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色素沉着绒毛结节性滑膜炎和腱鞘巨细胞瘤

[Pigmented villo-nodular synovitis and teno-synovial giant-cell tumors]].

作者信息

Bruns J, Yazigee O, Habermann C R

机构信息

Diakonie-Klinikum Hamburg, Krankenhaus Alten Eichen, Schwerpunkt orthopädische Chirurgie des Bewegungsapparates, Hamburg.

出版信息

Z Orthop Unfall. 2008 Sep-Oct;146(5):663-75; quiz 676-80. doi: 10.1055/s-2008-1038724. Epub 2008 Oct 23.

Abstract

Pigmented villo-nodular synovitis (PVS) and teno-synovial giant-cell tumors (TSGCT) are rare diseases of joints, tendon-sheaths and other synovial structures. Regarding PVS the knee joint is the most often involved joint and TSGCT are mostly located in the tendon-sheaths of fingers. Both diseases mostly occur in adults but are also observed in children. Symptoms of both diseases are non-specific. Optimal diagnosis includes an X-ray of the involved structure and a MRI. For PVS optimal therapy is a complete synovectomy, whereas, in TSGCT tumors resection of the tumor itself within marginal margins is sufficient. Because of the high rate of recurrence (up to 50 %) in cases suffering from PVS adjuvant therapeutical strategies such as postoperative radiation or radio-synoviorthesis are recommended. Although there are no significant analyses confirming the effect of an adjuvant therapy on the rate of recurrence scientifically at least there is a tendency that these strategies may reduce the rate of recurrence. Malignant dedifferentiation is rarely seen. The prognosis of the mostly benign disease depends on the extent of the disease, the involved structure, additional bony involvement and still existing degenerative changes. In TSGCT no severe sequelae are known. In contrast, PVS in the hip regularly is followed by a secondary osteoarthrosis, in other joints degenerative changes are depending on the still existing changes at the date of diagnosis. Data on the long-term prognosis are rare and only analysed retrospectively.

摘要

色素沉着绒毛结节性滑膜炎(PVS)和腱鞘巨细胞瘤(TSGCT)是关节、腱鞘及其他滑膜结构的罕见疾病。关于PVS,膝关节是最常受累的关节,而TSGCT大多位于手指的腱鞘。这两种疾病大多发生于成年人,但儿童中也有观察到。两种疾病的症状均不具有特异性。最佳诊断包括对受累结构进行X线检查和MRI检查。对于PVS,最佳治疗方法是彻底的滑膜切除术,而对于TSGCT,在肿瘤边缘进行肿瘤切除即可。由于PVS患者的复发率较高(高达50%),建议采用辅助治疗策略,如术后放疗或放射性滑膜切除术。尽管尚无科学分析证实辅助治疗对复发率的影响,但至少有趋势表明这些策略可能降低复发率。恶性去分化很少见。这种大多为良性疾病的预后取决于疾病的范围、受累结构、是否存在额外的骨质受累以及现存的退行性改变。在TSGCT中,尚无严重后遗症的报道。相比之下,髋关节的PVS常继发骨关节炎,其他关节的退行性改变取决于诊断时现存的改变。关于长期预后的数据很少,且仅进行了回顾性分析。

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