膝关节镜下诊治局灶性色素沉着绒毛结节性滑膜炎的临床疗效

目的 探讨采用关节镜技术诊治膝关节局灶性色素沉着绒毛结节性滑膜炎(localized pigmented villonodular synovitis,LPVNS)的临床疗效.方法 2004年6月至2007年9月,关节镜下辅助诊治12例LPVNS患者,男5例,女7例;年龄22～53岁,平均36.3岁.病程最短1个月,最长84个月,平均19.5个月.关节镜下行关节内肿物和局部滑膜切除术,根据膝关节Lysholm评分评估术后疗效.结果 膝关节镜检查发现2例伴内侧半月板前角损伤,1例伴外侧半月板损伤,4例内侧滑膜皱襞增生Ⅲ度,3例髌股关节炎Ⅱ度,其中1例伴内外侧髁软骨Ⅲ度磨损.3例肿物来源于内侧半月板前角附着处滑膜,1例在外侧半月板前角附着处滑膜,3例在髌下脂肪垫,1例在髁间窝,2例在内侧沟,1例在外侧沟.1 例来源于膝关节后纵隔内侧面滑膜.肿物大小平均1.7 cm×1.4 cm×0.8 cm(0.5 cm×0.5 cm×0.5 cm～3 cm×3 cm×2 cm);2例无蒂,10例带蒂,术后组织切片均明确LPVNS的诊断.术后无一例发生膝关节感染.术后随访6～45个月,平均19.9个月.7例无任何不适,3例膝关节下蹲时存在疼痛,1例活动后肿胀,1例行走后疼痛.术后膝关节Lysholm评分为78～100分,平均96.3分;8例优,3例良,1例中.结论 关节镜技术是诊治膝关节LPVNS的一种有效方法 .

Clinical results of arthroscopic treatment for localized pigmented villonodular synovitis of knee joint

Objective To investigate the clinical results of the patients with localized pigmented villonodular synovitis of knee joint treated by arthroscopic technique.Methods From June 2004 to September 2007,there were twelve patients,five males and seven females,between the ages of 22 and 53 years (mean,36.3 years).All patients were treated by arthroscopic resection with partial synovectomy.The course of disease ranged from 1 month to 84 months,with the mean of 19.5 months.All patients were followed up and evaluated the clinical results with the Lysholm Knee Scoring Scale questionnaire.Results There were two cases with anterior horn of medial meniscus rupture,one with lateral meniscus rupture,four with medial plica hyperplasia (gradeⅢ),and three with patellofemoral arthritis (grade Ⅱ ),one of them also with medial and lateral condylar cartilage wear (grade Ⅲ).The masses involved sites were three at the anteremedial synovium near the anterior horn of the medial meniscus,three at the infrapattella fat pad,one near the anterior horn of the lateral meniscus,one at condylar notch,two at medial gutter,one at lateral gutter and one at the posteromedial compartment.The average size of the masses was 1.7 cm×1.4 cm×0.8 cm (0.5 cm×O.5 cm×0.5 cm-3cru×3 cm×2 cm),two without pedicle,and ten with pedicle.During follow-up for an average of 19.9 months (range,6-45 months),8 patients were rated as excellent,3 good and 1 fair according to the Lysholm Knee Scoring Scale questionnaire (mean 96.3).Conclusion Arthroscopy is effective in the diagnosis of localized pigmented villonodular synovitis and complete arthroscopic excision can be considered the effective treatment for localized pigmented villonodular synovitis.