中国修复重建外科杂志

中国修复重建外科杂志

关节镜下治疗髋关节滑膜软骨瘤的疗效观察

查看全文

目的 总结关节镜下治疗髋关节滑膜软骨瘤的疗效。 方法 2012 年 4 月—2015 年 9 月,共 32 例髋关节滑膜软骨瘤患者于关节镜下行清除术。男 19 例,女 13 例;年龄 22~64 岁,平均 42.1 岁。左髋 17 例,右髋 15 例。患者主要临床表现为髋关节疼痛、肿胀,其中合并髋关节绞锁 6 例,下肢无力 2 例,髋关节弹响 1 例。“4”字试验阳性 9 例,Thomas 征阳性 4 例,屈曲滚动试验阳性 2 例。 结果 术后切口均Ⅰ期愈合。患者均获随访,随访时间 16~48 个月,平均 33.8 个月。患者疼痛症状均明显缓解或消失,VAS 评分由术前的(4.8±1.2)分降至末次随访时的(1.4±0.8)分,比较差异有统计学意义(t=6.382,P=0.013);髋关节功能恢复明显,Harris 评分由术前的(63.2±8.3)分提高至末次随访时的(92.6±6.7)分,比较差异有统计学意义(t=9.761,P=0.006)。末次随访时 3 例“4”字试验阳性,1 例 Thomas 试验阳性,其余患者无明显阳性体征。X 线片复查示患者均无复发征象。 结论 关节镜下治疗髋关节滑膜软骨瘤创伤小、清理彻底、术后恢复快,近期疗效确切。

Objective To evaluate the effectiveness of arthroscopy for synovial chondromatosis of hip joint. Methods Between April 2012 and September 2015, 32 patients with synovial chondromatosis of hip joint were treated by arthroscopy. There were 19 males and 13 females, with an average age of 42.1 years (range, 22-64 years). The synovial chondromatosis located at right hip in 15 cases and left hip in 17 cases. The main clinical symptoms were pain and swelling of hip joint. Of all patients, 6 cases were hip hinge, 2 cases were limb strength weakness, and1 case was snapping hip. The " 4” sign was positive in 9 cases, Thomas’ sign positive in 4 cases, and rolling test positive in 2 cases. Results All incisions healed by first intention, and no complications occurred. All patients were followed up 16-48 months (mean, 33.8 months). The visual analogue scale (VAS) was 1.4±0.8 at last follow-up, which was significantly lower than that before operation (4.8±1.2) (t=6.382, P=0.013). The hip Harris score was 92.6±6.7 at last follow-up, which was significantly higher than that before operation (63.2±8.3) (t=9.761, P=0.006). At last follow-up, the " 4” sign and Thomas' sign were positive in 3 cases and 1 case, respectively. The others had no positive sign. X-ray film showed no recrudescence in all cases. Conclusion Treating synovial chondromatosis of hip joint under arthroscopy has advantages of less traumas, complete debridement, quick postoperative recovery, and the satisfactory short-term effectiveness.

关键词: 髋关节; 滑膜软骨瘤; 关节镜

Key words: Hip joint; synovial chondromatosis; arthroscopy

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. de Sa D, Horner NS, Macdonald A, et al. Arthroscopic surgery for synovial chondromatosis of the hip: a systematic review of rates and predisposing factors for recurrence. Arthroscopy, 2014, 30(11): 1499-1504. e2.
2. Lim SJ, Chung HW, Choi YL, et al. Operative treatment of primary synovial osteochondromatosis of the hip. J Bone Joint Surg (Am), 2006, 88(11): 2456-2464.
3. Chen CY, Chen AC, Chang YH, et al. Synovial chondromatosis of the hip: management with arthroscope-assisted synovectomy and removal of loose bodies: report of two cases. Chang Gung Med J, 2003, 26(3): 208-214.
4. 吴华, 皇甫小桥. 关节镜下治疗髋关节滑膜软骨瘤的临床疗效. 中国修复重建外科杂志, 2012, 26(8): 915-917.
5. Krebs VE. The role of hip arthroscopy in the treatment of synovial disorders and loose bodies. Clin Orthop Relat Res, 2003, (406): 48-59.
6. Villet AD, Marks PH, Fowler PJ, et al. Occult posttraumatic osteochondral lesions of the knee: prevalence, classification, and shortterm sequelae evaluated with MR imaging. Radiology, 1991, 178(1): 271-276.
7. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
8. Milgram JW. Synovial osteochondromatosis: a histopathological study of thirty cases. J Bone Joint Surg (Am), 1977, 59(6): 792-801.
9. Abolghasemian M, Gharanizadeh K, Kuzyk P, et al. Hips with synovial chondromatosis may display the features of of femoroacetabular impingement. J Bone Joint Surg (Am), 2014, 96(2): e11.
10. Kose MM, Durmus O, Ayhan MY, et al. A rare cause of chronic hip pain: Intraarticular synovial chondromatosis. Acta Reumatol Port, 2014, 39(4): 349-350.
11. Matusmoto K, Sato T, Iwanari S, et al. The use of arthrography in the diagnosis of temporomandibular joint synovial chondromatosis. Dentomaxillofac Radiol, 2013, 42(1): 15388284.
12. Ji JH, Shafi M, Jeong DS. Secondary synovial chondromatosis of the shoulder. Knee Surg Sports Traumatol Arthosc, 2015, 23(9): 2624-2627.
13. Chen MJ, Yang C, Qiu YT, et al. Synovial chondromatosis of the tempromandibular joint: relationship between MRI information and potential aggressive behavior. J Craniomaxillofac Surg, 2015, 43(3): 349-354.
14. Testaverde L, Perrone A, Caporali L, et al. CT and MR findings in synovial chondromatosis of the temporomandibular joint: our experience and review of literature. Eur J Radiol, 2011, 78(3): 414-418.
15. Ozmeric A, Aydogan NH, Kocadal O, et al. Arthroscopic treatment of synovial chondromatosis in the ankle joint. Int J Surg Case Rep, 2014, 5(12): 1010-1013.
16. 郭世炳, 冯卫, 贾燕飞. 髋关节滑膜软骨瘤病的诊断与治疗. 中国矫形外科杂志, 2007, 15(7): 549-551.
17. Ferro FP, Philippon MJ. Arthroscopy provides symptom relief and good functional outcomes in patients with hip synovial chondromatosis. J Hip Preserv Surg, 2015, 2(3): 265-271.
18. Blitzer CM, Scarano, KA. Arthroscopic management of synovial osteochondromatosis of the hip. Orthopedics, 2015, 38(6): e536-e538.
19. Kowalczuk M, Bhandari M, Farrokhyar F, et al. Complications following hip arthroscopy: a systematic review and meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 2013, 21(7): 1669-1675.