CAJ | 학술논문

背景：踝关节色素绒毛结节性滑膜炎的治疗一直是令关节科医生困扰的难题，传统的开放手术虽然可以比较彻底的切除病变组织，但同时也有着许多缺点：创伤较大，并发症较多，有的患者恢复期较长，无法进行早期功能锻炼。随着关节镜技术的发展，我们尝试利用关节镜手术治疗该病。目的：探讨应用关节镜技术治疗踝关节色素绒毛结节性滑膜炎的临床疗效。方法：2007年1月至2012年1月，我科应用关节镜技术治疗踝关节色素绒毛结节性滑膜炎17例。其中男10例，女7例；年龄19~52岁，平均32.6岁；左侧11例，右侧6例。术前、术后踝关节功能应用AOFAS评分进行统计，评价临床疗效。结果：所有患者获得14~28个月的随访，未见复发病例，1例患者疼痛症状缓解不佳。6例主诉剧烈活动后有踝关节疼痛不适感，平时无不适。10例完全正常。所有患者均在术后1~2年行MR检查，仅1例在检查中见踝关节腔有少量积液，未见结节样绒毛增生病灶。术前，术后3、6、12个月的AOFAS评分分别为51.9±9.6、78.2±5.6、81.8±6.3、82.6±6.9，手术前、后评分具有显著的统计学差异（P＜0.05）。结论：踝关节镜下全关节滑膜切除术是治疗踝关节色素绒毛结节性滑膜炎的首选治疗方法。具有治疗彻底，创伤小的优点，但需要有较好的关节镜下技术，尤其是后踝关节镜手术技术。
배경：과관절색소융모결절성활막염적치료일직시령관절과의생곤우적난제，전통적개방수술수연가이비교철저적절제병변조직，단동시야유착허다결점：창상교대，병발증교다，유적환자회복기교장，무법진행조기공능단련。수착관절경기술적발전，아문상시이용관절경수술치료해병。목적：탐토응용관절경기술치료과관절색소융모결절성활막염적림상료효。방법：2007년1월지2012년1월，아과응용관절경기술치료과관절색소융모결절성활막염17례。기중남10례，녀7례；년령19~52세，평균32.6세；좌측11례，우측6례。술전、술후과관절공능응용AOFAS평분진행통계，평개림상료효。결과：소유환자획득14~28개월적수방，미견복발병례，1례환자동통증상완해불가。6례주소극렬활동후유과관절동통불괄감，평시무불괄。10례완전정상。소유환자균재술후1~2년행MR검사，부1례재검사중견과관절강유소량적액，미견결절양융모증생병조。술전，술후3、6、12개월적AOFAS평분분별위51.9±9.6、78.2±5.6、81.8±6.3、82.6±6.9，수술전、후평분구유현저적통계학차이（P＜0.05）。결론：과관절경하전관절활막절제술시치료과관절색소융모결절성활막염적수선치료방법。구유치료철저，창상소적우점，단수요유교호적관절경하기술，우기시후과관절경수술기술。
Background:It is always a conundrum for orthopedics surgeons to cure pigmented villondular synovitis in ankle joint. De-spite rigorous treatment effects, traditional open surgery often has some shortcomings, such as large trauma, many annoying complications and a longer recovery period. With the development of arthroscopic techniques, we use arthroscopy to treat the disease. Objective:To explore clinical outcomes of arthroscopic operation for the pigmented villondular synovitis in ankle joint. Methods:From January 2007 to January 2012, 17 patients with pigmented villonodular synovitis in ankle joint were treated by arthroscope. There were 10 males and 7 females with a mean age of 32.6 (range, 19-52 years). The left ankle was affect-ed in 11 cases and the right ankle was involved in 6 cases. Therapeutic effects and ankle function were evaluated by AOFAS score preoperatively and postoperatively. Results:No recurrence was found during follow-up (ranged from 14 to 28 months). One patient complained that the pain still existed. Six patients complained an ankle pain after strenuous exercise, while ten people recovered to normal. The MRI examination were taken within 1 to 2 years after the operation in all patients, and only one case's result showed a little ankle joint effusion, but no nodular villous lesions were found. The AOFAS scores were 51.9±9.6, 78.2±5.6, 81.8±6.3 and 82.6± 6.9, respectively, before treatment, and 3, 6, and 12 months after treatment. Preoperative score was significantly different from postoperative ones (P<0.05). Conclusions:The total ankle joint synovial resection through arthroscope is the first choice to remedy the ankle joint pig-mented villondular synovitis. It has the advantages of small trauma and fine efficacy. Notably, skilled arthroscopic technique is necessary in the operation, especially the posterior malleolus arthroscopic technique.