色素沉着绒毛结节性滑膜炎（PVNS）其X线及CT影像表现缺乏特异性，术前定性较困难。     

膝关节色素沉着绒毛结节性滑膜炎误诊1例

病例女,28岁.因右膝关节酸痛、肿胀及不敢活动半年来院,既往有外伤.偶有"交锁"现象,麦氏试验阳性,休息数天后肿胀好转,剧烈活动后加重,曾多次膝关节穿刺,抽出淡黄色液体,反复给予热敷、理疗及药物治疗,未达到满意疗效.查体:一般状况可,右膝关节肿胀,内侧间隙压痛,股四头肌萎缩,皮肤颜色正常,皮温略高,浮髌试验阳性,关节活动度0～80°,外周血运及感觉正常.实验室检查:白细胞9.1×109/L,中性粒细胞0.58,凝血功能正常.辅助检查:膝X线片示骨质、关节内组织未见异常.入院诊断:膝关节半月板损伤、滑膜炎.采取关节镜检查手术治疗,抽取少量关节液检查,呈红褐色,关节腔内滑膜充血、肿胀和增生,局限呈黄褐色绒毛结节状,彻底切除病变滑膜,冲洗关节腔,取部分滑膜组织送病理检查.病理诊断:色素沉着绒毛结节性滑膜炎.     

色素沉着绒毛结节性滑膜炎的MRI诊断

目的:探讨色素沉着绒毛结节性滑膜炎的MRI诊断价值.材料和方法:回顾性分析8例(男3例,女5例)经病理证实的色素沉着绒毛结节性滑膜炎的MRI表现.结果:8例均为单发,其中膝关节7例,髋关节1例.8例滑膜增厚均为弥漫型,无局灶型.增厚的滑膜T1WI呈等信号4例、稍高信号1例和低信号3例;T2WI呈高信号2例,高、低混杂信号6例,其中T2*WI低信号显示更为明显.5例膝关节增生的滑膜突破关节囊进入腘窝,形成多发大小不等结节状异常信号.髌上囊滑膜边缘呈波浪状改变6例,髌下脂肪囊见结节状、片状异常信号4例,前后交叉韧带区见混杂信号影4例.增强扫描呈中度至明显增强.3例出现骨质侵蚀性改变(膝关节2例,髋关节1例).3例膝关节病变伴有关节积液.结论:色素沉着绒毛结节性滑膜炎具有较特征性的MRI表现,大部分病例可准确诊断.     

色素沉着绒毛结节性滑膜炎诊断与治疗——附11例临床报道

对 11例弥漫型色素沉着绒毛结节性滑膜炎患者的临床资料进行了回顾性的随访。总结出MRI与B超是有效的诊断方法。MRI中T2像上低信号密度影是色素沉着绒毛结节性滑膜炎的特异性表现。在治疗方面 ,介绍了关节镜下次全滑膜切除术的方法 ,并对关节镜手术与切开手术进行比较。指出关节镜手术创伤小 ,并发症少 ,术中探查全面 ,术后容易康复的优点。推荐关节镜下次全滑膜切除术辅以术后放疗作为治疗弥漫型色素沉着绒毛结节性滑膜炎的有效方法。     

色素沉着绒毛结节性滑膜炎的MRI表现

目的 探讨色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis，PVNS)的MRI表现。方法 23例PVNS中膝关节9例，髋关节9例，踝关节3例，肘关节1例，腕关节1例，均经手术和病理证实。23例PVNS均行X线和MR检查，其中4例行CT检查。分析PVNS的影像学表现，着重总结PVNS的MR影像学特点。结果 X线表现：23例均可见关节及软组织肿胀，7例关节内外可出现较致密结节状或分叶状软组织肿块影，19例可见邻近关节骨质侵蚀性小缺损。CT表现：4例中3例可见关节内外结节状或分叶状软组织肿块，增强扫描可见结节样强化，1例CT仅显示关节囊增厚，关节内积液。MRI表现：23例病变部位增生肥厚的滑膜在T1WI上呈中等或中等稍低信号，在T2WI上呈中等稍高信号，其内可见多发散在结节，呈T1WI、T2WI低信号灶；增生肥厚的滑膜在快速梯度回波(FFE)T2WI序列上呈明显结节样低信号。23例病变关节均可见不同程度的关节积液。19例有骨质破坏，表现为凹陷性类圆形骨质缺损，骨缺损区T1、T2WI呈中等信号灶，周围有硬化边，呈T1WI、T2WI低信号。相邻骨髓腔内可见弥漫性反应性水肿灶，呈片状高T2信号。结论 MRI能准确显示PVNS的病变范围和程度，对PVNS有定性诊断价值。     

