徐州医科大学南京鼓楼临床学院运动医学与成人重建外科;南京大学医学院附属鼓楼医院运动医学与成人重建外科;国家骨科与运动康复临床医学研究中心分中心;
目的:评价关节镜手术治疗肩关节滑膜软骨瘤病(SC)的临床疗效,并分析复发部位特征。方法:回顾性分析2022年4月至2023年10月南京大学医学院附属鼓楼医院采用关节镜手术治疗的7例肩关节SC患者的临床资料,包括男2例,女5例,年龄20~61岁,平均(34.8±14.0)岁。症状持续时间为1~24个月,平均(11.8±6.2)个月。2例患者有骨关节炎表现。1例患者合并肱骨头后上方压缩性骨损伤。比较术前与末次随访时患者疼痛视觉模拟评分(VAS)、美国肩肘外科医师协会(ASES)评分、美国加州大学(UCLA)肩关节评分及Constant-Murley评分,以评估患者疼痛和功能恢复情况。结果:7例患者均获得随访,随访时间5~20个月,平均(9.9±6.3)个月。所有患者切口均Ⅰ期愈合,无一例患者发生感染。7例患者末次随访时疼痛VAS评分、ASES评分、UCLA肩关节评分及Constant-Murley评分均较术前明显改善。7例患者中2例复发,1例原发于盂肱关节间隙(GH),复发于结节间沟(ISH);1例原发于肩峰下囊(SAB)、喙突下滑囊(SCB)及三角肌下滑囊(SDB),复发于SAB及SDB。同时,盂肱关节外的SAB、SCB、SDB发病4例,复发1例;GH发病3例,复发1例。1例患者因游离体卡压导致肱骨头软骨损伤。结论:关节镜手术治疗肩关节SC的临床疗效显著。因该病复发率高,术中需完整切除病损部位滑膜组织;对发生在盂肱关节腔的SC,需重点清理ISH区域滑膜组织,以降低复发概率。
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[1] Tripathy SR, Parida MK, Thatoi PK, et al. Primary synovial chondromatosis(Reichel syndrome)[J]. The Lancet Rheumatology, 2020, 2(9):e576.
[2] Shearer H, Stern P, Brubacher A, et al. A case report of bilateral synovial chondromatosis of the ankle[J]. Chiropr Osteopat, 2007, 15:18.
[3] Tokis AV, Andrikoula SI, Chouliaras VT, et al. Diagnosis and arthroscopic treatment of primary synovial chondromatosis of the shoulder[J]. Arthroscopy, 2007, 23(9):1023.e1-1023.e5.
[4] Bruggeman NB, Sperling JW, Shives TC. Arthroscopic technique for treatment of synovial chondromatosis of the glenohumeral joint[J]. Arthroscopy, 2005, 21(5):633.
[5] Duymus TM, Yucel B, Mutlu S, et al. Arthroscopic treatment of synovial chondromatosis of the shoulder:A case report[J]. Ann Med Surg(Lond), 2015, 4(2):179-182.
[6] Raval P, Vijayan A, Jariwala A. Arthroscopic retrieval of over 100 loose bodies in shoulder synovial chondromatosis:a case report and review of literature[J]. Orthop Surg, 2016,8(4):511-515.
[7] Liu B, Kim SH, Jang YH, et al. Synovial Osteochondromatosis:clinical characteristics unique to the shoulder[J]. Clin Orthop Surg, 2023, 15(1):118-126.
[8] Villacin AB, Brigham LN, Bullough PG. Primary and secondary synovial chondrometaplasia[J]. Hum Pathol, 1979,10(4):439-451.
[9] Milgram JW. Synovial osteochondromatosis:a histopathological study of thirty cases[J]. J Bone Joint Surg Am,1977, 59(6):792-801.
[10] Balliu E, Medina V, Vilanova J, et al. Synovial chondromatosis of the temporomandibular joint:CT and MRI findings[J]. Dentomaxillofac Radiol, 2007, 36(1):55-58.
