CAJ | 학술논문

背景：外科治疗色素沉着绒毛结节性滑膜炎能够最大程度的切除病变滑膜，最大限度的恢复关节功能。 　　目的：探讨人工全膝关节置换与关节镜下滑膜切除治疗膝关节色素沉着绒毛结节性滑膜炎的膝关节功能和复发率。 　　方法：回顾性分析中南大学湘雅医院骨科2006年12月至2011年12月收治的34例膝关节色素沉着绒毛结节性滑膜炎行手术治疗患者，治疗后病检均为弥漫性色素沉着绒毛结节性滑膜炎，其中24例患者行膝关节镜下滑膜切除，10例色素沉着绒毛结节性滑膜炎患者行人工全膝关节置换，治疗后根据病情行辅助放疗。膝关节镜下滑膜切除组采用Lysholm功能评分，人工全膝关节置换组采用美国膝关节协会评分，比较两组患者治疗前后膝关节功能，随访观察比较两组间的膝关节功能恢复情况及复发率。 　　结果与结论：34例膝关节色素沉着绒毛结节性滑膜炎患者均获有效随访，随访时间12-66个月，平均41.3个月。统计学分析结果表明关节镜下滑膜切除组治疗后膝关节Lysholm功能评分为(86.3±10.3)分，明显高于治疗前的(55.5±13.2)分(t=3.81，P=0.016，P<0.05)。人工全膝关节置换组美国膝关节协会评分由治疗前的(40.7±2.2)分提高到(90.2±1.1)分(t =6.27，P <0.01)；关节镜下滑膜切除组美国膝关节协会评分由治疗前的(34.2±3.9)分提高到(80.8±1.9)分(t=16.58，P<0.01)。证实，关节镜下滑膜切除结合辅助放疗治疗膝关节色素沉着绒毛结节性滑膜炎可取得较好效果，人工全膝关节置换治疗晚期膝关节弥漫型色素沉着绒毛结节性滑膜炎可较好恢复膝关节功能，且复发率较低。
배경：외과치료색소침착융모결절성활막염능구최대정도적절제병변활막，최대한도적회복관절공능。 　　목적：탐토인공전슬관절치환여관절경하활막절제치료슬관절색소침착융모결절성활막염적슬관절공능화복발솔。 　　방법：회고성분석중남대학상아의원골과2006년12월지2011년12월수치적34례슬관절색소침착융모결절성활막염행수술치료환자，치료후병검균위미만성색소침착융모결절성활막염，기중24례환자행슬관절경하활막절제，10례색소침착융모결절성활막염환자행인공전슬관절치환，치료후근거병정행보조방료。슬관절경하활막절제조채용Lysholm공능평분，인공전슬관절치환조채용미국슬관절협회평분，비교량조환자치료전후슬관절공능，수방관찰비교량조간적슬관절공능회복정황급복발솔。 　　결과여결론：34례슬관절색소침착융모결절성활막염환자균획유효수방，수방시간12-66개월，평균41.3개월。통계학분석결과표명관절경하활막절제조치료후슬관절Lysholm공능평분위(86.3±10.3)분，명현고우치료전적(55.5±13.2)분(t=3.81，P=0.016，P<0.05)。인공전슬관절치환조미국슬관절협회평분유치료전적(40.7±2.2)분제고도(90.2±1.1)분(t =6.27，P <0.01)；관절경하활막절제조미국슬관절협회평분유치료전적(34.2±3.9)분제고도(80.8±1.9)분(t=16.58，P<0.01)。증실，관절경하활막절제결합보조방료치료슬관절색소침착융모결절성활막염가취득교호효과，인공전슬관절치환치료만기슬관절미만형색소침착융모결절성활막염가교호회복슬관절공능，차복발솔교저。
BACKGROUND:Surgical treatment for pigmented vil onodular synovitis can maximize the excision of synovial lesions and recovery of joint function. OBJECTIVE:To investigate the knee joint function and relapse rate fol owing treatment of pigmented vil onodular synovitis with total knee replacement and arthroscopic synovectomy. METHODS:We retrospectively analyzed 34 cases of knee pigmented vil onodular synovitis admitted for surgical treatment in the Department of Orthopedics, Xiangya Hospital of Central South University, China from December 2006 to December 2011. In these cases, 24 patients received arthroscopic synovectomy and 10 patients were subjected to total knee replacement. Adjuvant radiotherapy was conducted according to postoperative patient’s conditions. Lysholm scoring was employed in the arthroscopic synovectomy group, and American Knee Society scoring was used in the total knee replacement group. Knee function in two groups was compared before and after treatment. Fol ow-up observation was performed to compare knee function recovery and relapse rate between two groups. RESULTS AND CONCLUSION:Thirty-four patients were effectively fol owed up for 12-66 months, mean 41.3 months. Statistical analysis showed that in the arthroscopic synovectomy group, the postoperative Lysholm score was (86.3± 10.3) points, significantly higher than the preoperative score which was (55.5±13.2) points (t=3.81, P=0.016, P<0.05). In the total knee arthroplasty group, the American Knee Society score was increased from (40.7±2.2) points preoperatively to (90.2±1.1) points postoperatively (t=6.27, P<0.01). In the arthroscopic synovectomy group, the American Knee Society score was increased from (34.2±3.9) points preoperatively to (80.8±1.9) points postoperatively (t=16.58, P<0.01). Arthroscopic synovectomy combined with adjuvant radiotherapy can achieve better outcomes in pigmented vil onodular synovitis patients, while the total knee replacement for advanced with advanced knee diffuse pigmented vil onodular synovitis is better to restore knee function and the recurrence rate is low.