关节镜治疗色素沉着绒毛结节性滑膜炎

目的：探讨应用关节镜治疗膝关节色素沉着绒毛结节性滑膜炎的临床应用效果。方法：1996年8月～2003年8月对15例色素沉着绒毛结节性滑膜炎病人采用关节镜下行膝关节腔滑膜刨削、结节肿物取出术等镜下手术操作。并对其临床效果进行回顾性分析。结果：12例患者得到随访，该方法康复快，并发症少，随访复发率低。结论：对于色素沉着绒毛结节性滑膜炎的治疗应以关节镜下全滑膜切除术为首选方法。     

关节镜治疗膝关节色素沉着绒毛结节性滑膜炎

目的探讨关节镜下治疗膝关节色素沉着绒毛结节性滑膜炎的临床效果。方法回顾性分析自2005-08—2014-05诊治的42例色素沉着绒毛结节性滑膜炎,行关节镜下滑膜清理,少数结节性色素沉着绒毛结节性滑膜炎患者需辅助小切口取出关节内肿物。结果术后随访1~72个月,平均38个月,术后1例膝关节轻度肿胀,3例有轻微疼痛,其余患者均无交锁、无肿痛,关节功能正常。结论关节镜下治疗膝关节色素沉着绒毛结节性滑膜炎是一种创伤小、治疗相对彻底的有效方法。     

骨病

川芎嗪关节腔内注射对膝骨关节炎的治疗作用；膝关节色素沉着绒毛结节性滑膜炎的关节镜治疗；内镜辅助下手术治疗上干型胸廓出口综合征的临床应用；踝关节色素沉着绒毛结节性滑膜炎早期诊断与治疗；半月板囊肿的关节镜下手术治疗——附20例病例报告     

膝关节色素沉着绒毛结节性滑膜炎的关节镜下治疗

目的观察采用关节镜技术治疗膝关节色素沉着绒毛结节性滑膜炎的早期疗效。方法 2009年4月至2010年4月,收治12例膝关节色素沉着绒毛结节性滑膜炎患者。局限性10例,弥漫性2例;男7例,女5例;年龄12～31岁,平均23岁。主要临床症状为反复膝关节疼痛、肿胀。术前膝关节功能Lysholm评分（64.2±10.3）分。采用关节镜下病灶切除,术中强调对病变滑膜彻底切除,对弥漫性色素沉着绒毛结节性滑膜炎及关节外滑膜病变加用辅助小切口。结果术后病理检查均确诊为色素沉着绒毛结节性滑膜炎。手术后切口均Ⅰ期愈合,无感染及骨筋膜室综合征等并发症发生。全部病例获完整随访,随访时间12～24个月,平均15个月。末次随访未见复发,术后膝关节功能Lysholm评分（92.3±4.5）分。结论采用关节镜技术治疗膝关节色素沉着绒毛结节性滑膜炎创伤小、恢复快、并发症少,是一种可行的方法。     

关节镜下诊治膝关节色素绒毛结节性滑膜炎

目的探讨关节镜下诊治膝关节色素绒毛结节性滑膜炎（pigmented villonodular synovitis,PVS）的方法和转归。方法1997年9月～2006年7月,对11例PVS行关节镜诊断和治疗,10例为全镜下手术,1例附加膝关节后方的辅助切口。其中6例弥漫型和2例弥漫结节型术后行外放疗,3例局限型未行放疗。结果术后即行外放疗的7例平均随访45个月（12～108个月）未见复发;1例弥漫型术后未完成外放疗,3个月后原位复发,再行关节镜下切除手术,术后加做放疗后随访36个月未见复发;局限型3例未做外放疗,随访30、69、72个月,未见复发。Lysholm关节功能评分由术前（53.7±20.0）分增加到（87.5±3.8）分（配对t检验,t=-5.467,P=0.000）。无感染和关节功能受限等并发症。结论关节镜下病变滑膜切除术是治疗膝关节色素绒毛结节性滑膜炎的理想选择,对弥漫型和弥漫结节型PVS术后辅以适量外放疗对防止复发有益处。     

骨病

射频汽化仪在关节镜下治疗膝关节疾病中的应用,膝关节滑膜软骨瘤病的关节镜诊断与治疗,关节镜下滑膜切除联合射频汽化治疗膝关节类风湿关节炎,膝关节骨坏死样病变的MRI与组织病理学初步对照研究,膝关节弥漫型色素沉着绒毛结节性滑膜炎的关节镜治疗探讨，[编者按]     

