Kramer Dennis E, Frassica Frank J, Frassica Deborah A, Cosgarea Andrew J
Childrens Hospital Boston, Department of Orthopaedic Surgery, 300 Longwood Ave, Boston, MA 02115, USA.
J Knee Surg. 2009 Jul;22(3):243-54. doi: 10.1055/s-0030-1247756.
Pigmented villonodular synovitis (PVNS) of the knee is a benign but locally aggressive disease of synovial proliferation that occurs in localized nodular and diffuse villous growth patterns. Although inflammatory and neoplastic causes have been hypothesized, etiology remains unknown. Presenting as unilateral knee pain and swelling, PVNS mimics other knee ailments. Radiographs are often unremarkable, whereas magnetic resonance imaging may show characteristic intra-articular masses with signal dropout on T2-weighted sequences. Pigmented villonodular synovitis is surgically treated with open or arthroscopic total or partial synovectomy. High recurrence rates are associated with all treatments of diffuse PVNS. Complications of open synovectomy include arthrofibrosis and wound breakdown. Total arthroscopic synovectomy is technically demanding but can be advantageous. Transcondylar notch views, accessory posterior portals, and the posterior transseptal portal maximize arthroscopic access to the posterior knee. Intra-articular radioisotope injection and external beam radiation may be beneficial adjuvant therapy for extensive diffuse and recurrent PVNS of the knee.
膝关节色素沉着绒毛结节性滑膜炎（PVNS）是一种良性但具有局部侵袭性的滑膜增生性疾病，以局限性结节状和弥漫性绒毛状生长模式出现。尽管有炎症和肿瘤性病因的假说，但病因仍不清楚。PVNS表现为单侧膝关节疼痛和肿胀，易与其他膝关节疾病混淆。X线片通常无明显异常，而磁共振成像可能显示特征性的关节内肿块，在T2加权序列上有信号缺失。色素沉着绒毛结节性滑膜炎通过开放或关节镜下全滑膜或部分滑膜切除术进行手术治疗。弥漫性PVNS的所有治疗方法都有较高的复发率。开放滑膜切除术的并发症包括关节纤维性强直和伤口裂开。全关节镜滑膜切除术技术要求高，但可能具有优势。髁间切迹视图、辅助后外侧入路和后内侧横隔入路可最大限度地通过关节镜进入膝关节后方。关节内放射性同位素注射和外照射可能是膝关节广泛弥漫性和复发性PVNS的有益辅助治疗方法。
