關節鏡下和/ 或切開治療膝關節彌漫型色素沉著絨毛結節性滑膜炎療效分析_《中國修復重建外科雜志》

作者：

劉東 , 李棋 , 蔣勰 , 唐新 , 李箭

四川大學華西醫院骨科（成都，610041）;

關鍵詞：

膝關節彌漫型色素沉著絨毛結節性滑膜炎關節鏡

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目的探討關節鏡下和/ 或切開手術輔以術后關節外放療治療膝關節彌漫型色素沉著絨毛結節性滑膜
炎（pigmented villonodular synovitis，PVNS）的方法和療效。方法 2000 年9 月－ 2010 年8 月，收治97 例單膝彌漫型
PVNS。男38 例，女59 例；年齡8 ～ 75 歲，中位年齡33 歲。病程1 周～ 30 年；復發患者10 例。左膝52 例，右膝45 例。
術前膝關節伸直（1.9 ± 2.3）°，屈曲（122.9 ± 5.6）°；Lysholm 膝關節評分為（43.2 ± 6.7）分，國際膝關節文獻委員會（IKDC）
膝關節功能主觀評分為（53.2 ± 5.7）分。根據是否合并關節外病變及病變部位，82 例采用關節鏡下關節前后病變滑膜切
除術，3 例采用關節鏡下關節內病變滑膜切除聯合小切口切除關節外病灶，9 例采用關節鏡下關節內病變滑膜切除及后方
關節外軟組織內病灶切除術，3 例分期切除病灶并植骨。術后76 例接受關節外放療。結果術中1 例損傷腘動脈，3
例損傷腘靜脈分支；術后3 d 1 例膝關節血腫形成。其余患者切口均Ⅰ期愈合，無神經損傷等并發癥發生。患者均獲隨訪，
隨訪時間1 年3 個月～ 11 年2 個月，中位時間61 個月。89 例患者隨訪期間無復發，術后15 個月膝關節伸直（0.2 ± 1.3）°，
屈曲（135.9 ± 6.6）°，Lysholm 膝關節評分為（89.8 ± 5.8）分，IKDC 膝關節功能主觀評分為（87.8 ± 5.8）分，與術前比較
差異均有統計學意義（P lt; 0.05）。8 例于術后6 個月～ 8 年復發，再次手術后患者膝關節輕度活動受限，無疼痛、腫脹。
結論根據膝關節病變范圍及程度，選擇關節鏡下和/ 或切開手術輔以關節外放療治療膝關節彌漫型PVNS 可取得較好
療效。術后未接受正規放療是復發重要因素之一，復發者病變易導致骨質破壞。

引用本文： 劉東,李棋,蔣勰,唐新,李箭. 關節鏡下和/ 或切開治療膝關節彌漫型色素沉著絨毛結節性滑膜炎療效分析. 中國修復重建外科雜志, 2012, 26(5): 518-521. doi: 復制

1.	Ofluoglu O. Pigmented villonodular synovitis. Orthop Clin North Am, 2006, 37(1): 23-33.
2.	楊洪彬, 李忠, 張忠杰, 等. 膝關節色素沉著絨毛結節性滑膜炎的關節鏡治療探討. 現代預防醫學, 2009, 36(9): 1757-1759.
3.	Miquel A, Lesavre A, Menu Y, et al. Pigmented villonodular synovitis of the knee. Presse Med, 2006, 35(1 Pt 1): 67-68.
4.	Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis of the foot and ankle: Forty years of experience from the Scottish bone tumor registry. J Foot Ankle Surg, 2006, 45(5): 329-336.
5.	Rhee PC, Sassoon AA, Sayeed SA, et al. Arthroscopic treat ment of localized pigmented villonodular synovitis: long-term functional results. Am J Orthop (Belle Mead NJ), 2010, 39(9): E90-94.
6.	Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis: Diagnostic pitfalls and management strategy. Cur Orthop, 2005, 19(3): 215-222.
7.	Murphey MD, Rhee JH, Lewis RB, et al. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics, 2008, 28(5): 1493-1518.
8.	Kramer DE, Frassica FJ, Frassica DA, et al. Pigmented villonodular synovitis of the knee: diagnosis and treatment. J Knee Surg, 2009, 22(3): 243-254.
9.	段小軍, 楊柳, 陳光興, 等. 膝關節色素沉著絨毛結節性滑膜炎的微創治療. 中國微創外科雜志, 2008, 8(7): 648-650.
10.	孫笑非, 林建寧, 阮狄克, 等. 關節鏡下診治膝關節色素絨毛結節性滑膜炎. 中國微創外科雜志, 2009, 9(2): 128-130.
11.	Wu CC, Pritsch T, Bickels J, et al. Two incision synovectomy and radiation treatment for diffuse pigmented villonodular synovitis of the knee with extra-articular component. Knee, 2007, 14(2): 99-106.
12.	Chen WM, Wu PK, Liu CL. Simultaneous anterior and posterior synovectomies for treating diffuse pigmented villonodular synovitis. Clin Orthop Relat Res, 2012. [Epub ahead of print].
13.	Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis: diagnostic pitfalls and management strategy. Curr Orthop, 2005, 19: 215-222.
14.	Nishida Y, Tsukushi S, Nakashima H, et al. Osteochondral destruction in pigmented villonodular synovitis during the clinical course. J Rheumatol, 2012, 39(2): 345-351.
15.	Berger B, Ganswindt U, Bamberg M, et al. External beam radiotherapy as postoperative treatment of the diffuse pigmente villonodular synovitis. Int J Radiat Oncol Biol Phys, 2007, 67(4): 1130-1134.
16.	Ottaviani S, Ayral X, Dougados M, et al. Pigmented villonodular synovitis: a retrospective single-center study of 122 cases and review of the literature. Semin Arthritis Rheum, 2011, 40(6): 539-546.
17.	Nassar WA, Bassiony AA, Elghazaly HA. Treatment of diffuse pigmented villonodular of the knee with combined surgical and radiosynovectomy. HSS J, 2009, 5(1): 19-23.
18.	Horoschak M, Tran PT, Bachiredd P, et al. External beam radiation therapy enhances local control in pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys, 2009, 75(1): 183-187.

