关节镜滑膜切除术联合放射治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎

目的观察关节镜下滑膜切除术联合术后放射治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的疗效。方法26例膝关节弥漫型色素沉着绒毛结节性滑膜炎患者，行关节镜下滑膜切除术，同时6例伴有半月板损伤患者行半月板部分切除术，1例关节僵硬患者行关节松解术，1例软骨剥脱患者行微骨折术。手术后4周关节外放射治疗，采用直线型加速器6my—X线，照射范围包括患膝关节及手术切口上下缘3cm，每次2Gv，每周5次，总剂量30Gy。术后定期随访并进行Lysholm膝关节功能评分，评分结果进行统计学分析。结果所有患者均获得随访，随访时间12—40个月，平均29．5个月，术后未见复发及放射性治疗并发症，Lysholm评分术前43．28-4-4．1分，术后6个月85．73±3．4分，术后12个月94．89±5．1分，差别有统计学意义。结论关节镜下滑膜切除术联合术后放射治疗是治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎、减少术后复发的有效方法。

Arthroscopic synovectomy combined with radiotherapy in the treatment of diffuse pigmented villonodular synovitis of the knee

Objective To observe the therapeutic effect of arthroscopic synovectomy combined with radiotherapy in the treatment of diffuse pigmented villonodular synovitis of the knee. Methods 26 cases with diffuse pigmented villonodular synovitis of the knee were treated with arthroscopic synovectomy. Meanwhile 6 cases with menisci injury were given menisci partial excision, 1 case with anchylosis was given arthrolysis, and 1 case with articular cartilage denudation was given microfracture technique. Radiotherapy began 4 weeks postoperatively by using 6-mv X ray. The exposure range included the knee and the upper and lower margin to the operative incision 3cm. 2 Gy was applied per time and 5 times per week with a total dose of 30Gy. Regular followed-up was performed and the results measured with Lysholm mark was analyzed statistically. Results All the cases were followed up from 12 to 40 months with an average of 29.5 months. No recurrence and radiotherapy complication was found. The Lysholm score preoperative was 43.28：t：4.1, 6 months postoperative was 85.734-3.4 and 12 months postoperative was 94.89~5.1. Statistical differences existed. Conclusions Arthroscopic synovectomy combined with radiotherapy is an effective method for diffuse pigmented villonodular synovitis of the knee. Meanwhile, it can decrease the recurrence rate significantly.