肩关节外型色素绒毛结节性滑膜炎1例

患者,女,42岁,因右肩部酸痛1年余,发现肩部肿物半个月于2010年7月28日入院。自诉无明显诱因出现右肩部酸痛感,并伴有右上肢肌力下降,劳累后加重,休息后可缓解,未经系统诊治。半月前换衣服时发现右肩部较对侧肿大,于当地县医院行X线检查,骨质未见异常(图1),怀疑为"滑液囊肿",建议行关节穿刺,患者不同意,后就诊于其他医院,行关节穿刺活检,回报为"炎性改变,未见肿瘤细胞"。并在该院给予抗炎(头孢米诺钠3.0g加0.9%氯化钠注射液100ml,每日2次静脉滴注)对症治疗1周,肿物未见缩小,肩关节疼痛、活动受限症状未见好转,遂来我院就诊。入院查体:右肩关节前     

Arthroscopic treatment of pigmented villonodular synovitis of the shoulder

Pigmented villonodular synovitis (PVNS) rarely affects the shoulder. Fewer than 30 cases have been reported in the English and French language literature. In those patients, PVNS was treated by open surgery involving total or local synovectomy, sometimes associated with total shoulder replacement, cuff tear repair, or arthroplastic head resection. The authors report 2 cases of PVNS of the shoulder treated arthroscopically and discuss the advantages and limitations of this technique in the treatment of shoulder PVNS.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 1 (January), 2001: pp 81–87     

Ochronosis masquerading as pigmented villonodular synovitis: a case report

Alkaptonuria is an autosomal recessive disorder of tyrosine metabolism with a Mendelian pattern of inheritance. We present a unique, clinically asymptomatic case of ochronosis, first diagnosed on histopathological examination. This case is presented for its rarity. The knowledge of the histopathological changes would help to clinch the diagnosis even when it is not suspected clinically or radiologically, as in our case. An early and appropriate diagnosis would direct conservative therapy rather than major surgeries and would also help in preventing the development of fatal complications.     

Hemiarthroplasty for pigmented villonodular synovitis of the shoulder: a report of two cases

Pigmented villonodular synovitis is a reactive condition characterised by exuberant proliferation of synovial villi and nodules. It may be localised or diffuse and can cause severe articular damage. This report is of 2 patients with pigmented villonodular synovitis of the shoulder causing extensive arthritic changes. Both patients underwent shoulder hemiarthroplasty and total synovectomy and achieved satisfactory painless range of motion, with no signs of local recurrence or loosening of the prosthesis after 4 to 5 years of follow-up.     

弥漫型色素沉着绒毛结节性滑膜炎合并关节外巨大肿块1例

患者,女,40岁,右大腿远端肿物伴逐渐增大2年,于2017年12月3日为主诉入院。该患2年前发现右大腿远端肿物,当地医院怀疑为囊肿,多次给予穿刺抽液,穿刺液呈暗红色血性液体。治疗效果不佳,肿物逐渐增大。为求明确诊断被收入我科。查体:右大腿远端可见一肿物,大小约15 cm×10 cm。肿物表面皮温皮色正常,无压痛,触之质软,活动度较差。右膝关节肿胀,浮髌试验阳性,活动度正常。     

Hemiarthroplasty in a patient with pigmented villonodular synovitis of the shoulder

We report the 2-year follow-up results of a hemiarthroplasty in a 29-year-old patient with pigmented villonodular synovitis (PVNS) with extra-articular extension and severe bony destruction. The patient presented with diffuse pain and swelling of the right shoulder for several years. Radiographs showed severe osteolytic lesions in the humeral head and neck, greater tuberosity, and a small osteolytic lesion in the glenoid neck area. Further examination with magnetic resonance imaging of the shoulder joint showed a large, lobulated soft tissue mass extending from the subdeltoid area to the chest wall invading the adjacent bony structures. The operative findings included a large, multilobulated, yellowish-brown mass extending from the subdeltoid area to the axillary pouch, subacromial space, and thoracic wall. The mass invaded the anatomical neck area of the humeral head and caused a fracture of the humeral head. We observed a complete rupture of the long head of the biceps tendon, supraspinatus tendon, and infraspinatus tendon, but the subscapularis tendon was partially ruptured. We performed the complete excision and cemented hemiarthroplasty. At 2-year follow-up, no signs of local recurrence were present. The patient had no significant pain and achieved a good functional result.To the best of our knowledge, 1 report with shoulder hemiarthroplasty in PVNS of the shoulder has been published in the English literature. For PVNS of the shoulder with a large extra-articular extension and bony destruction, shoulder arthroplasty with total synovectomy produces the lowest recurrence rates because of better access and excision to the posterior location of the PVNS lesion.     

