晚期色素沉着绒毛结节滑膜炎全膝置换是否放疗  

Total knee arthroplasty for knee advanced pigmented villonodular synovitis with or without radiotherapy

作　　者：林三福[1] 巫海鹏 陈守勃[1] 王文怀[1] 肖丽华[1] 郑煜晖[1] LIN San-fu;WU Hai-peng;CHEN Shou-bo;WANG Wen-huai;XIAO Li-hua;ZHENG Yu-hui(Department of Orthopaedics,The Second Affiliated Hospital,Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属第二医院骨科,福建泉州362000

出　　处：《中国矫形外科杂志》2023年第21期1949-1955,共7页Orthopedic Journal of China

基　　金：福建省泉州市科技计划项目(编号:2018N022S)。

摘　　要：[目的]探讨全膝关节置换术(total knee arthroplasty,TKA)辅助关节外放疗治疗晚期色素沉着绒毛结节性滑膜炎(Pigmented Villonodular Synovitis,PVNS)的临床效果。[方法]回顾性分析2007年6月—2019年6月收治的39例晚期PVNS患者的临床资料。根据医患沟通结果,20例行滑膜全切和TKA,术后辅助关节外放疗(放疗组),另外19例单纯行滑膜全切和TKA (未放疗组)。比较两组围手术期、随访及影像资料。[结果]两组手术时间、切口总长度、术中失血量、术后5 d疼痛VAS评分、下地行走时间、住院时间的差异均无统计学意义(P>0.05)。随访平均时间(36.0±2.2)个月,随时间推移,两组VAS评分显著减少(P<0.05),HSS、KSS功能评分和KSS临床评分、膝关节活动度显著增加(P<0.05)。末次随访,放疗组的VAS评分[(1.7±0.5) vs (2.6±0.6),P<0.001]、HSS评分[(93.6±2.2) vs (87.1±2.1),P<0.001]、KSS功能评分[(93.3±2.0) vs (87.3±1.9),P<0.001]、KSS临床评分[(93.9±1.4) vs (87.7±1.8),P<0.001],以及膝伸屈ROM [(144.4±6.1)°vs (136.9±3.8)°,P<0.001]均显著优于未放疗组。至末次随访,放疗组复发率显著低于未放疗组(0%vs 21.1%,P=0.047)。影像方面,术后两组髌上囊积液厚度及髌上滑膜厚度较术前均显著减少(P<0.05)。末次随访时,放疗组髌上囊积液厚度[(1.4±0.5) mm vs (2.6±0.7) mm,P<0.001]及髌上囊滑膜厚度[(0.9±0.2)mm vs (1.8±0.5) mm,P<0.05]均显著小于未放疗组。相应时间点,两组骨密度T值的差异无统计学意义(P>0.05)。[结论]对于严重骨质破坏的膝关节PVNS患者行TKA,术后辅助放疗,能有效预防复发,安全性好,近期临床效果较未辅助放疗好。[Objective]To investigate the clinical outcomes of total synovectomy and total knee arthroplasty(TKA)with or without radiotherapy in the treatment of knee advanced pigmented villonodular synovitis(PVNS).[Methods]A retrospective study was done on 39 patients who received treatment for knee advanced PVNS from June 2007 to June 2019.According to the doctor-patient communication,20 patients received total synovectomy and TKA,followed by postoperative extra-articular radiotherapy(the RT group),while the remaining 19 patients received total synovectomy and TKA only(non-RT group).The perioperative,follow-up and imaging data of the two groups were compared.[Results]There were no significant differences in operation time,total incision length,intraoperative blood loss,pain VAS score 5 days after surgery,walking time and hospital stay between the two groups(P>0.05).As time went during the follow-up period lasted for(36.0±2.2)months in a mean,the VAS scores significantly reduced(P<0.05),whereas the HSS,KSS functional scores,KSS clinical scores and knee range of motion(ROM)significantly increased in both groups(P<0.05).The last follow-up,the RT group proved significantly superior to the non-RT group in terms of VAS[(1.7±0.5)us(2.6±0.6),P<0.001],HSS[(93.6±2.2)us(87.1±2.1),P<0.001],KSS functional score[(93.3±2.0)us(87.3±1.9),P<0.001],KSS clinical score[(93.9±1.4)us(87.7±1.8),P<0.001]and knee R0M[(144.4±6.1)°us(136.9±3.8)°,P<0.001j.By the latest follow-up,the RT group was significantly better than the non-RT group in recurrence rate(0%us 21.1%,P<0.047).Regarding imaging,the thickness of suprapatelar effusion and suprapatellar synovial were significantly reduced in both groups after operation(P<0.05).At the last follow-up,the RT group proved significantly superior to the non-RT group in terms of effusion thickness of suprapatellar bursae[(1.4±0.5)mm us(2.6±0.7)mm,P<0.001]and synovial thickness of suprapatellar bursae[(0.9±0.2)mm us(1.8±0.5)mm,P<O.001j.However,there was no significant difference in the T value of

关 键 词：色素沉着绒毛结节性滑膜炎 骨质破坏 滑膜切除 全膝关节置换术 放射治疗 

分 类 号：R687[医药卫生—骨科学]