关节镜下滑膜切除术治疗局限型膝关节色素沉着绒毛结节性滑膜炎的临床分析

【摘要】 目的 探讨关节镜下治疗局限型膝关节色素沉着绒毛结节性滑膜炎(PVNS)的方法及疗效。方法 回顾性分析2008年9月~2014年5月在我院术前行MRI检查、术后经病理证实的10例色素着绒毛结节性滑膜炎患者的临床资料及治疗方法,并对患者进行跟踪随访9~68个月,采用Lysholm膝关节功能评分了解患者术后患膝疼痛、肿胀及活动度等功能恢复情况。结果 10例患者在术后随访期均无并发症发生,复发2例,Lysholm 膝关节功能评分为91.80±5.28分,明显高于术前(P<0.01)。结论〓关节镜下对局限型色素沉着绒毛结节性滑膜炎的患者实施滑膜切除术,手术创伤小,术后膝关节功能恢复好,是一种安全有效的治疗膝关节局限型色素沉着绒毛结节性滑膜炎的方法。     

关节镜下诊治膝关节弥漫性色素沉着绒毛结节性滑膜炎

目的 探讨采用关节镜技术诊治膝关节弥漫性色素沉着绒毛结节性滑膜炎的临床疗效.方法 自2009年3月至2011年5月关节镜下诊治膝关节弥漫性色素沉着绒毛结节性滑膜炎7例,先行后内、后外侧间室的清理,然后清理髁间窝,交叉韧带表面,前内、外侧间室,内、外侧沟,最后行髌上囊清理,病变组织均送病检.术后常规放置引流管,按计划指导功能训练.结果 本组7例患者有4例MRI发现结节病变,诊断为弥漫性绒毛结节性滑膜炎;3例镜检发现术前穿刺液为鲜血或淡黄色液或褐色液.1例伴外侧半月板复杂撕裂;2例合并不同程度的骨关节炎.无一例发生膝关节感染.术后2例行放疗.全部患者获得随访,随访时间12.0~32.0个月,平均21.4月,无膝关节活动受限,未见复发病例.所有患者对术后疗效表示满意.Lysholm膝关节的功能评分由术前的50.7分增加到86.6分.结论 关节镜技术诊治膝关节弥漫性色素沉着绒毛结节性滑膜炎是一种创伤小,恢复快,病灶切除彻底,能有效地避免复发的治疗方法.     

关节镜治疗膝关节弥漫色素沉着绒毛结节性滑膜炎

目的探讨关节镜下手术切除膝关节弥漫性色素沉着绒毛结节性滑膜炎的方法与疗效。方法2004年2月至2006年11月，对17例睬关节弥漫性色素沉着绒毛结节性滑膜炎，采用标准膝前内、外侧入路并辅以髌上外侧入路行关节镜下膝前间室滑膜全切，后内、外侧入路行膝后间室滑膜全切，并用射频治疗仪辅助清理十字韧带、关节软骨和半月板表面的滑膜，电凝止血。结果本组17例，4例流动人口失去联系，13例获得14-33个月，平均21．6个月随访。术后2个月，2例有轻度疼痛，2例有轻度肿胀，1例关节置换术后及1例开放手术后复发患者膝关节屈曲小于120°。术后1年，13例均无肿胀及积液，3例有轻度疼痛，2例膝关节屈曲仍小于120°，但不影响日常生活。采用Lysholm评分方法评定膝关节功能，术前Lysholm评分为（38．6±4．5）分。最后随访时，13例无一例复发，Lysholm评分为（87．3±5．6）分。结论关节镜下治疗膝关节弥漫性色素沉着绒毛结节性滑膜炎，具有手术切口小、组织损伤少、术后痛苦少、可早期进行功能锻炼、避免关节黏连引起的功能障碍等优点，且术中病变滑膜切除彻底，术后不易复发。该术式早中期疗效肯定，远期疗效有待进一步观察。     