[11] Buddingh E P, Krallman P, Neff J R, et al. Chromosome 6abnormalities are recurrent in synovial chondromatosis[J].Cancer Genet Cytogenet, 2003, 140(1):18-22.
[12] Hopyan S, Nadesan P, Yu C, et al. Dysregulation of hedgehog signalling predisposes to synovial chondromatosis[J]. J Pathol, 2005, 206(2):143-150.
[13] Hocking R, Negrine J. Primary synovial chondromatosis of the subtalar joint affecting two brothers[J]. Foot Ankle Int,2003, 24(11):865-867.
[14] Yoshitake H, Kayamori K, Wake S, et al. Biomarker expression related to chondromatosis in the temporomandibular joint[J]. Cranio, 2021, 39(4):362-366.
[15] Li Y, El Mozen LA, Cai H, et al. Transforming growth factor beta 3 involved in the pathogenesis of synovial chondromatosis of temporomandibular joint[J]. Sci Rep, 2015, 5:8843.
[16]韩玮华,罗海燕,郭传瑸,等.软骨寡聚基质蛋白在颞下颌关节滑膜软骨瘤病中的表达[J].北京大学学报(医学版),2020, 53(1):34-39.
[17] Li Y, Zhou Y, Wang Y, et al. Synovial macrophages in cartilage destruction and regeneration-lessons learnt from osteoarthritis and synovial chondromatosis[J]. Biomed Mater,2021, 17(1).
[18] Adelani MA, Wupperman RM, Holt GE. Benign synovial disorders:[J]. J Am Acad Orthop Surg, 2008, 16(5):268-275.
[19] Lunn J V, Castellanos-Rosas J, Walch G. Arthroscopic synovectomy, removal of loose bodies and selective biceps tenodesis for synovial chondromatosis of the shoulder[J]. J Bone Joint Surg Br, 2007, 89(10):1329-1335.
[20] Utashima D, Matsumura N, Suzuki T, et al. Clinical results of surgical resection and histopathological evaluation of synovial chondromatosis in the shoulder:a retrospective study and literature review[J]. Clin Orthop Surg, 2020, 12(1):68-75.
[21] Wahab H, Hasan O, Habib A, et al. Arthroscopic removal of loose bodies in synovial chondromatosis of shoulder joint, unusual location of rare disease:a case report and literature review[J]. Ann Med Surg(Lond), 2018, 37:25-29..
[22] Buess E, Friedrich B. Synovial chondromatosis of the glenohumeral joint:a rare condition[J]. Arch Orthop Trauma Surg, 2001, 121(1-2):109-111.
[23] Jiménez-Martín A, Zurera-Carmona M, Santos-Yubero FJ,et al. Arthroscopic treatment of synovial chondromatosis,an unusual cause of shoulder pain[J]. Reumatol Clin, 2014,10(6):416-417.
[24]季伟,孙笑非,阮狄克.关节镜治疗肩关节滑膜软骨瘤病的临床疗效观察[J].中国骨与关节外科, 2013, 6(1):35-37.
[25] Kamineni S, O'Driscoll SW, Morrey BF. Synovial osteochondromatosis of the elbow[J]. J Bone and Joint Surg Br,2002, 84(7):961-966.
[26] Shpitzer T, Ganel A, Engelberg S. Surgery for synovial chondromatosis. 26 cases followed up for 6 years[J]. Acta Orthop Scand, 1990, 61(6):567-569.
[27] Ogilvie-Harris DJ, Saleh K. Generalized synovial chondromatosis of the knee:a comparison of removal of the loose bodies alone with arthroscopic synovectomy[J]. Arthroscopy, 1994, 10(2):166-170.
基本信息:
DOI:
中图分类号:R738.3
引用信息:
[1]杜瑞,李强强,陈东阳等.关节镜手术治疗肩关节滑膜软骨瘤病的疗效评价及复发部位特征分析[J].中华骨与关节外科杂志,2025,18(03):255-260.
基金信息:
国家自然科学基金面上项目(81972124); 江苏省基础研究计划(自然科学基金)青年基金(20170123)