本文選題：色素絨毛結(jié)節(jié)性滑膜炎 + 關(guān)節(jié)鏡手術(shù)��； 參考：《重慶醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的探討關(guān)節(jié)鏡手術(shù)聯(lián)合膠體磷酸鉻關(guān)節(jié)腔內(nèi)注射治療患者膝關(guān)節(jié)色素沉著絨毛結(jié)節(jié)性滑膜炎(pigmented villonodular synovitis, PVNS)的臨床療效,進(jìn)一步指導(dǎo)臨床治療。方法回顧性分析2010年1月～2014年6月在我院擇期行膝關(guān)節(jié)鏡手術(shù)治療的患者共11例,術(shù)后經(jīng)病理證實(shí)為色素沉著絨毛結(jié)節(jié)性滑膜炎。本組患者共11例,均為單側(cè)膝關(guān)節(jié)受累,其中左膝關(guān)節(jié)4例,右膝關(guān)節(jié)7例；男6例,女5例；平均年齡38.4歲；病程6士6.37年。治療方法主要通過(guò)關(guān)節(jié)鏡下病變組織切除、半月板及軟骨修整,術(shù)后4-6周患者于我院核醫(yī)學(xué)科接受關(guān)節(jié)腔內(nèi)膠體磷酸鉻185MBq(5mCi)注射行膝關(guān)節(jié)腔內(nèi)放射治療。要求患者術(shù)后1個(gè)月、3個(gè)月、半年、一年,以后每年門(mén)診復(fù)查1次,門(mén)診對(duì)患者進(jìn)行膝關(guān)節(jié)穿刺抽液,使用Lysholm膝關(guān)節(jié)功能評(píng)分表對(duì)患側(cè)膝關(guān)節(jié)進(jìn)行評(píng)分,檢查關(guān)節(jié)液常規(guī),結(jié)合患者病史、膝關(guān)節(jié)評(píng)估患者復(fù)發(fā)率。11例PVNS患者手術(shù)前、后Lysholm膝關(guān)節(jié)功能評(píng)分比較采用兩配對(duì)樣本t檢驗(yàn)。結(jié)果11例膝關(guān)節(jié)PVNS患者獲得有效隨訪,隨訪時(shí)間6～45個(gè)月。術(shù)中未發(fā)生神經(jīng)血管損傷術(shù)、術(shù)后患者手術(shù)切口I/甲愈合,未發(fā)生感染、傷口不愈合、放射性皮膚壞死、深靜脈血栓形成等手術(shù)及放療并發(fā)癥。至末次隨訪,患者膝關(guān)節(jié)穿刺抽液未見(jiàn)血性、紅褐色關(guān)節(jié)積液,關(guān)節(jié)液常規(guī)未見(jiàn)大量紅細(xì)胞,結(jié)合患者膝關(guān)節(jié)功能恢復(fù)情況考慮無(wú)復(fù)發(fā)病例。統(tǒng)計(jì)學(xué)分析結(jié)果表明手術(shù)后患側(cè)膝關(guān)節(jié)Lysholm功能評(píng)分為(83±5.48)分,明顯高于治療前的(47±5.22)分(t=37.835,P0.05),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。本組11例患者在膝關(guān)節(jié)鏡下發(fā)現(xiàn)均存在不同程度的軟骨或半月板損傷,其中1例患者可見(jiàn)病變滑膜侵蝕軟骨和交叉韌帶,3例患者可見(jiàn)病變滑膜侵蝕交叉韌帶,8例患者軟骨不同程度磨損,所有患者均伴有不同程度半月板損傷或退變。結(jié)論膝關(guān)節(jié)鏡手術(shù)聯(lián)合關(guān)節(jié)腔內(nèi)膠體磷酸鉻注射治療具有微創(chuàng)、療效可靠、膝關(guān)節(jié)功能恢復(fù)良好、并發(fā)癥少等優(yōu)點(diǎn),同時(shí)能對(duì)半月板、軟骨等膝關(guān)節(jié)內(nèi)組織結(jié)構(gòu)的損傷進(jìn)行處理,是一種具有可靠的治療PVNS的方法,可以降低膝關(guān)節(jié)PVNS復(fù)發(fā)。
[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 鹵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 鹵5.48, which was significantly higher than that before treatment (37. 835 鹵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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.4

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本文編號(hào)：1808824