Zhang Yi Min, Liu Xiaoguang
Department of Orthopaedics, Weifang People's Hospital, Weifang, China.
Department of Sports Medicine, Weifang Medical University, Weifang, China.
J Orthop Case Rep. 2016 Nov-Dec;6(5):51-54. doi: 10.13107/jocr.2250-0685.628.
Primary synovial osteochondromatosis of the hip is a benign disorder, which is not frequently seen clinically. The characteristic of this disease is proliferation of synovium and formation of loose bodies inside the joint. It is known that only the loose bodies derived from synovium were called synovial osteochondromatosis. Although it can take place in any joint, the knee is most commonly affected, involvement of the hip joint is relatively rare. We report a young man who has multiple synovial osteochondromatosis in his left hip.
A 21-year-old young man, who had progressive pain and functional impairment of his left hip, came to our hospital. He complained that 2 years ago, he began to feel painful of his left hip joint when walking and squatting. Physical examination found that the motion range of the hip was obviously limited, with internal rotation, abduction in particular. The Harris hip score was just 38 points. X-ray shew multiple osteochondromatosis with mild degenerative osteoarthritis existing inside the hip joint. Magnetic resonance imaging shew that the synovial osteochondromatosis intersperse inside the hip joint. During the operation, posterolateral incision of the hip was chosen with dislocation of the femoral head for total exposure of the hip joint to debride extensive loose bodies and proliferative synovial tissue. Pulse irrigation was applied to flush out the residuals. More than 872 of osteochondromatosis were removed out of the hip joint (some small ones were sucked during the operation). The size of the loose bodies ranged from 3 cm × 3 cm × 2.5 cm to 0.2 cm × 0.2 cm × 0.15 cm. Post-operation radiography shew most pathological tissues were taken out. After the operation, the patient rehabilitated fast. The pain relieved and he could bear weight and walked 3 days postoperatively. 1 and 3 months postoperatively, the patient came to us for visit, and he said that he just had a relatively satisfactory function of his affected hip. He could walk, slowly run, and squat freely. But sometimes he could feel a bit painful on his left hip joint after long walking and fatigue. And sometimes he could feel and hear mild crepitus on the left hip joint. 12 months later, the patient came again and complained that the pain of his operated hip became a bit more serious than before since about 20 days ago. The range (internal rotation, abduction in particular) of this hip joint could not live up to normal, compared with the uninvolved hip in physical examination. X-ray shew osteoarthritis had become a bit severer. The patient accepted the suggestion of prospective total hip replacement.
Multiple synovial osteochondromatosis is not a very uncommon condition. However, there may be unusual presentations. It can take place in any joint, the knee is most commonly affected, however, involvement of the hip joint is relatively rare as was seen in our patient.
髋关节原发性滑膜骨软骨瘤病是一种良性疾病，临床上并不常见。该病的特点是滑膜增生并在关节内形成游离体。已知只有源自滑膜的游离体才被称为滑膜骨软骨瘤病。尽管它可发生于任何关节，但最常累及膝关节，髋关节受累相对少见。我们报告一名左髋关节多发滑膜骨软骨瘤病的青年男性。
一名21岁青年男性，因左髋关节进行性疼痛和功能障碍前来我院就诊。他主诉2年前开始在行走和下蹲时感到左髋关节疼痛。体格检查发现髋关节活动范围明显受限，尤其是内旋和外展。Harris髋关节评分仅为38分。X线显示髋关节内有多发骨软骨瘤病并伴有轻度退行性骨关节炎。磁共振成像显示滑膜骨软骨瘤病散布于髋关节内。手术中，选择髋关节后外侧切口，股骨头脱位以充分暴露髋关节，清除大量游离体和增生的滑膜组织。采用脉冲冲洗清除残留物。从髋关节内取出872多个骨软骨瘤（术中吸出一些小的）。游离体大小从3cm×3cm×2.5cm到0.2cm×0.2cm×0.15cm不等。术后X线显示大部分病理组织已被取出。术后患者恢复很快。疼痛缓解，术后3天即可负重行走。术后1个月和3个月，患者前来复诊，称患侧髋关节功能恢复较为满意。他能够行走、慢跑且自由下蹲。但长时间行走和疲劳后，有时仍会感到左髋关节有点疼痛。有时左髋关节还能感觉到并听到轻微的摩擦音。12个月后，患者再次前来，抱怨自大约20天前起，手术髋关节的疼痛比以前加重了一些。体格检查发现，与未受累髋关节相比，该髋关节的活动范围（尤其是内旋、外展）未达正常。X线显示骨关节炎有所加重。患者接受了行全髋关节置换术的建议。
多发滑膜骨软骨瘤病并非十分罕见。然而，可能会有不寻常的表现。它可发生于任何关节，最常累及膝关节，不过，如我们的患者所示，髋关节受累相对少见。
