26例膝关节色素沉着绒毛结节性滑膜炎治疗效果分析

  目的  通过分析比较26例膝关节色素沉着绒毛结节性滑膜炎患者经关节镜下滑膜切除治疗前后关节功能变化、关节疼痛改善情况，评价关节镜治疗在膝关节色素沉着绒毛结节性滑膜炎患者中的治疗价值，同时评价联合局部方式治疗对于患者治疗效果的影响。  方法  回顾分析2008年1月—2019年12月于空军军医大学西京医院入院行膝关节镜下滑膜切除手术，术中改变及术后病理明确诊断为膝关节色素沉着绒毛结节性滑膜炎的患者26例，其中15例患者单纯行膝关节镜手术治疗，11例患者术后进行病变关节局部放射治疗。术后患者随访88.6(3~132)个月。分别记录患者关节镜手术治疗前及末次随访时关节疼痛评分(VAS评分)及膝关节功能评分(Lysholm评分)，统计分析关节镜治疗前后VAS评分、Lysholm评分变化。通过患者关节肿痛情况及MRI评估结果判定患者是否复发，并比较单纯关节镜治疗及术后联合局部放射治疗2组间复发有无差异。  结果  26例患者术后均进行随访，术后病理提示均提示符合色素沉着绒毛结节性滑膜炎。26例患者VAS评分由术前的(4.60±0.88)分降低至末次随访时的(1.35±0.82)分(P＜0.001)；Lysholm评分由(41.00±7.45)分升高至(80.27±4.53)分(P＜0.001)。单纯行关节镜治疗组术后复发比例为26.67%，关节镜联合术后局部放疗术后复发比例为9.09%，2组间比较差异无统计学意义(P＞0.05)。  结论  关节镜下滑膜切除治疗能有效减轻膝关节色素沉着绒毛结节性滑膜炎患者的疼痛，改善膝关节功能, 术后联合局部放射治疗，具有更优的治疗效果。 

Analysis of curative effect of 26 cases of pigmented villonodular synovitis of knee joint

  Objective  To analyze and compare the joint function and the improvement of joint pain in 26 patients with knee pigmented villonodular synovitis (PVNS) before and after arthroscopic synovectomy, evaluate the therapeutic value of arthroscopic treatment in patients with PVNS, and evaluate the effect of combined local treatment on the therapeutic effect of patients.  Methods  Twenty-six PVNS of the knee joint patients underwent arthroscopic synovectomy from January 2008 to December 2019 were analyzed retrospectively. Among them, 15 patients were treated with knee arthroscopy alone, and 11 patients were treated with local radiotherapy of diseased joints after operation. All 26 patients were followed up 88.6 (3-132) months. The joint pain score VAS score and knee function score Lysholm score were recorded before arthroscopic treatment and at the last follow-up, and the changes of VAS score and Lysholm score were statistically analyzed by t-test. The recurrence was determined by the joint swelling and pain and MRI evaluation results, and compared between the two groups.  Results  All 26 patients were followed up. The postoperative pathology showed that they were consistent with PVNS. The VAS score decreased from (4.60±0.88) points before surgery to (1.35±0.82) points at the last follow-up (P < 0.001), and Lysholm score increased from (41.00±7.45) points to (80.27±4.53) points (P < 0.001). The recurrence rate was 26.67% in the group receiving arthroscopy alone, and 9.09% in the group receiving arthroscopy combined with postoperative local radiotherapy (P>0.05).  Conclusion  Arthroscopy synoviectomy can relieve the pain and improve the joint function of the PVNS, and postoperative combined with local radiotherapy has a better therapeutic effect.