1. Ofluoglu O. Pigmented villonodular synovitis. Orthop Clin North Am, 2006, 37(1): 23-33.
2. 楊洪彬, 李忠, 張忠杰, 等. 膝關節色素沉著絨毛結節性滑膜炎的關節鏡治療探討. 現代預防醫學, 2009, 36(9): 1757-1759.
3. Miquel A, Lesavre A, Menu Y, et al. Pigmented villonodular synovitis of the knee. Presse Med, 2006, 35(1 Pt 1): 67-68.
4. Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis of the foot and ankle: Forty years of experience from the Scottish bone tumor registry. J Foot Ankle Surg, 2006, 45(5): 329-336.
5. Rhee PC, Sassoon AA, Sayeed SA, et al. Arthroscopic treat ment of localized pigmented villonodular synovitis: long-term functional results. Am J Orthop (Belle Mead NJ), 2010, 39(9): E90-94.
6. Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis: Diagnostic pitfalls and management strategy. Cur Orthop, 2005, 19(3): 215-222.
7. Murphey MD, Rhee JH, Lewis RB, et al. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics, 2008, 28(5): 1493-1518.
8. Kramer DE, Frassica FJ, Frassica DA, et al. Pigmented villonodular synovitis of the knee: diagnosis and treatment. J Knee Surg, 2009, 22(3): 243-254.
9. 段小軍, 楊柳, 陳光興, 等. 膝關節色素沉著絨毛結節性滑膜炎的微創治療. 中國微創外科雜志, 2008, 8(7): 648-650.
10. 孫笑非, 林建寧, 阮狄克, 等. 關節鏡下診治膝關節色素絨毛結節性滑膜炎. 中國微創外科雜志, 2009, 9(2): 128-130.
11. Wu CC, Pritsch T, Bickels J, et al. Two incision synovectomy and radiation treatment for diffuse pigmented villonodular synovitis of the knee with extra-articular component. Knee, 2007, 14(2): 99-106.
12. Chen WM, Wu PK, Liu CL. Simultaneous anterior and posterior synovectomies for treating diffuse pigmented villonodular synovitis. Clin Orthop Relat Res, 2012. [Epub ahead of print].
13. Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis: diagnostic pitfalls and management strategy. Curr Orthop, 2005, 19: 215-222.
14. Nishida Y, Tsukushi S, Nakashima H, et al. Osteochondral destruction in pigmented villonodular synovitis during the clinical course. J Rheumatol, 2012, 39(2): 345-351.
15. Berger B, Ganswindt U, Bamberg M, et al. External beam radiotherapy as postoperative treatment of the diffuse pigmente villonodular synovitis. Int J Radiat Oncol Biol Phys, 2007, 67(4): 1130-1134.
16. Ottaviani S, Ayral X, Dougados M, et al. Pigmented villonodular synovitis: a retrospective single-center study of 122 cases and review of the literature. Semin Arthritis Rheum, 2011, 40(6): 539-546.
17. Nassar WA, Bassiony AA, Elghazaly HA. Treatment of diffuse pigmented villonodular of the knee with combined surgical and radiosynovectomy. HSS J, 2009, 5(1): 19-23.
18. Horoschak M, Tran PT, Bachiredd P, et al. External beam radiation therapy enhances local control in pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys, 2009, 75(1): 183-187.

《中國修復重建外科雜志》

關節鏡下和/ 或切開治療膝關節彌漫型色素沉著絨毛結節性滑膜炎療效分析

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《中國修復重建外科雜志》

關節鏡下和/ 或切開治療膝關節彌漫型色素沉著絨毛結節性滑膜炎療效分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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