【摘要】 目的 探討關節鏡治療膝關節滑膜軟骨瘤病的療效。 方法 2005年1月—2009年10月，對23例（28膝）滑膜軟骨瘤病患者入院行X線片、關節活動度檢查、視覺模擬評分以及Lysholm膝關節功能評分。根據鏡下所見分為表淺型6例，游離體型17例。結合病理學檢查行Milgram 分期，Ⅱ期16例，Ⅲ期7例。所有患者均行關節鏡下病變滑膜切除及游離體取出治療。 結果 所有患者均隨訪13~57個月，平均（32.3±6.7）個月，術后傷口均甲級愈合。術后（5.05±2.43） d恢復正常生活或工作。癥狀明顯改善21例（91.30%），部分改善2例（8.70%），對療效滿意23例（100%）。膝關節關節活動度由術前的伸膝（14.29±16.34）°以及屈膝（106.07±35.83）°提高到術后的伸膝（1.79±2.79）°及屈膝（132.64±35.64）°，差異具有統計學意義（P lt;0.05）。負重行走時疼痛視覺模擬評分由術前的（3.81±2.02）分降低到術后的（0.37±0.65）分（P lt;0.05）。Lysholm評分由術前的（43.20±8.24）分升至術后6個月的（86.72±5.40）分（P lt;0.05）；術后1年復診并檢查膝關節正側位X線片，均未見滑膜軟骨瘤體，所有患者無復發。 結論 關節鏡下游離體取出術聯合病變滑膜切除術療效滿意，關節疼痛明顯減輕，功能恢復，是一種治療膝關節滑膜軟骨瘤病確切有效的方法。
【Abstract】 Objective To investigate the therapeutic effect of arthroscopic treatment on synovial chondromatosis. Methods A total of 23 patients (28 knees) with synovial chondromatosis were diagnosed and treated in our hospital from January 2005 to October 2009. All of the patients underwent radiographic imaging examination, knee joint range of motion (ROM), visual analogue scale (VAS) and Lysholm score. According to distinct arthroscopic appearance, superficial pattern was found in 6 patients and loose body lesion pattern was in 17. Additionally, combined with pathological examination, according to the Milgram staging，Stage Ⅱ was in 6 patients and Stage Ⅲ was in 7. Arthroscopic limited synovectomy and removal of loose bodies were performed on all the patients. Results The patients were followed up for 13-57 months with the mean of (32.3±6.7) months. The wound of all patients healed up. The time of returning to normal work and life was (5.05±2.43) days for average. The postoperative symptom was markedly alleviated in 21 patietns and partly alleviated in 2. All patients were satisfied with the therapeutic effect. The mean activity of knee joint was significantly different befoe and after the surgery (P lt;0.05) preoperative extension and flexion degrees were (14.29±16.34) and (106.07±35.83) degrees, respectively; postoperative extension and flexion degrees were (1.79±2.79) and (132.64±35.64) degrees (flexion) , respectively. The mean VAS score of weight bearing walking was 0.37±0.65 after theoperation and 3.81±2.02 before the peration; the difference was significantly different (P lt;0.05). The preoperative Lysholm knee score was 34-67 with the mean of 43.20±8.24, and the post-operative score was 71-99 with the mean of 86.72±5.40. There were differences in preoperative and post-operative scores (P lt;0.05) . Radiographic imaging examination of knee joint was performed 1 year after the opertation, no loose bodies was seen and no patients recurred. Conclusion The therapeutic effect of arthroscopic limited synovectomy and removal of loose bodies is good on synovial chondromatosis.
引用本文： 何欣,李棋,唐新,劉東,李箭. 關節鏡下治療膝關節滑膜軟骨瘤病. 華西醫學, 2011, 26(5): 691-694. doi: 復制