膝关节滑膜脂肪瘤病的诊断与治疗
The diagnosis and therapy of synovial lipomatosis of the knee joint
任富继 1赵力 2王瑞琳 3赵金岩 2熊光宜3
作者信息
- 1. 300070,天津医科大学研究生院
- 2. 天津市天津医院关节镜科
- 3. 天津市天津医院病理科
- 折叠
摘要
目的 探讨膝关节滑膜脂肪瘤病的命名、诊断及关节镜辅助治疗方法,提高对膝关节滑膜脂肪瘤病的认识.方法 回顾性分析2006年2月至2008年2月收治的9例滑膜脂肪瘤病病例资料,男4例,女5例;年龄32～71岁,平均51.1岁.9例均行病灶清理术,其中8例关节镜下手术,1例开放性手术.4例关节镜下表现为膝关节髌上囊滑膜大量、多发球形和绒毛状突起.绒毛饱满,呈浅黄色,严重时累及膝关节内侧室和外侧室;5例关节镜下表现为滑膜簇状增生,呈手指样.MRI显示关节腔积液,滑膜呈树枝状增生、肥厚.组织学检查显示绒毛最外层为两或三层滑膜细胞,绒毛间质由大量成熟的脂肪细胞构成.全部患者随访6～29个月,平均18.2个月.随访内容包括:病情主诉、膝关节活动度测量及膝关节功能Lysholm评分.结果 随访期间均未再发膝关节肿胀、积液.末次随访膝关节活动度111.67°±11.18°,Lysholm评分(72.44°13.93)分,二者与术前比较[101.11°±16.54°,(40.56±19.93)分]差异均有统计学意义(t值分别为3.447和6.728,P值分别为0.009和0.001).结论 临床上存在对滑膜脂肪瘤病的认识不足,常与膝关节滑膜脂肪瘤混淆.诊断主要依靠特异性的MRI表现、关节镜下特征及病理改变.对膝关节滑膜脂肪瘤病行关节镜下病灶清理术创伤小、恢复快.
Abstract
Objective To investigate the denomination, diagnosis, and arthroscopic therapy of syn-ovial lipomatosis of knee joint. Methods Nine cases of synovial lipomatosis were retrospectively evaluated.There were 4 males and 5 females, with an average age of 51.1 years (range, 32-71 years). All patients were treated surgically, including 1 case of open surgery and 8 case of arthroscopy, with a mean follow-up of 18.2 months (range, 6-29 months). Under arthroscope, patellar bursa was occupied by light yellow, round and vil- lous processes in 4 cases, medial and lateral compartment were also involved. Synovial membrane manifested "finger" like clustery hyperplasia in 5 cases. MRI showed effusion of joint and "tree" like synovial mem-brane. Histology showed outer sphere of villi was formed with two or three layers of synovial cells, and inner part were filled with amount of mature iipocyte. The content of follow-up include: chief complaints, range of motion of knee joint and Lysholm score. Results No swollen nor effusion of the infected knee was found in all patients during the follow-up. Range of motion was 111.67°±11.18° at last follow-up. Lysholm scores was 72.44±13.93. The difference between results was statistically significant (t=3.447, 6.728, P=0.009, 0.001)compared with preoperative data 001.11°±16.54°, 40.56±19.93). Conclusion Synovial lipomatosis was usually misdiagnosed as synovial lipoma, and a thorough understanding of this disease is required. A clini-cal diagnosis comes from significant MRI manifestation, arthroscopic feature and histological finding. With the advantage of mini invasion and early recovery, arthroscopic cleaning is preferred to synovial lipomato-sis.
关键词
脂肪瘤样病/脂肪瘤/膝关节/磁共振成像/关节镜检查Key words
Lipomatosis/Lipoma/Knee joint/Magnetic resonance imaging/Arthroscopy引用本文复制引用
出版年
2009
NETL
NSTL
维普
万方数据