关节镜手术联合32磷关节腔内注射治疗膝关节PVNS

发布时间：2018-04-27 02:36

本文选题：色素绒毛结节性滑膜炎 + 关节镜手术　；参考：《重庆医科大学》2015年硕士论文

【摘要】：目的探讨关节镜手术联合胶体磷酸铬关节腔内注射治疗患者膝关节色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis, PVNS)的临床疗效,进一步指导临床治疗。方法回顾性分析2010年1月～2014年6月在我院择期行膝关节镜手术治疗的患者共11例,术后经病理证实为色素沉着绒毛结节性滑膜炎。本组患者共11例,均为单侧膝关节受累,其中左膝关节4例,右膝关节7例；男6例,女5例；平均年龄38.4岁；病程6士6.37年。治疗方法主要通过关节镜下病变组织切除、半月板及软骨修整,术后4-6周患者于我院核医学科接受关节腔内胶体磷酸铬185MBq(5mCi)注射行膝关节腔内放射治疗。要求患者术后1个月、3个月、半年、一年,以后每年门诊复查1次,门诊对患者进行膝关节穿刺抽液,使用Lysholm膝关节功能评分表对患侧膝关节进行评分,检查关节液常规,结合患者病史、膝关节评估患者复发率。11例PVNS患者手术前、后Lysholm膝关节功能评分比较采用两配对样本t检验。结果11例膝关节PVNS患者获得有效随访,随访时间6～45个月。术中未发生神经血管损伤术、术后患者手术切口I/甲愈合,未发生感染、伤口不愈合、放射性皮肤坏死、深静脉血栓形成等手术及放疗并发症。至末次随访,患者膝关节穿刺抽液未见血性、红褐色关节积液,关节液常规未见大量红细胞,结合患者膝关节功能恢复情况考虑无复发病例。统计学分析结果表明手术后患侧膝关节Lysholm功能评分为(83±5.48)分,明显高于治疗前的(47±5.22)分(t=37.835,P0.05),差异有统计学意义(P0.05)。本组11例患者在膝关节镜下发现均存在不同程度的软骨或半月板损伤,其中1例患者可见病变滑膜侵蚀软骨和交叉韧带,3例患者可见病变滑膜侵蚀交叉韧带,8例患者软骨不同程度磨损,所有患者均伴有不同程度半月板损伤或退变。结论膝关节镜手术联合关节腔内胶体磷酸铬注射治疗具有微创、疗效可靠、膝关节功能恢复良好、并发症少等优点,同时能对半月板、软骨等膝关节内组织结构的损伤进行处理,是一种具有可靠的治疗PVNS的方法,可以降低膝关节PVNS复发。
[Abstract]:Objective to investigate the clinical effect of arthroscopic surgery combined with colloidal chromium phosphate injection in the treatment of pigmented villonodular synovitis (PVNS) in patients with pigmented villonodular synovitis of knee joint. Methods from January 2010 to June 2014, 11 patients with pigmented villonodular synovitis were retrospectively analyzed. There were 11 cases of unilateral knee involvement, including 4 cases of left knee joint, 7 cases of right knee joint, 6 cases of male and 5 cases of female. The mean age was 38.4 years and the course of disease was 6 卤6.37 years. The main methods of treatment were arthroscopic tissue resection, meniscus and cartilage repair. The patients were treated with intracorporeal colloidal chromium phosphate (Colloidal Chromium Phosphate 185 MBq5 mCie) injection in our department of nuclear medicine 4 to 6 weeks after operation, and the knee joint was treated by intracavitary radiotherapy. One month, three months, six months, one year and one year after the operation, the patients were required to recheck the outpatient service once a year. The patients were required to puncture and draw fluid from the knee joint in the outpatient department. The knee joint was evaluated with the Lysholm knee joint function scale, and the joint fluid routine was examined. According to the patient's history, the recurrence rate of 11 patients with PVNS was evaluated. The knee joint function scores of 11 patients with PVNS before and after operation were compared with two matched samples t test. Results 11 cases of knee joint PVNS were followed up for 6 ~ 45 months. No neurovascular injury occurred during the operation, and the postoperative incision I / nail healing, no infection, wound non-union, radiation skin necrosis, deep vein thrombosis and other surgical and radiotherapy complications. To the last follow-up, there was no blood, reddish brown joint effusion, no red blood cells in the joint fluid routine, and no recurrence case considering the recovery of knee joint function. The results of statistical analysis showed that the score of Lysholm function of knee joint in the affected side after operation was 83 卤5.48, which was significantly higher than that before treatment (37. 835 卤5. 05) and the difference was statistically significant (P 0. 05). All the 11 patients were found to have different degree of cartilage or meniscus injury under knee arthroscopy. Among them, one patient could see the lesion of synovial erosion cartilage and three patients with cruciate ligament. 8 patients had different degree of cartilage wear, all the patients had meniscus injury or degeneration. Conclusion knee arthroscopy combined with intra articular colloidal chromium phosphate injection has the advantages of minimally invasive, reliable curative effect, good recovery of knee joint function, less complications, and can be used to treat meniscus at the same time. It is a reliable method to treat the injury of tissue structure in knee joint such as cartilage, which can reduce the recurrence of PVNS in knee joint.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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