CAJ | 학술논문

目的：探讨应用关节镜结合髌上囊小切口切开滑膜切除治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎（ PVNS）患者的疗效。方法本组对2006年1月至2011年12月因膝关节弥漫型PVNS的32例患者进行回顾性分析，该组患者全部采用膝关节镜结合髌上囊局部切开滑膜切除的治疗方法。本研究对患者的基本情况、治疗方法、复发率和症状进展进行的记录，最短随访时间为7个月（平均中位数为49.8个月；范围7～141个月）。结果应用膝关节镜结合髌上囊局部切开滑膜切除方法治疗PVNS的复发率低（6.3％），肿胀和疼痛术后好转，其中明显好转没有疼痛和活动不适的为50％，而关节炎持续进展的为11.1％，但是没有患者在最后随访期内发展进行膝关节置换。最常见的并发症为血肿，发生率为3％，但是没有发现对患者术后疗效产生明显影响。术前KSS临床评分为（62.7±17.7）分；功能评分为（45.0±24.0）分，术后临床KSS评分（85.2±10.9）分；功能评分（79.5±12.3）分，比较均有统计学差异（临床KSS评分：t＝4.456，P＜0.001；功能KSS评分：t＝5.279，P＜0.001）；而Lysholm评分术前（64.7±15.0）分，术后提高到（83.2±8.4）分，二者间比较有统计学差异（ t＝4.451，P＜0.001）。结论结合相关文献报道，膝关节镜结合髌上囊局部切开滑膜切除方法是治疗膝关节弥漫型PVNS的较好方法，有着较低的复发率和并发症。
목적：탐토응용관절경결합빈상낭소절구절개활막절제치료슬관절미만형색소침착융모결절성활막염（ PVNS）환자적료효。방법본조대2006년1월지2011년12월인슬관절미만형PVNS적32례환자진행회고성분석，해조환자전부채용슬관절경결합빈상낭국부절개활막절제적치료방법。본연구대환자적기본정황、치료방법、복발솔화증상진전진행적기록，최단수방시간위7개월（평균중위수위49.8개월；범위7～141개월）。결과응용슬관절경결합빈상낭국부절개활막절제방법치료PVNS적복발솔저（6.3％），종창화동통술후호전，기중명현호전몰유동통화활동불괄적위50％，이관절염지속진전적위11.1％，단시몰유환자재최후수방기내발전진행슬관절치환。최상견적병발증위혈종，발생솔위3％，단시몰유발현대환자술후료효산생명현영향。술전KSS림상평분위（62.7±17.7）분；공능평분위（45.0±24.0）분，술후림상KSS평분（85.2±10.9）분；공능평분（79.5±12.3）분，비교균유통계학차이（림상KSS평분：t＝4.456，P＜0.001；공능KSS평분：t＝5.279，P＜0.001）；이Lysholm평분술전（64.7±15.0）분，술후제고도（83.2±8.4）분，이자간비교유통계학차이（ t＝4.451，P＜0.001）。결론결합상관문헌보도，슬관절경결합빈상낭국부절개활막절제방법시치료슬관절미만형PVNS적교호방법，유착교저적복발솔화병발증。
Objective To investigate the effectiveness of arthroscopy and/or arthrotomy combined with small incision at the suprapatellar bursa in the treatment for diffuse pigmented villonodular synovitis ( PVNS) of the knee.Methods Thirty-two patients with diffuse PVNS of the knee treated between Jan 2006 and Dec 2012 were retrospectively identified. All of these patients were treated by the knee arthroscopy with a small incision at the suprapatellar bursa for synovectomy.The patient demographics, treatment profiles, recurrence rates, complication and progression were recorded.The minimum follow-up time was seven months (median, 49.8 months; range, 7-141 months).Results The recurrence rate was 6.3%after the knee arthroscopy with the small incision in the suprapatellar bursa for synovectomy. Fifty percent of these patients had no pain or swelling, and the arthritic progression occurred in 11.1%of the total within the follow-up period.The most common complication was hemarthrosis (3%of the total), but there was no detectable effect on the recovery.The KSS score of the knee and the function score were (62.7 ±17.7 ) and ( 45.0 ±24.0 ) respectively, and the Lysholm score was ( 64.7 ±15.0 ), preoperatively;the KSS score of the knee and the function score were (85.2 ±10.9) (t=4.456, P<0.001) and (79.5 ±12.3) (t=5.279, P<0.001), and the Lysholm score was (83.2 ±8.4) (t =4.451, P<0.001) in the follow-up period.Conclusion Compared with the literature, the arthroscopy with local incision in the suprapatellar bursa for synovectomy is a viable, comprehensive approach for the diffuse PVNS of the knee and provides both low recurrence rates and complication rates.