色素绒毛结节性滑膜炎28例报道

目的探讨色素绒毛结节性滑膜炎(PVS)的临床病理特点、治疗和预后的关系。方法本组PVS28例,男13例,女15例,年龄12～53岁。膝关节15例,手指7例,足背4例,颞颌及骶髂关节各1例,多肢体1例。局限型19例,弥漫型9例。伴外伤史3例,骨破坏4例,恶变2例,半月板破裂1例,滑膜血管瘤1例。均行滑膜切除,早期操练,3例加放疗。28例均经病理证实。结果22例随访2～18年,13例功能良好;9例复发5例功能欠佳,2例截指(趾),2例死亡。放疗3例均复发。结论PVS临床病理均有肿瘤的特征,可恶变和转移,易复发,最佳治疗是彻底的滑膜切除而不是放疗。     

Atypical and bilateral pigmented villonodular synovitis of wrist in an adolescent patient: case report and literature review

Background: Pigmented villonodular synovitis (PVNS) is a rare benign proliferative disorder of the synovium. It rarely occurs in adolescents, particularly in immature patients with bilateral manifestation. Case presentation: We present a case of atypical and bilateral PVNS of wrist in a 14-year-old boy. Initially, the patient presented with left wrist pain and swelling without the history of trauma. Physical examination revealed an obvious lesion in the dorsal part of left wrist. Radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) showed multiple abnormal signal shadows and arthroedema in the left wrist. Arthroscopy operation was performed, and histologic examination suggested the diagnosis of PVNS. Only 10 months later, the patient presented with the similar symptoms and signs in the right wrist. But MIR and histologic examination were atypical. In this article, we also review and summarize 26 studies on 30 adolescent patients with PVNS. Conclusions: This study provides an example of atypical and bilateral PVNS in adolescents.     

单纯膝关节镜手术与联合术后放疗治疗弥漫性色素沉着绒毛结节性滑膜炎的临床研究

目的 探讨单纯膝关节镜手术与联合术后放疗治疗膝关节弥漫性色素绒毛结节性滑膜炎(DPVNS)的临床疗效和安全性。方法 武汉市中心医院及北京军区总医院于2009年1月至2014年1月收治的30例膝关节DPVNS患者,平均病程为35.6个月(4~121个月)。按患者治疗意愿分为手术联合术后放射治疗(联合治疗)组16例,单纯手术组14例。联合治疗组行关节镜下滑膜切除联合术后局部放射治疗,总剂量40 Gy,每次2 Gy。所有患者治疗后平均随访时间38.7个月(12~72个月),比较两组术后复发率、KSS临床评分和功能评分。结果 联合治疗组优良率(14/16)明显高于单纯手术组(11/14)(χ²=9.87,P<0.05),且复发率(1/16)明显低于单纯手术组(3/14)(χ²=1.83,P<0.05),治疗后KSS临床评分和功能评分改善明显优于单纯手术组(χ²=15.00、15.78,P<0.05)。放疗的不良反应为白细胞下降、肢体浮肿、皮肤出现色素沉着,联合治疗组患者均能较好地耐受。结论 关节镜术后放疗治疗膝关节DPVNS是一种安全有效的治疗手段,值得临床推广应用。     

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。     

膝关节弥漫型色素沉着绒毛结节性滑膜炎的手术治疗

目的比较开放性滑膜切除术与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(PVNS)的治疗效果。方法回顾性分析北京协和医院1994年3月至2013年10月手术治疗的有完整随访资料的膝关节弥漫型PVNS患者47例,所有患者根据手术方式分为开放性手术组和关节镜手术组,其中开放性手术组17例(接受开放性滑膜切除术)、关节镜手术组30例(接受关节镜下滑膜切除术),两组术后常规放疗。术后平均随访时间(15.7±16.3)个月(10~30个月),记录所有患者手术前及末次随访时的关节活动度、国际膝关节评分委员会(IKDC)评分和Lysholm评分以及两组患者复发率,比较两组患者治疗效果和复发率。结果随访期间共8例患者复发,复发率17.0%;其中开放性手术组3例复发,复发率17.6%;关节镜手术组5例复发,复发率16.7%;两组复发率比较差异无统计学意义。开放性手术组末次随访和术前的膝关节活动度、IKDC评分和Lysholm评分分别为(97.5±14.3)°和(69.7±12.6)°,(74.5±6.1)和(38.6±5.4)分,(77.5±5.8)和(42.4±4.6)分,关节镜手术组末次随访和术前的膝关节活动度、IKDC评分以及Lysholm评分分别为(128.6±13.9)°和(64.9±13.2)°,(87.4±6.7)和(37.2±4.9)分,(86.2±6.2)和(41.9±5.3)分,末次随访均较术前显著增加(P均<0.05),关节镜手术组末次随访的关节活动度、IKDC评分和Lysholm评分均较开放性手术组显著增加,差异有统计学意义(P均<0.05)。结论开放性滑膜切除术与关节镜下滑膜切除术治疗弥漫型PVNS的复发率相当,但后者膝关节活动度、膝关节功能评分显著高于前者,所以关节镜治疗膝关节弥漫型PVNS是一个较好的选择。     