色素绒毛结节性滑膜炎膝关节组织的病理学个案研究

目的:研究膝关节色素绒毛结节性滑膜炎关节软骨、滑膜、半月板和前、后交叉韧带的病理学变化。方法:一例膝关节色素绒毛结节性滑膜炎的患者进行关节置换时,选取关节的软骨、滑膜、半月板和前、后交叉韧带组织进行HE染色,观察色素绒毛结节性滑膜炎对上述组织的影响。结果:软骨、滑膜、半月板和前交叉韧带细胞,可吞噬含铁血黄素,导致滑膜细胞增生,绒毛结节形成,软骨细胞和半月板细胞的死亡,软骨、半月板和前交叉韧带组织的退变。     

色素沉着绒毛结节性滑膜炎

色素沉着绒毛结节性滑膜炎(pigrnented viuonodular syrlovitis，PVNS)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。有关本病的病因、病名、病变性质、临床表现及治疗等观点众多；另外，随影像设备的进展和完善，人们对本病各种不同的影像表现也有进一步的补充和新的认识，对影像形成的病理基础也有了进一步的阐述。为对本病有较全面的了解，笔者复习了以往文献，现综述如下。     

膝关节色素沉着绒毛结节性滑膜炎的CT诊断

色素沉着绒毛结节性滑膜炎是一种少见的滑膜组织良性病变。病因至今尚未明了。临床以缓慢进行性关节肿胀及不适为主要症状 ,传统Ｘ线表现缺乏特征性。笔者报告 5例经手术病理证实的膝关节色素沉着绒毛结节性滑膜炎ＣＴ所见 ,并结合文献探讨该病的ＣＴ表现。1　资料与方法5例中 ,男 2例 ,女 3例 ,年龄 1 9～ 38岁 ,平均 2 5 .8岁。病程 7个月～ 1 2年不等 ,平均 6年。全部患者均有膝关节肿胀和疼痛症状。其中 3例关节活动受限 ,1例局部皮温略升高 ,1例可见局部肌肉萎缩。 4例关节积液 ,穿刺可抽出液体(3例为红色或棕色 ,1例为黄褐色 )。 5例…     

膝关节色素沉着绒毛结节性滑膜炎的MRI表现

目的：探讨膝关节色素沉着绒毛结节性滑膜炎的MRI表现。方法：回顾性分析8例经手术及病理证实的膝关节PVNS的MRI影像资料。结果：MRI表现中弥漫型6例,局灶型2例。PVNS主要表现为滑膜不规则结节状增生或弥漫性增生,增生的滑膜内含铁血黄素沉着（T2WI低信号）、邻近半月板和（或）骨侵蚀、关节腔积液等。结论：MRI是本病理想的检查方法。     

MRI of the knee in diffuse pigmented villonodular synovitis

Magnetic resonance imaging (MRI) was performed on 11 patients with surgically proven pigmented villonodular synovitis (PVNS) of the knee. PVNS was diagnosed on the basis of presence of hemosiderin, joint effusion, and hyperplastic synovium without significant joint destruction. MRI provided a detailed map of the distribution of the disease within the joint, emphasizing the common occurrence of the disease behind the cruciate ligaments and in synovial cysts in the popliteal fossa. MRI aided in preoperative planning and postoperative follow-up for residual and recurrent disease. Nine additional cases of joint hemorrhage, hemophilia, desmoplastic tumors, and synovial chondromatosis were included to delineate differential diagnostic criteria.     

