• 四川大學華西醫(yī)院骨科（成都，610041）;

【摘要】　目的　 探討關(guān)節(jié)鏡治療膝關(guān)節(jié)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(guān)節(jié)活動度檢查、視覺模擬評分以及Lysholm膝關(guān)節(jié)功能評分。根據(jù)鏡下所見分為表淺型6例，游離體型17例。結(jié)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(guān)節(jié)鏡下病變滑膜切除及游離體取出治療。　結(jié)果　 所有患者均隨訪13~57個月，平均（32.3±6.7）個月，術(shù)后傷口均甲級愈合。術(shù)后（5.05±2.43） d恢復(fù)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(guān)節(jié)關(guān)節(jié)活動度由術(shù)前的伸膝（14.29±16.34）°以及屈膝（106.07±35.83）°提高到術(shù)后的伸膝（1.79±2.79）°及屈膝（132.64±35.64）°，差異具有統(tǒng)計學意義（P lt;0.05）。負重行走時疼痛視覺模擬評分由術(shù)前的（3.81±2.02）分降低到術(shù)后的（0.37±0.65）分（P lt;0.05）。Lysholm評分由術(shù)前的（43.20±8.24）分升至術(shù)后6個月的（86.72±5.40）分（P lt;0.05）；術(shù)后1年復(fù)診并檢查膝關(guān)節(jié)正側(cè)位X線片，均未見滑膜軟骨瘤體，所有患者無復(fù)發(fā)。　結(jié)論　 關(guān)節(jié)鏡下游離體取出術(shù)聯(lián)合病變滑膜切除術(shù)療效滿意，關(guān)節(jié)疼痛明顯減輕，功能恢復(fù)，是一種治療膝關(guān)節(jié)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(guān)節(jié)鏡下治療膝關(guān)節(jié)滑膜軟骨瘤病. 華西醫(yī)學, 2011, 26(5): 691-694. doi: 復(fù)制

1. 　韓綱, 王巖, 畢文志. 滑膜軟骨瘤病的臨床病理特點[J]. 軍醫(yī)進修學院學報, 2007, 28(3): 234-236.
2. 　孫笑非, 阮狄克, 邱強, 等. 關(guān)節(jié)鏡下診斷與治療滑膜軟骨瘤病[J]. 中國矯形外科雜志, 2001, 8(10): 973-974.
3. 　陳堅, 杜莉如, 谷國良. 關(guān)節(jié)鏡下診斷與治療膝關(guān)節(jié)滑膜軟骨瘤病[J]. 中華骨科雜志, 1999, 19(5): 278-280.
4. 　Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J]. Am J Sports Med, 1983, 10(3): 152-154.
5. 　Hugh M, Vivek G, Samantha T. A rare case of a swollen knee due to disseminated synovial chondromatosis: a case report[J]. J Med Case Reports, 2010, 4: 113.
6. 　Ackerman D, Lett P, Galat DD Jr, et al. Results of total hip and total knee arthroplasties in patients with synovial chondromatosis[J]. J Arthroplasty, 2008, 23(3): 395-400.
7. 　劉鐵利, 董越, 王晶, 等. MRI在滑膜軟骨瘤病中的診斷價值[J]. 大連醫(yī)科大學學報, 2010, 32(5): 524-527.
8. 　Milgram JM, Dunn EJ. Periarticular chondromas and osteochondromas: a report o f three cases [J]. Clin Orthop Rel Res, 1980, 148(5): 147-151.
9. 　Holmlund AB, Eriksson L, Reinholt FP. Synovial chondromatosis of the temporomandibular joint: clinical, surgical and histological aspects[J]. Int J Oral Maxillofac Surg, 2003, 32(2): 143-147.
10. 　董越, 伍建林, 張麗芝, 等. 滑膜軟骨瘤病的影像表現(xiàn)與病理對照分析[J]. 中國臨床醫(yī)學影像雜志, 2009, 20(10): 736-739.
