膝弥漫型色素绒毛结节性滑膜炎四种治疗比较  

Comparison of four treatments for diffuse pigmented villonodular synovitis of the knee

作　　者：张绍华 张青松 李涛[1] 方禹舜 李亚楠 汤明 谈鸿飞 ZHANG Shao-hua;ZHANG Qing song;LI Tao;FANG Yu-Shun;LI Ya-nan;TANG Ming;TAN Hong-fei(Department of Sports Medicine,The Fourth Hospital of Wuhan City,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属武汉第四医院运动医学科,湖北武汉430030

出　　处：《中国矫形外科杂志》2023年第1期32-37,共6页Orthopedic Journal of China

摘　　要：[目的]比较四种不同治疗方法治疗膝关节弥漫型色素绒毛结节性滑膜炎(pigmented villonodular synovitis, PVNS)的临床疗效。[方法]回顾性分析2010年1月—2019年12月在本院治疗的52例膝关节弥漫型PVNS患者的临床资料,根据术前医患沟通结果,8例采用关节镜滑膜切除(arthroscopic synovectomy, AS),22例采用关节镜滑膜切除辅助术后放疗(AS+postoperative radiotherapy, ASRT),5例采用关节镜结合后路开放滑膜切除(AS+posterior open synovectomy, ASPO),17例采用关节镜结合后路开放滑膜切除和辅助术后放疗(AS+posterior open synovectomy+postoperative radiotherapy, APRT)。比较四组围手术期情况、随访和影像资料。[结果] AS组与ASRT的手术时间、切口总长度、术后引流量、下地行走时间、住院时间均显著优于ASPO和APRT组(P<0.05)。所有患者均获随访25~118个月,平均(59.8±20.2)个月。AS组和ASRT组恢复完全负重活动早于ASPO组和APRT组(P<0.05)。与术前相比,末次随访时四组患者VAS评分均显著降低(P<0.05),而Ogilvie-Harris评分显著增加(P<0.05)。相应时间点,四组间VAS评分的差异无统计学意义(P>0.05)。末次随访时Ogilvie-Harris评分由高至低依次为:ASRT组>APRT组>AS组>ASPO组,差异有统计学意义(P<0.05)。MRI影像评估方面,与术前相比,末次随访时四组关节积液均显著减少(P<0.05);PVNS复发率,由高至低依次为ASPO组3/5 (60.0%)>AS组3/8 (37.5%)>APRT组1/17 (5.9%)>ASRT组1/22(4.6%),差异有统计学意义(P<0.05)。[结论]对膝关节弥漫型PVNS,位于关节内,建议行关节镜手术,侵袭至关节外者,建议行关节镜结合后路开放滑膜切除手术。两者通过术后辅助低剂量放疗,均可降低复发率。[Objective] To compare the clinical efficacy of four different treatments for diffuse pigmented villonodular synovitis(PVNS)of the knee. [Methods] From January 2010 to December 2019, 52 patients with diffuse PVNS of the knee were retrospectively analyzed. According to preoperative doctor-patient communication, 8 patients were treated with arthroscopic synovectomy(AS), 22 patients underwent AS combined with radiotherapy(ASRT), 5 patients underwent AS combined with posterior open synovectomy(ASPO), while the remaining17 patients were treated with AS combined with posterior open synovectomy and radiotherapy(APRT). The perioperative, follow-up and imaging data were compared among the four groups. [Results] The AS group and ASRT group proved significantly superior to the ASPO group and APRT group in terms of operation time, total incision length, postoperative drainage volume, postoperative walking time and hospital stay(P<0.05). All patients were followed up for 25~118 months, with an average of(59.8±20.2) months. The AS and ASRT groups returned to full weight-bearing activity significantly earlier than the ASPO and APRT groups(P<0.05). At last follow-up, the VAS scores significantly decreased(P<0.05), while the Ogilvie-Harris score significantly increased in all the 4 groups compared with those preoperatively(P<0.05). At the corresponding time points, there was no significant difference in VAS score among the four groups(P>0.05). At the last followup, the Ogilvie-Harris scores were ranked from high to low ASRT > APRT > AS > ASPO, which was statistically significant(P<0.05). In term of MRI assessment, joint effusion was significantly reduced in all four groups at last follow-up compared with those preoperatively(P<0.05). The recurrence rate of PVNS was ranked up-down as follows: ASPO group 3/5(60.0%) > AS group 3/8(37.5%) > APRT group 1/17(5.9%) > ASRT group 1/22(4.6%), which was statistically significant(P<0.05). [Conclusion] For diffuse PVNS of the knee, arthroscopic surgery is recommended if it involves intraarti

关 键 词：弥漫型色素绒毛结节性滑膜炎 膝关节 关节镜 后方开放切除 低剂量放疗 

分 类 号：R686.7[医药卫生—骨科学]