Akinci Orhan, Akalin Yavuz, İncesu Mustafa, Eren Ahmet
Department of Orthopedics and Traumatology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey.
Acta Orthop Traumatol Turc. 2011;45(3):149-55. doi: 10.3944/AOTT.2011.2442.
The aim of this study was to evaluate the long-term results of total synovectomy in pigmented villonodular synovitis of the knee (PVNS).
Open total synovectomy was performed for 19 patients (9 men, 10 women; mean age: 42.8 years) with PVNS. Of these patients, 15 had diffuse and 4 localized PVNS. The patients were followed for an average of 80.2 months and the average time between the onset of complaints and surgery was 23 months. In 4 patients, PVNS was identified during total knee replacement (TKR) performed due to gonarthrosis. Radiotherapy was performed as an adjuvant treatment in one patient with recurrence. Puncture was performed in 11 patients due to effusion and 8 to 70 cc of fluid was aspirated. Diagnosis was made during the exposure for TKR in 4 patients, by a biopsy in 2 and based on joint puncture and MRI findings in the rest.
Recurrence occurred in 5 patients. A second total synovectomy was performed in 4 patients. Radiotherapy was used for the remaining one patient. Two patients were operated three times. During the follow-up, TKR was performed in 7 of the 19 patients. None of the patients developed infection and hemarthrosis requiring puncture nor required amputation or arthrodesis. Three patients had a postoperative knee joint stiffness of 10 to 25 degrees. The patients were evaluated according to the Knee Society Score and 8 (42.2%) had perfect, 9 (47.3%) good and 2 (10.5%) bad results.
PVNS is a disease with a high risk of recurrence. No individual or combined treatment method can offer a definitive solution. Open or arthroscopic radical synovectomy is still considered as the gold standard. If necessary, adjuvant intraarticular or extraarticular radiotherapy can be added to the treatment.
本研究旨在评估膝关节色素沉着绒毛结节性滑膜炎（PVNS）全滑膜切除术的长期效果。
对19例PVNS患者（9例男性，10例女性；平均年龄：42.8岁）实施开放性全滑膜切除术。其中，15例为弥漫性PVNS，4例为局限性PVNS。患者平均随访80.2个月，主诉出现至手术的平均时间为23个月。4例患者在因膝关节病行全膝关节置换（TKR）时确诊为PVNS。1例复发患者接受了辅助放疗。11例患者因积液接受穿刺，抽出8至70毫升液体。4例患者在TKR手术暴露时确诊，2例通过活检确诊，其余患者根据关节穿刺和MRI检查结果确诊。
5例患者复发。4例患者接受了二次全滑膜切除术。其余1例患者接受了放疗。2例患者接受了三次手术。随访期间，19例患者中有7例行TKR。所有患者均未发生需要穿刺的感染和关节积血，也未进行截肢或关节融合术。3例患者术后膝关节僵硬10至25度。根据膝关节协会评分对患者进行评估，8例（42.2%）结果完美，9例（47.3%）结果良好，2例（10.5%）结果较差。
PVNS是一种复发风险较高的疾病。没有单一或联合治疗方法能提供确定性解决方案。开放性或关节镜下根治性滑膜切除术仍被视为金标准。必要时，可在治疗中添加辅助性关节内或关节外放疗。