11. 　Ranalletta M, Bongiovanni S, Calvo JM, et al. Arthroscopic treatment of synovial chondromatosis of the shoulder:Report of three patients[J]. J Shoulder Elbow Surg, 2009, 18(3): 4-8.
12. 　Lin RC, Lue KH, Lin ZI, et al. Primary synovial chondromatosis mimicking medial meniscal tear in a young man[J]. Arthroscopy, 2006, 22(7): 803.e1-803.e3.
13. 　Coolican MR, Dandy DJ. Arthroscopic management of synovial chondromaotosis of the knee: findings and results in 18 case[J]. J Bone Joint Surg(Br), 1989, 71-B(3): 498-500.
14. 　Dorfmawn H, Debie B, Bonvarlet JP, et al. Arthroscopic treatment of synovial chondromatosis of the knee[J]. Arthroscopy, 1989, 5(1): 48-51.
  1. 1. 　韓綱, 王巖, 畢文志. 滑膜軟骨瘤病的臨床病理特點[J]. 軍醫(yī)進修學院學報, 2007, 28(3): 234-236.
  2. 2. 　孫笑非, 阮狄克, 邱強, 等. 關(guān)節(jié)鏡下診斷與治療滑膜軟骨瘤病[J]. 中國矯形外科雜志, 2001, 8(10): 973-974.
  3. 3. 　陳堅, 杜莉如, 谷國良. 關(guān)節(jié)鏡下診斷與治療膝關(guān)節(jié)滑膜軟骨瘤病[J]. 中華骨科雜志, 1999, 19(5): 278-280.
  4. 4. 　Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J]. Am J Sports Med, 1983, 10(3): 152-154.
  5. 5. 　Hugh M, Vivek G, Samantha T. A rare case of a swollen knee due to disseminated synovial chondromatosis: a case report[J]. J Med Case Reports, 2010, 4: 113.
  6. 6. 　Ackerman D, Lett P, Galat DD Jr, et al. Results of total hip and total knee arthroplasties in patients with synovial chondromatosis[J]. J Arthroplasty, 2008, 23(3): 395-400.
  7. 7. 　劉鐵利, 董越, 王晶, 等. MRI在滑膜軟骨瘤病中的診斷價值[J]. 大連醫(yī)科大學學報, 2010, 32(5): 524-527.
  8. 8. 　Milgram JM, Dunn EJ. Periarticular chondromas and osteochondromas: a report o f three cases [J]. Clin Orthop Rel Res, 1980, 148(5): 147-151.
  9. 9. 　Holmlund AB, Eriksson L, Reinholt FP. Synovial chondromatosis of the temporomandibular joint: clinical, surgical and histological aspects[J]. Int J Oral Maxillofac Surg, 2003, 32(2): 143-147.
  10. 10. 　董越, 伍建林, 張麗芝, 等. 滑膜軟骨瘤病的影像表現(xiàn)與病理對照分析[J]. 中國臨床醫(yī)學影像雜志, 2009, 20(10): 736-739.
  11. 11. 　Ranalletta M, Bongiovanni S, Calvo JM, et al. Arthroscopic treatment of synovial chondromatosis of the shoulder:Report of three patients[J]. J Shoulder Elbow Surg, 2009, 18(3): 4-8.
  12. 12. 　Lin RC, Lue KH, Lin ZI, et al. Primary synovial chondromatosis mimicking medial meniscal tear in a young man[J]. Arthroscopy, 2006, 22(7): 803.e1-803.e3.
  13. 13. 　Coolican MR, Dandy DJ. Arthroscopic management of synovial chondromaotosis of the knee: findings and results in 18 case[J]. J Bone Joint Surg(Br), 1989, 71-B(3): 498-500.
  14. 14. 　Dorfmawn H, Debie B, Bonvarlet JP, et al. Arthroscopic treatment of synovial chondromatosis of the knee[J]. Arthroscopy, 1989, 5(1): 48-51.