Objective To explore the technique of arthroscopic treatment of synovial chondromatosis of the hip and to evaluate its effectiveness. Methods Between July 2009 and June 2011, 15 patients with synovial chondromatosis of the hip underwent arthroscopic synovectomy and removal of loose bodier. Of 15 patients, 11 were male and 4 were female, aged from 21 to 45 years with an average of 33.1 years. The location was the left side in 6 cases and the right side in 9 cases. The disease duration was 12-43 months (mean, 23 months) Pain and functional motion limitation were the main clinical symptoms. The visual analogue scale (VAS) score was 5.8 ± 1.1; the range of motion (ROM) of the hip was (149.8 ± 27.5)°; the Harris hip score was 54.5 ± 13.3. Results All incisions healed by first intention. All the patients were followed up 6 months to 2 years (mean, 17.4 months). At last follow-up, the VAS score was 2.0 ± 1.2; the ROM of the hip was (258.3 ± 35.4)°; the Harris hip score was 93.0 ± 18.7; and the above indexes were significantly improved when compared with preoperative values (P lt; 0.05). No recurrence was found on postoperative MRI. Conclusion Arthroscopic treatment of synovial chondromatosis of the hip has the advantages of minimal invasion, quick recovery, and best recovery of hip function and ROM.
【摘要】 目的 探讨关节镜治疗膝关节滑膜软骨瘤病的疗效。 方法 2005年1月—2009年10月，对23例（28膝）滑膜软骨瘤病患者入院行X线片、关节活动度检查、视觉模拟评分以及Lysholm膝关节功能评分。根据镜下所见分为表浅型6例，游离体型17例。结合病理学检查行Milgram 分期，Ⅱ期16例，Ⅲ期7例。所有患者均行关节镜下病变滑膜切除及游离体取出治疗。 结果 所有患者均随访13~57个月，平均（32.3±6.7）个月，术后伤口均甲级愈合。术后（5.05±2.43） d恢复正常生活或工作。症状明显改善21例（91.30%），部分改善2例（8.70%），对疗效满意23例（100%）。膝关节关节活动度由术前的伸膝（14.29±16.34）°以及屈膝（106.07±35.83）°提高到术后的伸膝（1.79±2.79）°及屈膝（132.64±35.64）°，差异具有统计学意义（Plt;0.05）。负重行走时疼痛视觉模拟评分由术前的（3.81±2.02）分降低到术后的（0.37±0.65）分（Plt;0.05）。Lysholm评分由术前的（43.20±8.24）分升至术后6个月的（86.72±5.40）分（Plt;0.05）；术后1年复诊并检查膝关节正侧位X线片，均未见滑膜软骨瘤体，所有患者无复发。 结论 关节镜下游离体取出术联合病变滑膜切除术疗效满意，关节疼痛明显减轻，功能恢复，是一种治疗膝关节滑膜软骨瘤病确切有效的方法。【Abstract】 Objective To investigate the therapeutic effect of arthroscopic treatment on synovial chondromatosis. Methods A total of 23 patients (28 knees) with synovial chondromatosis were diagnosed and treated in our hospital from January 2005 to October 2009. All of the patients underwent radiographic imaging examination, knee joint range of motion (ROM), visual analogue scale (VAS) and Lysholm score. According to distinct arthroscopic appearance, superficial pattern was found in 6 patients and loose body lesion pattern was in 17. Additionally, combined with pathological examination, according to the Milgram staging，Stage Ⅱ was in 6 patients and Stage Ⅲ was in 7. Arthroscopic limited synovectomy and removal of loose bodies were performed on all the patients. Results The patients were followed up for 13-57 months with the mean of (32.3±6.7) months. The wound of all patients healed up. The time of returning to normal work and life was (5.05±2.43) days for average. The postoperative symptom was markedly alleviated in 21 patietns and partly alleviated in 2. All patients were satisfied with the therapeutic effect. The mean activity of knee joint was significantly different befoe and after the surgery (Plt;0.05) preoperative extension and flexion degrees were (14.29±16.34) and (106.07±35.83) degrees, respectively; postoperative extension and flexion degrees were (1.79±2.79) and (132.64±35.64) degrees (flexion) , respectively. The mean VAS score of weight bearing walking was 0.37±0.65 after theoperation and 3.81±2.02 before the peration; the difference was significantly different (Plt;0.05). The preoperative Lysholm knee score was 34-67 with the mean of 43.20±8.24, and the post-operative score was 71-99 with the mean of 86.72±5.40. There were differences in preoperative and post-operative scores (Plt;0.05) . Radiographic imaging examination of knee joint was performed 1 year after the opertation, no loose bodies was seen and no patients recurred. Conclusion The therapeutic effect of arthroscopic limited synovectomy and removal of loose bodies is good on synovial chondromatosis.
