本文選題：彌漫型色素沉著絨毛結(jié)節(jié)性滑膜炎　切入點(diǎn)：膝關(guān)節(jié)　出處：《山東大學(xué)》2015年碩士論文

【摘要】：目的：比較關(guān)節(jié)鏡下滑膜切除術(shù)聯(lián)合術(shù)后關(guān)節(jié)腔內(nèi)放療與單純關(guān)節(jié)鏡滑膜切除術(shù)治療膝關(guān)節(jié)彌漫型色素沉著絨毛結(jié)節(jié)性滑膜炎(PVNS)的臨床療效,總結(jié)有效降低本病復(fù)發(fā)率的治療方法。方法：選取自2009年1月至2014年10月于我院住院、經(jīng)術(shù)前膝關(guān)節(jié)MRI檢查、關(guān)節(jié)鏡手術(shù)和術(shù)后病理學(xué)檢查確診為膝關(guān)節(jié)彌漫型PVNS患者57例,30例進(jìn)行單純關(guān)節(jié)鏡下滑膜切除術(shù)治療,其中男16例,女14例,年齡(36.4±13.70)歲；27例行關(guān)節(jié)鏡下滑膜切除術(shù)聯(lián)合術(shù)后關(guān)節(jié)腔內(nèi)放療,其中男17例,女10例,年齡(36.6±14.31)歲,所有患者術(shù)前均進(jìn)行Lysholm評分及國際膝關(guān)節(jié)文獻(xiàn)委員會(IKDC)膝關(guān)節(jié)功能主觀評分。術(shù)后隨訪了解膝關(guān)節(jié)的活動度、腫脹、疼痛等并發(fā)癥及病情復(fù)發(fā)等情況,并再次進(jìn)行Lysholm評分及IKDC 2000評分以判斷預(yù)后。結(jié)果：所有患者平均隨訪(31.3±17.80)個(gè)月。兩組患者性別、年齡比較無統(tǒng)計(jì)學(xué)意義。單純手術(shù)組：術(shù)前Lysholm評分(48.8±8.67)分,末次隨訪時(shí)(83.4±5.99)分,比較有統(tǒng)計(jì)學(xué)意義(t=17.986,p0.05)；術(shù)前IKDC膝關(guān)節(jié)功能主觀評分(54.2±6.84)分,末次隨訪時(shí)(84.6±6.63)分,比較有統(tǒng)計(jì)學(xué)意義(t=17.961,p0.05),術(shù)后較術(shù)前兩種評分均有明顯提高；聯(lián)合放療組：術(shù)前Lysholm評分(49.0±9.11)分,末次隨訪時(shí)(85.1±5.91)分,比較有統(tǒng)計(jì)學(xué)意義(t=17.283,p0.05)；術(shù)前IKDC膝關(guān)節(jié)功能主觀評分(52.3±7.20)分,末次隨訪時(shí)(85.8±6.61)分,比較有統(tǒng)計(jì)學(xué)意義(t=17.819,p0.05),術(shù)后較術(shù)前兩種評分均有明顯提高。膝關(guān)節(jié)活動度：單純手術(shù)組術(shù)前為(54.5±18.82)。,末次隨訪時(shí)為(118.5±12.61)。,比較有統(tǒng)計(jì)學(xué)意義(t=15.470,p0.05)；聯(lián)合放療組術(shù)前為(55.3±18.74)。,末次隨訪時(shí)為(119.6±13.37)。,比較有統(tǒng)計(jì)學(xué)意義(t=14.513,p0.05),兩組患者術(shù)后患膝關(guān)節(jié)活動度較術(shù)前均有明顯改善。單純手術(shù)組復(fù)發(fā)9例,聯(lián)合放療組復(fù)發(fā)2例,差異有統(tǒng)計(jì)學(xué)意義(X2=5.747,p0.05),手術(shù)聯(lián)合關(guān)節(jié)腔內(nèi)放療治療PVNS較單純關(guān)節(jié)鏡下滑膜切除術(shù)明顯降低復(fù)發(fā)率；單純手術(shù)組術(shù)后3例患者患膝輕度腫脹,無感染病例；聯(lián)合放療組6例患者出現(xiàn)患膝疼痛,3例患者皮膚色素沉著,3例患者患膝腫脹,無感染病例。兩組患者并發(fā)癥發(fā)生率行X2檢驗(yàn),差異有統(tǒng)計(jì)學(xué)意義(X2=6.518,p0.05)。結(jié)論：關(guān)節(jié)鏡下滑膜切除術(shù)聯(lián)合術(shù)后關(guān)節(jié)腔內(nèi)放療治療膝關(guān)節(jié)彌漫型PVNS可顯著降低PVNS病的復(fù)發(fā)率,且功能評分與單純手術(shù)組大致相同。但其并發(fā)癥的發(fā)生率較單純關(guān)節(jié)鏡下滑膜切除術(shù)更高。
[Abstract]:Objective: to compare the clinical effects of arthroscopic synovectomy combined with postoperative intra-articular radiotherapy and arthroscopic synovectomy in the treatment of diffuse pigmented villonodular synovitis of knee joint (PVNSs). Methods: from January 2009 to October 2014, the patients were hospitalized in our hospital and examined with MRI before operation. Thirty patients with diffuse PVNS of knee joint were treated by arthroscopic synovectomy, including 16 males and 14 females. Twenty-seven patients (male 17, female 10, age 36.6 鹵14.31) underwent arthroscopic synovectomy combined with postoperative intraarticular radiotherapy. All the patients were evaluated with Lysholm score before operation and the subjective score of the knee