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。

Surgical Treatment of Diffuse Pigmented Villonodular Synovitis of the Knee

Objective To compare the roles of open synovectomy and arthroscopic synovectomy in the treatment of diffuse pigmented villonodular synovitis(D-PVNS).Methods Forty-seven patients suffered from D-PVNS of knee joint who underwent surgical treatment with complete follow-up data from March 1994 to October 2013 were retrospectively analyzed. All patients were divided into two groups as open synovectomy group(n=17)and arthroscopic synovectomy group(n=30)according to the surgical procedure. Routine radiation therapy was applied in both groups after the surgery. The mean follow-up period was(15.7±16.3)months(range:10-30 month). The range of motion,International Knee Documentation Committee(IKDC)score and Lysholm score before the surgery and at the final follow-up were compared respectively.Results Recurrence was noted in 8 patients(17.0%),among whom 3 were from the open synovectomy group and 5 from the arthroscopic synovectomy group,resulting a recurrence rate of 17.6% and 16.7%,respectively,in these two groups(P＞0.05). The range of motion,IKDC score,and Lysholm score at final follow-up and before the operation were(97.5±14.3)° vs.(69.7±12.6)°,(74.5±6.1) vs. (38.6±5.4)scores,and (77.5±5.8) vs. (42.4±4.6)scores,respectively,in the open synovectomy group,and were(128.6±13.9)° vs.(64.9±13.2)°,(87.4±6.7) vs. (37.2±4.9)scores,and (86.2±6.2) vs. (41.9±5.3)scores,respectively,in the arthroscopic synovectomy group(all P＜0.05). Obviously,the range of motion,IKDC score,and Lysholm score at the final follow-up were significantly superior to the pre-operative findings,and were also significantly better in the arthroscopic synovectomy group than in the open synovectomy group(P＜0.05).Conclusions Open synovetomy and arthroscopic synovetomy have similar recurrent rates in treating D-PVNS of the knee joint,while the latter has better postoperative range of motion and functional scores. Thus,arthroscopic synovectomy is a better option for the surgical treatment of D-PVNS.