膝关节液中白细胞介素1β、白细胞介素6、白细胞介素8及肿瘤坏死因子α表达与组织病理学的相关性研究

目的 研究患者膝关节液中4种炎性因子（IL-1β、IL-6、IL-8、TNF-α）的表达水平及其与相应组织病理学的关系。方法 在关节外科手术前,抽取31例患者的膝关节液,采用流式细胞小球微阵列术方法检测膝关节液中IL-1β、IL-6、IL-8、TNF-α表达水平,同时分析其滑膜组织病理学特征。所有患者按照组织病理学诊断分为骨关节炎（OA）、假体置换后翻修（RPR）、色素性绒毛结节性滑膜炎（PVNS）和类风湿关节炎（RA）,另根据滑膜组织内含铁血黄素情况分为含铁血黄素沉着组和非含铁血黄素沉着组,根据滑膜组织内炎细胞浸润情况分为炎细胞浸润组和非炎细胞浸润组,按照膝关节液颜色分为血性膝关节液组和非血性膝关节液组。结果 31例患者中男9例、女22例,平均年龄（63.60±9.19）岁,左膝12例、右膝19例,OA 18例,RPR 5例,PVNS 5例,RA 3例。OA组患者膝关节液中4种炎性因子含量均最低,与其他3组比较差异均有统计学意义（P均<0.05）;RA组膝关节液中IL-1β水平高于RPR组和PVNS组,差异均有统计学意义（P均<0.05）,但后两组间差异无统计学意义（P>0.05）;RA组膝关节液中IL-6水平高于PVNS组,但低于RPR组,3组间差异均有统计学意义（P均<0.05）;RA组膝关节液中IL-8水平高于RPR组和PVNS组,3组间差异均有统计学意义（P均<0.05）;RA组膝关节液中TNF-α水平高于RPR组和PVNS组,3组间差异均有统计学意义（P均<0.05）。炎细胞浸润组（11例）膝关节液中4种炎性因子水平均高于非炎细胞浸润组（20例）,差异均有统计学意义（P均<0.05）。含铁血黄素沉着组（7例）膝关节液中4种炎性因子水平均高于非含铁血黄素沉着组（24例）,差异均有统计学意义（P均<0.05）。血性膝关节液组（4例）与非血性膝关节液组（27例）相比,IL-1β差异有统计学意义（P<0.05）,但IL-6、IL-8及TNF-α差异均无统计学意义（P均>0.05）。结论 IL-1β、IL-6、IL-8及TNF-α在多种关节疾病中有表达,且与其病理学特征等有相关性。这一发现有助于进一步研究某些关节疾病的发病和发展,可为临床诊断、治疗和基础研究提供参考。     

Multi‐lineage differentiation and angiogenesis potentials of pigmented villonodular synovitis derived mesenchymal stem cells ‐ pathological implication

Pigmented villonodular synovitis (PVNS) is a benign tissue proliferation characterized by its hyper‐vascularity within the lesion. The true etiology and cell source of this disease entity still remain unclear. Mesenchymal stem cells (MSCs) exist in various tissues of human body. However, it has not been clarified whether MSCs could be isolated from tissue of PVNS. Here, we isolated MSCs from PVNS (PVNS‐SCs), and by comparing to the MSCs from normal synovium (Syn‐SCs) of the same individual, we investigated whether PVNS‐SCs differed in the capacity for multi‐differentiation and inducing angiogenesis. We first demonstrated that PVNS‐SCs existed in the lesion of PVNS of three individuals. Moreover, we showed PVNS‐SCs had better osteogenic differentiation potential than Syn‐SCs, whereas Syn‐SCs had better capacity for adipogenic and chondrogenic differentiation. By genome–wide analysis of gene expression profile using a complementary DNA microarray and comparing to Syn‐SCs, we identified in PVNS‐SCs a distinct gene expression profile characterized by up‐regulation of genes involved in angiogenesis. In vitro and in vivo studies further confirmed that PVNS‐SCs had better capacities for promoting angiogenesis. In summary, the identification of PVNS‐SCs in PVNS tissue and their distinct angiogenic potential may help elucidate the underlying etiology of this disease. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:395–403, 2016.     

Long-term functional outcomes of diffuse pigmented villonodular synovitis of knee: The role of adjuvant radiotherapy

Diffuse pigmented villonodular synovitis (PVNS) of knee is a rare benign disease that has a destructive clinical course. Synovectomy and adjuvant radiotherapy (RT) have been reported as treatment options but literatures reporting functional outcomes were sparse. This study aimed to evaluate the long-term functional outcomes and disease control among treatment modalities through the 22 years of experience.A single-center database was searched for patients who received synovectomy of knee with the pathologic diagnosis of PVNS. General data, treatment modalities, and recurrent status were retrospectively collected from medical records. Functional outcomes were evaluated by Western Ontario and McMaster Universities Osteoarthritis Index through phone interviews by an independent orthopedist.From January 1995 to December 2017, 24 patients with diffuse PVNS of knee were identified, including 19 receiving open synovectomy (OP) and 5 undergoing arthroscopic surgery. Adjuvant RT was performed on 14 patients with a median dose of 35 Gy (range 20–40 Gy). After median follow up of 6 years, recurrences were recorded in 10 cases. The recurrence rate was significantly lower in the OP + RT group than the OP group (8.3% vs 57.1%, P = .038). Among those with preserved knee joints, there was no significant difference in the Western Ontario and McMaster Universities Osteoarthritis Index score and stiffness score between patients in the OP + RT and OP groups.For patients with diffuse PVNS of knee, the addition of moderate-dose adjuvant RT following OP provided excellent local control while maintaining good joint function with limited treatment-related morbidity. Our study emphasized the importance of moderate dose RT in diffuse PVNS of knee joint.