ObjectiveTo evaluate the results of corticoplasty for multiple enchondromatosis of the hand. MethodsBetween February 2003 and January 2011, 6 patients with multiple enchondromatosis were treated. Of 6 cases, 1 was boy and 5 were girls with an average age of 10.8 years (range, 9-12 years); 5 cases presented with painless mass as first symptom, and 1 case was found to have mass by X-ray film because of hand injury. Physical examination at admission showed multiple mass on the hands, fingers deformity, and limited range of motion; X-ray film results showed large lesions in the phalanges and metacarpals. Corticoplasty and simple curettage without bone grafting were performed on 24 fingers (60 bones) with multiple enchondromatosis of the hand. The fingers active range of motion was used to evaluate the finger function; the diameter of the tumors was measured on the X-ray films; and according to Tordai's classification, tumor recurrence and new bone formation were observed. ResultsOnce, twice, or three-time operations were performed in 2 cases, respectively. All patients were followed up 17-83 months with an average of 52.2 months. At last follow-up, the active range of motion was significantly increased from (230.8±53.2)° at preoperation to (255.0±28.7)° at postoperation (t=—3.829, P=0.001); the tumor diameter was significantly decreased from (15.6±5.8) mm at preoperation to (10.7±3.7) mm at postoperation (t=8.304, P=0.000). Of 60 bones, 34 (56.7%) were rated as Tordai grade 1, and 26 (43.3%) as Tordai grade 2. During follow-up, clinical manifestation, characteristics of radiology and pathological examination showed no pathological fracture or malignant change. ConclusionCorticoplasty is a safe and effective treatment for multiple enchondromatosis of the hand in children. The procedure can improve appearance and motion function of the hand.
ObjectiveTo explore the influence factors of the surgical effectiveness for solitary enchondroma of the hand with pathologic fracture. MethodsA retrospective analysis was made on the clinical data of 65 patients with solitary enchondroma of the hand with pathologic fracture who were treated with operation and were accorded with selective standard between March 2010 and June 2013.There were 26 males and 39 females,aged 17 to 63 years (mean,36 years).The left hands were involved in 32 cases and the right hands in 33 cases.The tumor located at the metacarpus in 18 cases,and at the phalanx in 47 cases (at the proximal phalanx in 30 cases,at the middle phalanx in 9 cases,and at the distal phalanx in 8 cases).The duration from fracture to operation was 2 days to 2 years (mean,56 days).The operative methods were curettage and bone grafting.The ratios of the total active range of motion (ROM) of the metacarpophalangeal joint and interphalangeal joint between ipsilateral and contralateral fingers were used to evaluate the ipsilateral fingers'function.The time of returning to work was recorded.The multiple linear regressions were performed to analyze the risk factors of the effectiveness. ResultsA total of 65 cases were followed up 5-44 months (mean,24 months).All incisions achieved primary healing.No infection,re-fracture,or recurrence occurred.The X-ray films showed fracture healing,the healing time was 5-10 weeks (mean,6.5 weeks).All the bone grafts healed well.At last follow-up,the ROM ratio of the fingers was 0.46-1.00(mean,0.90).The time of returning to work was 92-180 days (mean,130 days).Multiple linear regressions showed that internal fixation was risk factor for the ROM ratio of the fingers (P=0.013).The duration from fracture to operation,internal fixation,and the tumor site were risk factors for the time of returning to work (P<0.05). ConclusionTo obtain good effectiveness for patients with solitary enchondroma of the hand with pathologic fracture,it is suggested that immediate operative treatment including tumor curettage,open reduction,and internal fixation with plate and screws of the fracture.
目的探讨原发性肺软骨瘤（chondroma）的临床特点、诊断及其治疗方法，以提高临床医师对本病的认识和诊疗水平 方法回顾性分析我院4例（男2例、女2例，年龄50～63岁）肺软骨瘤的临床资料，并结合国内外1983年1月至2013年9月30年文献报道的51例患者的临床资料进行分析和总结。 结果55例患者中男30例，女25例，发病年龄10～84（42.47± 17.27）岁。主要临床表现有咳嗽、咳痰、痰中带血、胸闷、胸痛、呼吸困难、喉部不适等，也有无临床症状，于体检发现。临床诊断以肺癌、结核、错构瘤、炎性假瘤、肺畸胎瘤及肺部包块等。55例患者都行手术治疗，无手术死亡。 结论肺软骨瘤是临床上一种较为罕见的良性肿瘤，临床表现缺乏特异性，术前误诊率较高，影像资料有助于诊断和鉴别诊断，确诊依靠病理诊断以及肺软骨瘤与Carney’s综合征的关系，手术切除治疗疗效确切。