Blanco C E, Leon H O, Guthrie T B
Orthopaedic Division, Hospital Hermanos Ameijeiras, Havana, Cuba.
Arthroscopy. 2001 May;17(5):527-31. doi: 10.1053/jars.2001.24068.
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.
我们展示了关节镜下部分滑膜切除术联合低剂量外照射放疗（RT）治疗膝关节弥漫性色素沉着绒毛结节性滑膜炎（PVNS）的结果。机械性滑膜切除术是治疗膝关节PVNS的有效手段，但单独使用时可能不足以清除所有受累组织。可在机械性滑膜切除术中加用关节内放疗或外照射放疗来治疗复发情况，但在初次滑膜切除术时并非常规进行。在膝关节PVNS的初始治疗中，将关节镜下滑膜切除术与RT联合应用可能会降低复发率。我们对22例经临床、超声及组织学确诊为膝关节弥漫性PVNS的患者进行了一项前瞻性治疗研究。典型的临床症状包括疼痛、肿胀和红斑。这些患者于1990年至1998年在古巴哈瓦那“阿梅耶拉斯兄弟”医院骨科的关节镜手术组接受治疗。治疗方案包括前侧（髌股关节、内侧和外侧）关节镜下滑膜切除术及术后RT，总剂量为2600 cGy。这种联合治疗在减轻疼痛和水肿症状以及改善患者整体功能方面有效。19例患者（86%）在平均33个月（范围为26至76个月）的随访中获得了良好或极佳的效果。3例患者有残留的僵硬和肿胀，其中2例也有疼痛。3例患者经临床和超声证实疾病复发，并接受了再次关节镜下滑膜切除术，未出现RT的有害影响。在所有需要再次关节镜下滑膜切除术的病例中，我们观察到滑膜炎症组织重新组织形成的纤维带、半月板退缩以及纤维化和细胞稀少的微观表现。在我们的患者系列中，部分关节镜下滑膜切除术联合抗炎剂量的低剂量RT在治疗PVNS方面取得了良好效果，且无明显并发症。膝关节PVNS的部分关节镜下滑膜切除术可与RT联合应用以降低疾病复发风险。对于接受根治性滑膜切除术以治疗难以触及或隐匿的疾病部位的患者，也应考虑辅助RT。在本系列中，部分（前侧）滑膜切除术与RT联合应用的复发率与完全滑膜切除术的复发率相当。将RT与根治性关节镜下滑膜切除术联合应用可能会进一步降低复发率。