关节镜下滑膜全切术治疗膝关节慢性滑膜炎

[目的]探讨关节镜下膝关节滑膜全切术的手术方法及临床疗效.[方法]自2007年6月～2010年8月,收治各种原因导致的膝关节反复积液的患者共32例,男18例,女14例;年龄12 ～64岁,平均36.5岁,病程3个月～5年,平均8.4个月.膝关节慢性感染8例,类风湿性关节炎10例,色素沉着绒毛结节性滑膜炎8例,膝关节滑膜结核3例,不明原因3例.所有患者行关节镜下膝关节滑膜全切术,在常规前内、前外入路的基础上,结合后内侧、后外侧及髌上外侧入路,6例色素沉着绒毛结节性滑膜炎患者采用跨后纵隔入路.术后配合相应的药物治疗.[结果]所有患者均获得随访,随访时间24 ～ 46个月,平均30.5个月.2例色素沉着绒毛结节性滑膜炎患者手术24个月后膝关节肿胀复发,余患者关节肿胀消退,浮髌试验阴性.末次随访时膝关节屈曲由术前的(36.25 ±7.93)°增加到术后(120.00±13.20)°,Lysholm评分由术前的(34.84 ±7.04)分提高到术后(85.00±5.75)分,优良率87.50％.[结论]通过关节镜技术能彻底切除膝关节滑膜,创伤小,能最大程度的恢复膝关节功能.     

Result of arthroscopic treatment of pigmented villonodular synovitis of the knee

Purpose:We report 10 years’ experience in arthroscopic treatment of pigmented villonodular synovitis (PVNS) of the knee in a series of patients affected by the localized or diffuse form of the disease. The purpose of the study is to critically examine the results of arthroscopic synovectomy in the knee affected by PVNS, to determine the safety and effectiveness of the procedure.Type of Study:Retrospective case analysis.Methods:The study population consists of 19 patients, with an average follow-up of 60 months (minimum, 12; maximum, 128). All patients underwent knee arthroscopy. The 3 standard portals were used; posteromedial and posterolateral portals were added if required. Four patients were affected by localized PVNS and were subject to partial synovectomy with excision of the pathologic tissue. The remaining 15 patients presented a diffuse form of PVNS; 7 of them underwent extended arthroscopic synovectomy and 8 underwent partial synovectomy. The diagnosis was confirmed by synovial biopsy.Results:In the group affected by the localized form of PVNS, the arthroscopic local excision resulted in a complete and persistent regression of the pathology. Among the patients affected by the diffuse form of PVNS, clinical results were better and the recurrence rate was lower in the group treated with extended synovectomy. No relevant complications were encountered. In particular, no cases of infection, stiffness, or neurovascular lesions were seen.Conclusions:Arthroscopic synovectomy is an appropriate treatment for knee PVNS. Extended synovectomy must be performed in all cases of diffuse PVNS.     

Combined partial arthroscopic synovectomy and radiation therapy for diffuse pigmented villonodular synovitis of the knee

We present the results of combined partial arthroscopic synovectomy and low-dose external-beam radiation therapy (RT) in the treatment of diffuse pigmented villonodular synovitis (PVNS) of the knee. Mechanical synovectomy is an effective tool in treating PVNS of the knee, but when used alone it may be insufficient to eliminate all affected tissue. Intra-articular radiation or external-beam radiation may be added to mechanical synovectomy to treat recurrence but is not routinely done at the time of initial synovectomy. Combining intra-articular synovectomy with RT at the initial treatment for PVNS of the knee may reduce the recurrence rate. We present a prospective study of the treatment of 22 patients with clinical, ultrasonic, and histologically confirmed findings of diffuse PVNS of the knee. Characteristic clinical findings included pain, swelling, and erythema. These patients were treated by the Arthroscopic Surgery Group of the Orthopaedic Service at the Hospital “Hermanos Ameijeiras” in Havana, Cuba from 1990 to 1998. The protocol included anterior (patellofemoral, medial, and lateral) arthroscopic synovectomy and postoperative RT with a total dose of 2,600 cGy. This combination therapy was effective in reducing symptoms of pain and edema, and in improving overall function of patients. Nineteen patients (86%) had good or excellent results at an average follow-up of 33 months (range, 26 to 76 months). Three patients had residual stiffness and swelling, 2 of whom also had pain. Three had clinically and ultrasonically confirmed recurrence of disease and were treated with repeat arthroscopic synovectomy without harmful effects from RT. In all of the cases requiring repeat arthroscopic synovectomy, we observed fibrous bands secondary to reorganization of synovial inflamed tissue, meniscal retraction, and microscopic findings of fibrosis and cellular paucity. Partial arthroscopic synovectomy combined with low-dose RT in anti-inflammatory doses produced good results in the treatment of PVNS without significant complications in our patient series. Partial arthroscopic synovectomy of the knee for PVNS may be combined with RT to reduce the risk of disease recurrence. Adjuvant RT should also be considered for patients receiving a radical synovectomy to treat inaccessible or hidden disease sites. Rates of recurrence with combined partial (anterior) synovectomy and RT approach that of complete synovectomy in this series. Combining RT with radical arthroscopic synovectomy might further reduce recurrence rates.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 5 (May-June), 2001: pp 527–531     