膝关节色素沉着绒毛结节性滑膜炎的MRI影像分析

目的:分析膝关节色素沉着绒毛结节性滑膜炎(PVNS)的MRI影像表现,提高对本病的认识。方法:回顾性分析13例经病理证实的膝关节色素沉着绒毛结节滑膜炎,总结其MRI表现特点。结果:13例患者中弥漫型9例,局限型4例。PVNS主要表现为滑膜不规则结节状增生或弥漫性增生,增生的滑膜和结节内沉着含铁血黄素(T1WI、T2WI双低信号)。关节内外结构可受侵。结论:PVNS所致的滑膜增生和含铁血黄素沉着在MRI上具有特征性的表现和信号,对诊断本病具有重要意义。     

An unusual presentation of peroneal neuropathy secondary to pigmented villonodular synovitis: a case report

Pigmented villonodular synovitis (PVS) is a benign proliferative disorder of unknown origin that affects synovial joints, most commonly the knee. The joint knee can be affected by localized or diffuse form. Diffuse PVS, the aggressive form of the disease is much more problematic, especially when it extends extra-articularly, and is associated with high recurrence rates. Although this disease is categorized as an inflammatory process rather than a neoplasm, it may be locally destructive and involve muscles, tendons, bone and skin. Neural involvement of the disease is rather rare, and only limited knowledge about neuropathy due to PVS we have yet. The presentation of the disease in our patient is a peroneal neuropathy which is the first reported case in English language literature of PVS of the knee seen with extra-articular tissue involvement.     

Pigmented villonodular synovitis of the knee: computed tomographic appearances

Five patients with pigmented villonodular synovitis (PVNS) of the knee demonstrate the value of preoperative, contrast medium-enhanced CT scanning. The technique is shown to be particularly useful in locating recurrent lesions and in demonstrating that popliteal and posterior calf masses are due to PVNS affecting the knee joint itself. In two of the five patients PVNS was not considered a possibility before the CT scan, and none had evidence of bone erosion on plain radiographs. In none of the patients was the unenhanced CT scan able to demonstrate evidence of decreased radiolucency due to fat within the tumour or density greater than the adjacent skeletal muscle, indicating haemosiderin deposits.     

膝关节色素沉着绒毛结节性滑膜炎的影像学和病理学表现

目的:探讨膝关节色素沉着绒毛结节性滑膜炎(PVNS)的影像学和病理学表现。方法:回顾分析20例经手术和病理证实的PVNS影像学和病理学资料,并进行总结。结果:①X线表现:20例中,关节间隙增宽3例和变窄7例;10例在髌骨上下囊区可见单个或多个密度增高的椭圆形或分叶形阴影;关节骨面破坏6例;②MRI表现中弥漫型9例,局灶型3例。弥漫型中可见关节腔积液,髌上囊中见低信号结节,交叉韧带表面有增厚的低信号滑膜覆盖,并见关节骨面破坏,病灶周围有硬化环。局灶型表现为单发性肿块。结论:膝关节PVNS的MRI表现具有特征性,与术中所见和病理大多相符,能够作出正确诊断。     

髋关节色素沉着绒毛结节性滑膜炎的MRI诊断

目的：探讨髋关节色素沉着绒毛结节性滑膜炎的MRI表现。方法：对8例髋关节PVNS患者行常规MRI检查,结合术后病理结果进行对照分析。结果：8例MRI均显示滑膜不同程度肿胀、增厚以及关节间隙软组织肿胀,增生的滑膜组织于T1WI上呈等信号～低信号,T2WI上呈低信号夹杂混杂信号。结论：PVNS的MRI表现具有一定的特征性,MRI可显示病变的范围和程度,能准确反映关节内外受侵情况,对本病的临床诊治具有较高价值。     

Concentric joint space narrowing of the hip associated with hemosiderotic synovitis (HS) including pigmented villonodular synovitis (PVNS)

Concentric joint space narrowing of the hip is an expected radiographic finding in cases of inflammatory arthritis such as rheumatoid arthritis or sepsis. However, similar joint space narrowing is associated with chronic hemorrhagic conditions that produce hemosiderotic synovitis. Hemosiderotic synovitis results from chronic intraarticular bleeding such as occurs in pigmented villonodular synovitis, generalized bleeding diathesis, synovial hemangioma, and chronic trauma. Five hips in five patients with concentric joint space narrowing not associated with inflammatory arthritis or with hemophilia were reviewed clinically, radiographically, and pathologically. All patients had a hemosiderotic synovitis. The definitive diagnosis of pigmented villonodular synovitis was made pathologically in two cases that demonstrated nodular areas of giant cell proliferation, collagen production, and lipid-laden histiocytes on histologic samples.