膝部滑膜皺襞症候羣的診斷與治療

Diagnosis and Treatment of the Plica Syndrome of the Knee

詹美華(Mei-Hwa Jan) ； 林永福(Yeong-Fwu Lin)

《物理治療學會雜誌》 11卷 (1986/11) Pp. 9-14

https://doi.org/10.29617/JPT.198611.0002

摘要

臺北市立中興醫院自民國七十年二月至七十五年二月間，利用關節鏡檢查的機會，總共發現了93位具有滑膜皺襞的患者。其中15位患者是雙膝皆具有滑膜皺襞，所以整個系列共有108例滑膜皺襞。全部患者中，男性占43位，女性50位；平均年齡是35.5歲。這些患者與國外文獻的報告相似，在膝部發生症狀前，有55.9%的患者膝部曾受到明顯的傷害(trauma)，而且以二十多歲的年輕患者居多（占43%）。又未利用關節鏡檢查，僅憑臨床診斷而確定是滑膜皺襞者僅28例，但利用關節鏡檢查者，卻有100%的診斷正確率。診斷滑膜皺襞最有可能發生的錯誤是讓人誤以為是半月軟骨破裂或髕骨軟骨軟化。
滑膜皺襞的存在是先天胚胎組織的分化不完全。正常的柔軟、富彈性的滑膜皺襞是不會引出症狀；由於外來因素造成滑膜的發炎，繼而失去彈性變厚，才會逐漸地成為髕骨在髕骨窩上滑動的障礙物，日積月累終造成症狀；是故以髕骨內方滑膜皺襞較易引發膝部機能障礙，因其所屬位置最易阻礙髕骨的滑動。羣眾中有20%左右的人具有滑膜皺襞，發現機能障礙者以年輕人較多，但在本系亦有多位中、老年人的患者存在。

並列摘要

The term ”plica” has been used to describe some of these inconstant remnants of the development of the synovial tissue. On occasion a plica may become symptomatic, and then it-is responsible for the so called plica syndrome.
In early intra-uterine life, the medial and lateral compartments as well as the suprapatellar pouch of the knee are separated from each other by thin membranes. During later fetal life these thin, membranous partitions involute and the knee becomes a single cavity. A plica exists when any portion of the embryonic synovial septae persists into adult life. The incidence of these persistent embryonic structures in the general population is approximately 20 per cent.
Most synovial folds of the knee joint are asymptomatic and are of little clinical consequence. However, when there is inflammation with associated edema and thickening, the plica can become relatively inelastic and eventually symptomatic as it snaps over the femoral condyle.
Several etiological factors can precipitate the inflammatory cycle leading to the plica syndrome. Blunt, direct trauma to the plica itself may be the initial event, or the plica may become inflamed secondary to one of several other pathological derangements of the knee, including loose bodies, osteochondritis dissecans, or meniscal tears.
The diagnosis of the plica syndrome rests on data obtained from the patient's history and physical examination. Characteristically, the patient has a history of blunt or twisting trauma to the knee followed by pain and effusion. The pain characteristically is intermittent, dull and aching and is located about the superior aspect of the knee. It generally is increased with activities, particularly stair climbing. Some patients note that the pain is greatest after long periods of sitting.
Ninety-three patients were diagnosed as having symptomatic plicae of the knee, and in fifteen of those patients there were bilateral involvement. There were forty-three men, and fifty women, the mean age was 35.5 years. Fifty-two patients gave a history of trauma.
Thirty-five patients of all patients with symptomatic synovial plica received conservative treatments, which including resting, Ouadriceps strengthening exercises, Hamstring stretching exercises and anti-inflammatory medicine. The other fifty-eight patients including eleven bilateral involvement received surgery treatment. There are 42 cases receiving arthroscopic excision of plica, 10 cases receiving arthroscopic meniscectomy, 6 cases receiving arthroscopic excision of plica and shaving of articular surface, and the restful cases all receiving arthrotomy, such as Pridie operation, meniscectomy, synovectomy etc.

並列關鍵字

Plica syndrome ； Synovectomy ； Exercise