Ramseier Leonhard E, Exner G Ulrich
Department of Orthopaedics, University of Zurich, Switzerland.
J Pediatr Orthop. 2004 Jan-Feb;24(1):83-6. doi: 10.1097/00004694-200401000-00016.
Degenerative changes resembling hemophilic arthropathy may be a complication of synovial hemangioma in the knee. It is thought that arthropathy is caused by repeated bleeding episodes similar to the joint disease in hemophilia. Four children aged 4 to 9 years at surgery were treated by anterior open synovectomy for intra-articular synovial hemangiomas. At open surgery the cartilage of all patients showed changes on the surface with yellow hematin staining in all cases, without ulceration in three patients but one, who showed severe degenerative changes at age 9 years. At 15 months follow-up the patient with severe degenerative changes had severely impaired flexion and mild extension deficit. The three others were asymptomatic at 1 to 6 years follow-up. The magnetic resonance images were typical and can be considered pathognomonic; however, the referral diagnosis included the correct diagnosis in none of them. Treatment should be initiated as early as possible to reduce the risk of damage to the cartilage. Treatment by complete open synovectomy in these four patients was performed without significant bleeding problems, and no recurrence was seen.
类似血友病性关节病的退行性改变可能是膝关节滑膜血管瘤的一种并发症。据认为，关节病是由反复出血发作引起的，类似于血友病中的关节疾病。4名手术时年龄在4至9岁的儿童因关节内滑膜血管瘤接受了前路开放性滑膜切除术治疗。在开放手术中，所有患者的软骨表面均有改变，所有病例均有黄色含铁血黄素染色，3例患者无溃疡，但1例在9岁时出现严重退行性改变。在15个月的随访中，有严重退行性改变的患者屈曲严重受损，伸展轻度受限。其他3例在1至6年的随访中无症状。磁共振成像典型，可认为具有诊断意义；然而，转诊诊断中无一例包含正确诊断。应尽早开始治疗，以降低软骨受损的风险。这4例患者通过完全开放性滑膜切除术进行治疗，无明显出血问题，且未见复发。