joint function by the International knee Joint documentation Committee. The postoperative follow-up was conducted to understand the knee joint motion, swelling, pain and other complications, as well as the recurrence of the disease, etc. Lysholm score and IKDC 2000 score were used to judge prognosis again. Results: all patients were followed up for an average of 31.3 鹵17.80 months. There was no significant difference in sex and age between the two groups. In the simple operation group, the preoperative Lysholm score was 48.8 鹵8.67, and the last follow-up was 83.4 鹵5.99. The subjective score of knee joint function of IKDC was 54.2 鹵6.84 before operation and 84.6 鹵6.63 at the last follow-up, which was significantly higher than that before operation. The preoperative Lysholm score was 49.0 鹵9.11 in combined radiotherapy group. At the last follow-up, the score was 85.1 鹵5.91, which was statistically significant, and the subjective score of IKDC knee joint function was 52.3 鹵7.20 before operation and 85.8 鹵6.61 at the last follow-up. The range of knee motion in the simple operation group was 54.5 鹵18.82% before operation, and 118.5 鹵12.61g in the last follow-up, which was statistically significant compared with that in the combined radiotherapy group before operation (55.3 鹵18.74) and in the combined radiotherapy group before operation (118.5 鹵12.61), and in the combined radiotherapy group it was 55.3 鹵18.74. The mean time was 119.6 鹵13.37, and there was significant difference between the two groups. The range of motion of the knee joint in the two groups was significantly improved compared with that before operation, and 9 cases of recurrence were found in the simple operation group, and there was no significant difference between the two groups. The recurrence rate in combined radiotherapy group was significantly lower than that in arthroscopic synovectomy group (P 0.05, P 0.05), and there were 3 cases with mild swelling of knee and no infection after surgery alone, and the recurrence rate was significantly lower in the combined radiotherapy group than in the simple arthroscopic synovectomy group (P 0.05). In the combined radiotherapy group, there were 6 cases of knee pain and 3 cases of skin pigmentation, 3 cases of knee swelling and no infection. The incidence of complications in both groups was examined by X2 test. Conclusion: arthroscopic synovectomy combined with postoperative intra-articular radiotherapy for diffuse PVNS of knee joint can significantly reduce the recurrence rate of PVNS's disease. The functional score was approximately the same as that in the simple operation group, but the incidence of complications was higher than that of arthroscopic synovectomy alone.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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