Miszczyk Leszek, Wozniak Grzegorz, Jochymek Bozena, Spindel Jerzy, Wygoda Zbigniew
Zakład Radioterapii, Centrum Onkologii, Instytut im. M. Skłodowskiej-Curie, Oddział w Gliwicach.
Przegl Lek. 2007;64(7-8):450-3.
Chronic knee synovitis with effusion, because of the special role of knee joint is an important therapeutic problem. This leads to searching for new treatment modalities. One of them is radiosynovectomy based on anti-proliferative and anti-inflammatory activity of ionizing radiation. It is made using 90Y mainly (high energy of beta [electrons] radiation [2.2 MeV], large average penetration in soft tissues [3.6 mm] and long physical half-life [2.7 days]).
Analyzed material is comprised of 30 patients (33 treatments) suffering from proliferative synovitis of knee joint treated by radiosynovectomy using intra-articular injection of 6 mCi 90Y. In 20 cases the reason of disease was non-specific reactive arthritis, in 5 rheumatoid arthritis, in 3 villonodular synovitis, in 3 psoriasis and in 2 ulcerative colitis. Symptoms duration varied from 3 to 144 months (mean 43). A knee circumference at the treatment day varied from 33.5 cm to 49 cm (mean 41). The operation was based on knee biopsy, evacuation of exudate and delivery of 6 mCi of colloid 90Y. Follow up ranged up to 14 months (mean 4.4). Patients were examined 2 weeks, 1, 3, 6 and 12 months after treatment. During examination a knee circumference was measured, a knee mobility, temperature and patella floating symptom were examined. Pain in treated region was assessed and amount of exudate was measured.
A knee circumference and exudate amount enlarged during following controls, and compared between the treatment day and the last control did not differ significantly (41 vs. 41.6 cm and 43 vs. 42.5 ml respectively) but number of biopsies decreased. A percentage of patients with impaired knee mobility also did not change (59% vs. 58%). Probably, it was caused by resignation from control examination when symptoms disappeared. A percentage of patients without pain relief decreased from 43.5% 2 weeks after treatment to 20% one year later and a patient percentage with complete pain relief increased from 8.5% to 60%. A patient percentage with increased knee temperature and with floating patella decreased significantly (54 vs. 25% and 83 vs. 48% respectively).
Obtained results do not allow to form univocal conclusions regarding effectiveness of 90Y radiosynovectomy. The decreasing biopsies number, decreasing percentage of patient with increased knee temperature and with floating patella; increased percentage of patients with analgetic effect and with total pain relief show a necessity of renewed evaluation of this treatment modality on the base of bigger patients number and longer and more precise observation.
伴有积液的慢性膝关节滑膜炎，由于膝关节的特殊作用，是一个重要的治疗难题。这促使人们寻找新的治疗方法。其中之一是基于电离辐射的抗增殖和抗炎活性的放射性滑膜切除术。主要使用90Y进行（β[电子]辐射能量高[2.2兆电子伏特]，在软组织中的平均穿透深度大[3.6毫米]，物理半衰期长[2.7天]）。
分析的材料包括30例患者（33次治疗），他们患有膝关节增殖性滑膜炎，通过关节内注射6毫居里90Y进行放射性滑膜切除术治疗。20例患者的病因是非特异性反应性关节炎，5例是类风湿性关节炎，3例是绒毛结节性滑膜炎，3例是银屑病，2例是溃疡性结肠炎。症状持续时间从3个月到144个月不等（平均43个月）。治疗当天膝关节周长从33.5厘米到49厘米不等（平均41厘米）。手术基于膝关节活检、排出渗出液并注入6毫居里的90Y胶体。随访时间长达14个月（平均4.4个月）。在治疗后2周、1个月、3个月、6个月和12个月对患者进行检查。检查期间测量膝关节周长，检查膝关节活动度、温度和髌骨漂浮症状。评估治疗区域的疼痛情况并测量渗出液量。
在后续检查中，膝关节周长和渗出液量有所增加，治疗当天与最后一次检查相比差异不显著（分别为41厘米对41.6厘米和43毫升对42.5毫升），但活检次数减少。膝关节活动受限的患者百分比也没有变化（59%对58%）。这可能是因为症状消失后患者不再接受对照检查。无疼痛缓解的患者百分比从治疗后2周的43.5%降至1年后的20%，完全疼痛缓解的患者百分比从8.5%增至60%。膝关节温度升高和髌骨漂浮的患者百分比显著下降（分别为54%对25%和83%对48%）。
所获得的结果不允许就90Y放射性滑膜切除术的有效性形成明确结论。活检次数减少、膝关节温度升高和髌骨漂浮的患者百分比降低；有镇痛效果和完全疼痛缓解的患者百分比增加，这表明有必要在更大数量的患者基础上，进行更长时间和更精确的观察，重新评估这种治疗方法。
