目的 通过介绍1例复发性肩峰下米粒体滑囊炎的临床诊治经验、病理特征,结合文献复习,为提高对该病的认知提供参考。方法 收治1例因“右肩关节滑膜软骨瘤”在外院接受右肩关节镜手术后1年余,再发右肩关节肿胀疼痛1个月的中年女性患者,经体检、完善MRI等影像学检查及类风湿因子等实验室检查后初步诊断为右肩关节滑膜软骨瘤病再发,行肩关节镜下游离体取出及滑膜切除术。结果 患者术后胀痛等症状消失,右肩关节恢复正常活动度。术后病理报告提示慢性滑囊炎症和纤维结构游离体,最终诊断为复发性肩峰下米粒体滑囊炎。结论 肩峰下米粒体滑囊炎的发病机制仍未明确,其诊断主要基于MRI、镜下观察和病理检查,关节镜手术是有效的治疗方法,彻底清理和随访是预防复发的关键。
Objective To summarize the clinical diagnosis and treatment and pathological features of a case with recurrent subacromial rice body bursitis, combined with literature review, and to raise understanding of the disease. Methods A middle-aged female was admitted, who had received arthroscopic surgery on the right shoulder for "synovial chondroma of the right shoulder joint" in another hospital 1 year ago, and suffered from recurrence of swelling and pain in the right shoulder joint for more than 1 month. After physical examination, MRI, and rheumatoid factor assays, the preliminary diagnosis was recurrent synovial chondromatosis of the right shoulder joint. Subsequently,arthroscopic synovectomy and loose body removal were performed. Results The patient's postoperative swelling and pain disappeared, and the range of motion of the right shoulder joint is recovered. Postoperative pathological reports indicated chronic bursitis and fibrous structured loose bodies, leading to the final diagnosis of recurrent subacromial rice body bursitis. Conclusion The pathogenesis of subacromial rice body bursitis remains unclear, and the diagnosis is predominantly reliant on MRI, arthroscopic assessment, and histopathological examination. Arthroscopic surgery is an effective therapeutic approach, with comprehensive debridement and subsequent follow-up essential to prevent recurrence.
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