Arthroscopic treatment of pigmented villonodular synovitis of the knee.

Pigmented villonodular synovitis (PVNS) is a rare disease, with multiple forms, anatomic sites, and treatment methods having been described. During a 10-year period, 14 patients, 7 male and 7 female, average age 35 years (range, 19 to 64 years) were treated for PVNS with arthroscopic partial or total synovectomy. Average follow-up was 42 months (range, 8 to 83 months). Twelve patients had diffuse and 2 had a localized form. Results were assessed subjectively, clinically, and radiographically, and were rated as excellent, good, fair, or poor. There were no complications and 10 patients (72%) were rated as excellent or good, 2 patients (14%) as fair, and 2 patients (14%) as poor. The recurrence rate was 14% and occurred in the group with diffuse PVNS. Radiographs did not show any bone erosion. The most widely accepted treatment for PVNS is synovectomy, and both open and arthroscopic synovectomy have been advocated as treatment. Advantages of arthroscopic treatment include accurate evaluation of the knee joint, treatment of other pathology, more rapid rehabilitation, decreased risk of joint stiffness, and less pain. In our experience, it appears that arthroscopic synovectomy is an effective method of treatment of this disorder.     

关节镜下滑膜切除术治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎

目的探讨采用关节镜技术治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎（pigmented villonodular synovitis,PVNS）的方法及疗效。方法26例膝关节弥漫型PVNS患者均行关节镜下滑膜全切除术。术前国际膝关节砰分委员会（IKDC）膝关节功能主观评分为（36．8±4,6）分,Lysholm膝关竹功能评分为（31．7±5．6）分？结果术后均获随访,平均38（13～61）个月。1例患者术后22月复发,再次行关节镜下滑膜切除术。IKDC膝关市功能主观评分为（55．6±3.2）分,Lyshohn膝关节功能评分为（88.5±7.2）分,均明显高于术前（P〈0.01）。结论通过不同天节镜入路,成用刨削器结合等离子汽化技术能够完成膝关节弥漫掣PVNS的滑膜彻底切除,术后近期复发率低,且关节镜下手术具有损伤少、恢复快的优点。     

Use of polymethylmethacrylate to treat pigmented villonodular synovitis in the posterior compartment of the knee

Pigmented villonodular synovitis (PVNS) is a benign process that mainly affects the knee joint. There are two types of PVNS, a localised and a diffuse form. Although adjuvant therapies are possible, the treatment consists of arthroscopic or open synovectomy of the affected area. The most common complication is local recurrence. We report the case of a patient with PVNS and osteolysis of the femoral condyle, treated with anterior arthroscopic synovectomy and posterior approach for the treatment of the femoral condyle erosion. The bone erosion was treated with polymethylmethacrylate (PMMA) cement. There are no publications indexed in our knowledge that explain the treatment of PVNS associated with bone erosion by PMMA. Nine years after the procedure, the patient is leading a fully active life with no evidence of active disease.     

Recurrent pigmented villonodular synovitis (PVNS)

AIM: The pigmented vilionodular synovitis (PVNS) is a tumour like disease of unknown origin that often shows recurrence. The pathogenesis is still unknown and therefore the question of the right therapy is not resolved. MATERIAL: With a case report of a patient with recurrence after two arthroscopic synovectomies, PVNS is discussed against the background of the clinical, histological, and radiological features. RESULTS: We performed an open synovectomy and cystic lesions in both condyles of the femur and proximal tibia were filled with homologous and autologous cancellous bone. Three months later the patient had no pain and the bone density in the former cystic lesions was appropriate. DISCUSSION: The pathogenesis is still unknown. Diagnosis often is obtained much too late due to missing specific symptoms. PVNS occurs in local forms as well as in a diffuse growth pattern. Recurrence rates of up to 78% are very high. Besides arthroscopic and open synovectomy, the treatment with radiosynoviorthesis must be considered. Depending on the growth pattern, the tumour masses, and the affected joint, the therapy has to be chosen very carefully and sometimes different forms have to be combined if a recurrence--free result is to be achieved.     