肩关节色素沉着绒毛结节性滑膜炎1例

1 病例资料 患者,男,45岁.因左肩部疼痛2年余,加重伴左肩部肿胀、活动障碍2个月,于2009年4月13日来院就诊.患者2年前时感左肩部酸痛不适,呈隐痛,症状不重,能参加日常劳动,未予诊治;2个月前感左肩部肿胀,疼痛明显加重,伴左肩部局部麻木感,左上肢活动受限,并逐渐加重,病程中无畏寒、发热、盗汗及进行性消瘦等症状.入院查体:T 37.4℃,P 80次.左肩部周围呈弥漫性肿胀,压痛,皮温不高;左肩关节活动障碍:外展60°、内收15°、前屈50°、后伸20°.实验室检查:血、尿、便常规及肝、肾功能、乙肝5项均正常;血沉14 mm/1 h.     

腰5峡部裂色素沉着绒毛结节性滑膜炎1例报道

1病案资料 患者女,40岁。主诉：腰痛伴活动受限1年余。1年前患者无明显诱因下出现腰部酸痛,长时间坐位及下蹲后站起后加重,在当地医院行相关检查,提示“腰5骶1椎间盘突出”,经卧床休息腰部症状可缓解,疼痛不向他处放射,平时症状不明显,未进行其他相应治疗,后感酸痛逐渐加重,就诊于我院并行摄片提示“腰5椎弓不连伴滑脱”,遂收住院。查体：脊柱生理弯曲变直,未见明显侧弯畸形,腰5-骶1棘间隙压痛、叩击痛阳性,双下肢直腿抬高试验及加强试验阴性,双下肌肉无痿缩、肌张力无增高、感觉正常,马鞍区皮肤感觉正常,病理反射阴性。腰椎CT提示：腰5椎弓结构不连续,小关节毛糙、硬化,腰4-5、腰5-骶1椎间盘突出（图1、2）;腰椎MRI：腰5椎体略前移,两侧椎弓结构欠规则,部分椎体前后缘变尖;腰5-骶1椎间盘及腰椎峡部信号减低,椎间盘并超出椎体后缘,压迫硬膜囊及两侧神经根;腰髓信号无明显异常（图3）。入院后诊断为：腰5峡部裂;腰4-5、腰5-骶1椎间盘突出。在全麻下行腰5峡部裂切开复位椎弓根内固定术＋植骨横突融合术,术中见腰5双侧峡部不连,以右侧为重,峡部不连接处骨质硬化,形成假关节,无明显微动,并且腰5下关节突处骨质缺失,假关节处有大量增生滑膜组织,呈土黄色,并与周围组织粘连。于腰5-骶1双侧置入椎弓根钉并分别连接短棒。予仔细清除峡部增生滑膜组织,取右侧髂后上棘骨质并剪成骨条备用。生理盐水冲洗后将髂骨条植于双侧峡部,以丝线逐层缝合切口。术中取出滑膜组织病理送检结果为：色素性绒毛结节性滑膜炎（图4、5）。     

Diffuse pigmented villonodular synovitis of the shoulder. A case report & review of literature.

The combination of a diffuse pigmented villonodular synovitis and a rotator cuff tear of the shoulder in a 64-year-old man is described. The patient was treated by complete synovectomy, open repair of the rotator cuff tear and a Neer acromioplasty. Six months after this surgical treatment the patient was free of pain, and clinical examination revealed an almost normal range of motion.     

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,     

Arthroscopic treatment of pigmented villonodular synovitis of the knee.

Pigmented villonodular synovitis (PVNS) is a rare disease, with multiple forms, anatomic sites, and treatment methods having been described. During a 10-year period, 14 patients, 7 male and 7 female, average age 35 years (range, 19 to 64 years) were treated for PVNS with arthroscopic partial or total synovectomy. Average follow-up was 42 months (range, 8 to 83 months). Twelve patients had diffuse and 2 had a localized form. Results were assessed subjectively, clinically, and radiographically, and were rated as excellent, good, fair, or poor. There were no complications and 10 patients (72%) were rated as excellent or good, 2 patients (14%) as fair, and 2 patients (14%) as poor. The recurrence rate was 14% and occurred in the group with diffuse PVNS. Radiographs did not show any bone erosion. The most widely accepted treatment for PVNS is synovectomy, and both open and arthroscopic synovectomy have been advocated as treatment. Advantages of arthroscopic treatment include accurate evaluation of the knee joint, treatment of other pathology, more rapid rehabilitation, decreased risk of joint stiffness, and less pain. In our experience, it appears that arthroscopic synovectomy is an effective method of treatment of this disorder.     

