CAJ | 학술논문

目的探讨膝关节滑膜脂肪瘤病的命名、诊断及关节镜辅助治疗方法,提高对膝关节滑膜脂肪瘤病的认识.方法回顾性分析2006年2月至2008年2月收治的9例滑膜脂肪瘤病病例资料,男4例,女5例;年龄32～71岁,平均51.1岁.9例均行病灶清理术,其中8例关节镜下手术,1例开放性手术.4例关节镜下表现为膝关节髌上囊滑膜大量、多发球形和绒毛状突起.绒毛饱满,呈浅黄色,严重时累及膝关节内侧室和外侧室;5例关节镜下表现为滑膜簇状增生,呈手指样.MRI显示关节腔积液,滑膜呈树枝状增生、肥厚.组织学检查显示绒毛最外层为两或三层滑膜细胞,绒毛间质由大量成熟的脂肪细胞构成.全部患者随访6～29个月,平均18.2个月.随访内容包括:病情主诉、膝关节活动度测量及膝关节功能Lysholm评分.结果随访期间均未再发膝关节肿胀、积液.末次随访膝关节活动度111.67°±11.18°,Lysholm评分(72.44°13.93)分,二者与术前比较[101.11°±16.54°,(40.56±19.93)分]差异均有统计学意义(t值分别为3.447和6.728,P值分别为0.009和0.001).结论临床上存在对滑膜脂肪瘤病的认识不足,常与膝关节滑膜脂肪瘤混淆.诊断主要依靠特异性的MRI表现、关节镜下特征及病理改变.对膝关节滑膜脂肪瘤病行关节镜下病灶清理术创伤小、恢复快.
목적 탐토슬관절활막지방류병적명명、진단급관절경보조치료방법,제고대슬관절활막지방류병적인식.방법 회고성분석2006년2월지2008년2월수치적9례활막지방류병병례자료,남4례,녀5례;년령32～71세,평균51.1세.9례균행병조청리술,기중8례관절경하수술,1례개방성수술.4례관절경하표현위슬관절빈상낭활막대량、다발구형화융모상돌기.융모포만,정천황색,엄중시루급슬관절내측실화외측실;5례관절경하표현위활막족상증생,정수지양.MRI현시관절강적액,활막정수지상증생、비후.조직학검사현시융모최외층위량혹삼층활막세포,융모간질유대량성숙적지방세포구성.전부환자수방6～29개월,평균18.2개월.수방내용포괄:병정주소、슬관절활동도측량급슬관절공능Lysholm평분.결과 수방기간균미재발슬관절종창、적액.말차수방슬관절활동도111.67°±11.18°,Lysholm평분(72.44°13.93)분,이자여술전비교[101.11°±16.54°,(40.56±19.93)분]차이균유통계학의의(t치분별위3.447화6.728,P치분별위0.009화0.001).결론 림상상존재대활막지방류병적인식불족,상여슬관절활막지방류혼효.진단주요의고특이성적MRI표현、관절경하특정급병리개변.대슬관절활막지방류병행관절경하병조청리술창상소、회복쾌.
Objective To investigate the denomination, diagnosis, and arthroscopic therapy of syn-ovial lipomatosis of knee joint. Methods Nine cases of synovial lipomatosis were retrospectively evaluated.There were 4 males and 5 females, with an average age of 51.1 years (range, 32-71 years). All patients were treated surgically, including 1 case of open surgery and 8 case of arthroscopy, with a mean follow-up of 18.2 months (range, 6-29 months). Under arthroscope, patellar bursa was occupied by light yellow, round and vil- lous processes in 4 cases, medial and lateral compartment were also involved. Synovial membrane manifested "finger" like clustery hyperplasia in 5 cases. MRI showed effusion of joint and "tree" like synovial mem-brane. Histology showed outer sphere of villi was formed with two or three layers of synovial cells, and inner part were filled with amount of mature iipocyte. The content of follow-up include: chief complaints, range of motion of knee joint and Lysholm score. Results No swollen nor effusion of the infected knee was found in all patients during the follow-up. Range of motion was 111.67°±11.18° at last follow-up. Lysholm scores was 72.44±13.93. The difference between results was statistically significant (t=3.447, 6.728, P=0.009, 0.001)compared with preoperative data 001.11°±16.54°, 40.56±19.93). Conclusion Synovial lipomatosis was usually misdiagnosed as synovial lipoma, and a thorough understanding of this disease is required. A clini-cal diagnosis comes from significant MRI manifestation, arthroscopic feature and histological finding. With the advantage of mini invasion and early recovery, arthroscopic cleaning is preferred to synovial lipomato-sis.