Pigmented villonodular synovitis of the knee: average five-year follow-up of arthroscopic treatment

We have reviewed the results of arthroscopic treatment of pigmented villonodular synovitis (PVNS) with reference to both recurrence and to function. Between 1985 and 1995, a single surgeon treated eight patients. At an average 5-year follow-up, all patients were interviewed and had assessment of Hospital for Special Surgery (HSS) knee score for both the affected and unaffected knees. Also recorded were age, sex, and whether disease was recurrent, localized, or diffuse. Disease recurred in 4 patients, all with diffuse PVNS, and 3 of them required a further arthroscopic synovectomy at a mean of 16 months after the index procedure. All patients had good or excellent functional results. There was no significant difference between HSS knee scores for affected and unaffected knees. Arthroscopic synovectomy is a successful treatment in patients with localized PVNS of the knee and results in a knee that is functionally not different from its unaffected partner.     

Open synovectomy with cryosurgical adjuvant for treatment of diffuse pigmented villonodular synovitis of the knee

Pigmented villonodular synovitis (PVNS) is an uncommon, benign disorder usually affecting the synovial membrane of large joints. The diffuse form of PVNS is extremely difficult to control, and long-term recurrence inevitably results in arthrodesis or arthroplasty. Current treatments include surgical, chemical, and radiation synovectomy, but all have significant failure rates. In hope of obtaining a more complete synovectomy, we used cryosurgery as an adjuvant to open synovectomy in three patients. Two patients presented with multiple failed arthroscopic synovectomies, and one patient presented with arthroscopically unresectable PVNS. The surgical approach involved take down and repair of the anterior meniscal attachments, and direct entry into the posterior space through medial and lateral femoral capsular attachments. Cryosurgical surface spray was used on all non-cartilaginous surfaces. At follow-up of 14, 30, and 31 months, all three patients remained symptom-free and there were no indications of clinical recurrence. There were no obvious complications or morbidity from the cryosurgical procedure and all patients had excellent functional recovery. All patients returned to sports and their jobs without restrictions. In the past, it has been shown that cryosurgery is a safe and effective treatment modality for proliferative joint disease. We propose the use of adjuvant cryosurgery for PVNS patients selected for open synovectomy.     

Pigmented villonodular synovitis of the shoulder associated with massive rotator cuff tear treated by arthroscopic synovectomy and debridement

Pigmented villonodular synovitis (PVNS) is a rare condition. Our purpose is to describe the largest series of patients with shoulder PVNS, massive irreparable rotator cuff tear, and glenohumeral osteoarthritis treated with arthroscopic debridement and synovectomy. We treated 9 patients with PVNS of the shoulder, irreparable rotator cuff tear, and slight glenohumeral arthropathy (group I). Patients underwent arthroscopic synovectomy and debridement. Results [constant score (CS) and subjective shoulder value (SSV)] were compared to those obtained from a control group (group II) of 20 consecutive patients undergoing arthroscopic debridement for irreparable cuff tear associated with hemorrhagic synovitis with no or slight glenohumeral arthropathy. Histologic examination was obtained in all cases to obtain the correct diagnosis. The preoperative shoulder function in group I was reduced with respect to group II. Upon follow-up, CS and SSV were lower in group I. Preoperatively, the differences relating to the CS value and to each item of the score were always statistically significant; instead, at follow-up, significant differences emerged in the CS, ADL, and ROM. At follow-up, significant differences emerged between CS of group I and of group II without glenohumeral arthropathy. Differences using the SSV were always statistically significant. The poor functional outcome of patients affected by PVNS can be attributed to the coexistence of the irreparable cuff tear and to the glenohumeral arthropathy. All patients with PVNS had shoulder osteoarthritis; it cannot be simply attributed to natural history of massive irreparable cuff tears, but to the pigmented villonodular synovitis.