关节镜下治疗膝关节滑膜软骨瘤病

【】　目的　探讨关节镜治疗膝关节滑膜软骨瘤病的疗效。　方法　2005年1月―2009年10月，对23例（28膝）滑膜软骨瘤病患者入院行X线片、关节活动度检查、视觉模拟评分以及Lysholm膝关节功能评分。根据镜下所见分为表浅型6例，游离体型17例。结合病理学检查行Milgram分期，Ⅱ期16例，Ⅲ期7例。所有患者均行关节镜下病变滑膜切除及游离体取出治疗。　结果　所有患者均随访13~57个月，平均（32.3±6.7）个月，术后伤口均甲级愈合。术后（5.05±2.43）d恢复正常生活或工作。症状明显改善21例（91.30%），部分改善2例（8.70%），对疗效满意23例（100%）。膝关节关节活动度由术前的伸膝（14.29±16.34）°以及屈膝（106.07±35.83）°提高到术后的伸膝（1.79±2.79）°及屈膝（132.64±35.64）°，差异具有统计学意义（P<0.05）。负重行走时疼痛视觉模拟评分由术前的（3.81±2.02）分降低到术后的（0.37±0.65）分（P<0.05）。Lysholm评分由术前的（43.20±8.24）分升至术后6个月的（86.72±5.40）分（P<0.05）；术后1年复诊并检查膝关节正侧位X线片，均未见滑膜软骨瘤体，所有患者无复发。　结论　关节镜下游离体取出术联合病变滑膜切除术疗效满意，关节疼痛明显减轻，功能恢复，是一种治疗膝关节滑膜软骨瘤病确切有效的方法。【Abstract】　Objective　Toinvestigatethetherapeuticeffectofarthroscopictreatmentonsynovialchondromatosis.　Methods　Atotalof23patients(28knees)withsynovialchondromatosiswerediagnosedandtreatedinourhospitalfromJanuary2005toOctober2009.Allofthepatientsunderwentradiographicimagingexamination,kneejointrangeofmotion(ROM),visualanaloguescale(VAS)andLysholmscore.Accordingtodistinctarthroscopicappearance,superficialpatternwasfoundin6patientsandloosebodylesionpatternwasin17.Additionally,combinedwithpathologicalexamination,accordingtotheMilgramstaging，StageⅡwasin6patientsandStageⅢwasin7.Arthroscopiclimitedsynovectomyandremovalofloosebodieswereperformedonallthepatients.　Results　Thepatientswerefollowedupfor13-57monthswiththemeanof(32.3±6.7)months.Thewoundofallpatientshealedup.Thetimeofreturningtonormalworkandlifewas(5.05±2.43)daysforaverage.Thepostoperativesymptomwasmarkedlyalleviatedin21patietnsandpartlyalleviatedin2.Allpatientsweresatisfiedwiththetherapeuticeffect.Themeanactivityofkneejointwassignificantlydifferentbefoeandafterthesurgery(P<0.05)preoperativeextensionandflexiondegreeswere(14.29±16.34)and(106.07±35.83)degrees,respectively;postoperativeextensionandflexiondegreeswere(1.79±2.79)and(132.64±35.64)degrees(flexion),respectively.ThemeanVASscoreofweightbearingwalkingwas0.37±0.65aftertheoperationand3.81±2.02beforetheperation;thedifferencewassignificantlydifferent(P<0.05).ThepreoperativeLysholmkneescorewas34-67withthemeanof43.20±8.24,andthepost-operativescorewas71-99withthemeanof86.72±5.40.Thereweredifferencesinpreoperativeandpost-operativescores(P<0.05).Radiographicimagingexaminationofkneejointwasperformed1yearaftertheopertation,noloosebodieswasseenandnopatientsrecurred.　Conclusion　Thetherapeuticeffectofarthroscopiclimitedsynovectomyandremovalofloosebodiesisgoodonsynovialchondromatosis.