Arthroscopic treatment for localized pigmented villonodular synovitis of the knee

This study investigated 11 patients with localized pigmented villonodular synovitis of the knee that was diagnosed and treated by arthroscopic technique. There were six male and five female patients between the ages of 15 and 59 years (mean, 34.6 years). Seven patients reported extension limitation without joint line tenderness. Four of the 11 patients had a history of trauma before the onset of knee symptoms. All patients were treated by arthroscopic resection with partial synovectomy. The most common involved site was the anteromedial synovium near the anterior horn of the medial meniscus (five patients). The remaining cases were located in the anterior fat pad (two patients), suprapatellar pouch, posteromedial compartment, medial gutter, and the anterior horn of the lateral meniscus. Nine patients had one mass, and the remaining patients each had two or three masses. There was no evidence of recurrence at followup for an average of 29.9 months (range, 24-48 months). Arthroscopy is effective in the diagnosis of localized pigmented villonodular synovitis with minimal morbidity, and complete arthroscopic excision can be considered the definitive treatment for localized pigmented villonodular synovitis.     

Localized pigmented villonodular synovitis of the knee. Arthroscopic treatment

Localized pigmented villonodular synovitis is a lesion that may affect any joint but is frequently found in the knee. Because of its rarity, diagnostic omissions are common. Definitive treatment usually involves resection of the lesions as well as a synovectomy. Nine patients were treated arthroscopically, thereby avoiding arthrotomy. There was no evidence of recurrence at the follow-up evaluation (range, 25-108 months; mean, 48 months). The patients with mechanical knee symptoms had small nodular lesions anteriorly related to the menisci; those with degenerative symptoms had slightly more prolific nodules in other sites. No recurrence occurred in either group.     

Arthroscopic treatment of localized pigmented villonodular synovitis: long-term functional results

Pigmented villonodular synovitis (PVNS) is a proliferative disorder that may lead to joint destruction and activity limitation. We conducted a retrospective study to determine the long-term results of localized PVNS (LPVNS) treated with arthroscopic excision, specifically with respect to postoperative activity level and symptom resolution. We reviewed the cases of 11 patients who had been treated with arthroscopic excision and partial synovectomy of LPVNS and been followed up for a mean of 112 months. Preoperative and postoperative Ogilvie-Harris scores, Tegner activity level scores, and UCLA activity level scores were calculated to determine disease-specific and general functional outcomes, respectively. We noted 2 cases in which posteromedial lesions recurred, moderate resolution of preoperative symptoms in most cases, and 2 cases in which the patient developed secondary osteoarthritis requiring surgical intervention. Arthroscopic excision of LPVNS can improve symptoms with a return to preoperative activity levels, but patients may develop secondary osteoarthritis after treatment, as noted in long-term follow-up.     

Evaluation of the hip with pigmented villonodular synovitis. A case report.

Pigmented villonodular synovitis (PVNS) is an uncommon disorder of the synovium that rarely involves the hip joint. The natural history of an untreated case of PVNS is presented herein. A young adult with a painful hip and destructive changes on plain roentgenograms requires further diagnostic evaluation. The relative value of current imaging techniques is discussed in this report. Plain roentgenograms alone often suggest the correct diagnosis of PVNS of the hip, but traditional criteria have proven to be inaccurate. Computed tomography (CT) is helpful in demonstrating the location and degree of bone loss throughout the pelvis and assists in determining the need for bone graft or prosthetic modification in preoperative planning. Experience with magnetic resonance imaging (MRI) in this disorder is limited, but no clear advantage over CT has been demonstrated thus far. Three-dimensional reconstruction has provided no useful information not already found on plain CT or MRI. For diagnostic accuracy and effective preoperative planning, evaluation should include a complete blood count, sedimentation rate, CT scan, and MRI.     

A case of aggressive pigmented villonodular synovitis

An unusual case of pigmented villonodular synovitis affecting a knee joint is described. Shortly after synovectomy, extensive bone and ligament destructions occurred and made conservative surgery impossible.     

踝关节色素沉着绒毛结节性滑膜炎误诊1例报告

患者,女性,53岁,发现左外踝无痛性肿物2年余,无外伤史。发病1个月后曾在外院诊断为“血管瘤”,建议观察随诊。近期肿物逐渐增大,查体发现肿物位于外踝尖的前后侧分为两部分,轻度压痛,有揉面感,踝关节活动无受限。超声示外踝附近两个不规则低回声影,边界清,内部回声不均匀,内可见血流信号,为实性肿物。踝关节X线片未见明显骨质破坏,关节面光滑,关节间隙较对侧稍增宽。病理报告见图1。图1滑膜上皮呈乳头状增生,间质大量纤维组织细胞增生,淋巴细胞、多核巨细胞浸润,并伴大量含铁血黄素沉积(HE染色,×20)2005年1月12日行肿瘤切除术,由外踝沿肿…