Kubat Ozren, Mahnik Alan, Smoljanović Tomislav, Bojanić Ivan
University of Zagreb, Zagreb University Hospital Center, Department of Orthopaedic Surgery, Zagreb, Croatia.
Coll Antropol. 2010 Dec;34(4):1467-72.
Pigmented villonodular synovitis (PVNS) is a rare proliferative synovial disorder of uncertain etiology. Two forms of this disorder, a localized (LPVNS) and diffuse (DPVNS) form, are well differentiated. The therapy of choice for LPVNS is arthroscopic partial synovectomy with excision of the lesion. Total synovectomy, whether done arthroscopically or through an open arthrotomy, is the recommended treatment for DPVNS. During an eight-year period 13 patients, six male and seven female, average age 28 years (range, 16 to 60 years) were treated for PVNS of the knee with arthroscopic synovectomy. Average follow-up was 84 months (range, 28 to 127 months). Four patients were affected by localized PVNS and were subjected to partial arthroscopic synovectomy (two to three portals) with a complete lesion excision. The remaining nine patients presented with the diffuse form of PVNS and all of them underwent total arthroscopic synovectomy (five portals). The diagnosis was confirmed by synovial biopsy. Each patient was evaluated before treatment and at final follow-up. Results were assessed clinically, radiographically and subjectively and were rated as excellent, good, fair, or poor. No complications or recurrences were noted in the LPVNS group, and all four patients were rated as excellent. In the DPVNS group, eight patients were rated as excellent and one patient was rated as fair and it was the patient who suffered the only recurrence in our case series. No relevant complications were encountered. No cases of infection, joint stiffness or neurovascular lesions were seen. Arthroscopy has become the golden standard in treatment of LPVNS, and can undoubtedly give results that are as good as with open synovectomy when treating DPVNS, if performed by an experienced arthroscopic surgeon.
色素沉着绒毛结节性滑膜炎（PVNS）是一种病因不明的罕见的增殖性滑膜疾病。该疾病有两种形式，即局限性（LPVNS）和弥漫性（DPVNS），二者有明显区别。LPVNS的首选治疗方法是关节镜下部分滑膜切除术并切除病变。无论是通过关节镜还是开放性关节切开术进行全滑膜切除术，都是DPVNS的推荐治疗方法。在八年期间，13例患者（6例男性，7例女性，平均年龄28岁，范围16至60岁）接受了关节镜下滑膜切除术治疗膝关节PVNS。平均随访时间为84个月（范围28至127个月）。4例患者患有局限性PVNS，接受了关节镜下部分滑膜切除术（两到三个切口）并完全切除病变。其余9例患者表现为弥漫性PVNS，均接受了关节镜下全滑膜切除术（五个切口）。通过滑膜活检确诊。对每位患者在治疗前和最终随访时进行评估。结果通过临床、影像学和主观评估，并分为优、良、中、差。LPVNS组未发现并发症或复发，所有4例患者均评为优。在DPVNS组中，8例患者评为优，1例患者评为中，该患者是我们病例系列中唯一复发的患者。未遇到相关并发症。未发现感染、关节僵硬或神经血管损伤病例。关节镜检查已成为LPVNS治疗的金标准，如果由经验丰富的关节镜外科医生进行，在治疗DPVNS时无疑可以取得与开放性滑膜切除术同样好的效果。
