Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan.
J Rheumatol. 2012 Feb;39(2):345-51. doi: 10.3899/jrheum.110730. Epub 2011 Dec 15.
In pigmented villonodular synovitis (PVNS), some cases recur and progress to osteochondral destruction. The aim of our study was to clarify the occurrence of osteochondral destruction according to the location of PVNS during the clinical course.
Seventy-two patients with PVNS (43 female, 29 male) with a mean age of 40 years (range 3-87 yrs) had been referred to our institutions. Factors influencing the occurrence of osteochondral destruction were investigated.
Mean followup was 60 months (range 12-190 mo). Adjacent bone change occurred in 24 (42%) of 57 patients, who were evaluated at the time of the first consultation. Eight (89%) of 9 patients with hip lesions initially had bone lesions, significantly more frequently than those with other lesions (p = 0.038). Duration of symptoms was significantly correlated with the occurrence of bone lesions in diffuse knee lesions (p = 0.005). During followup, patients with location in the knee had a significantly higher incidence of osteoarthritic change (73%) compared to those with foot and ankle involvement (p = 0.027). Re-operation was more frequently required for knee lesions due to the high recurrence rate (32%). Patients who required re-operation had significantly more marked osteoarthritic change in knees (p = 0.001) during followup than those who did not.
For PVNS arising in knees, repeated recurrences followed by re-operation resulted in the progression of osteoarthritic change. PVNS arising in hips, feet, and ankles developed bone lesions initially, probably due to the limited volume of these joints. The indications for re-operation for recurrent knee lesions require careful consideration regarding progression of osteoarthritic change.
在色素绒毛结节性滑膜炎（PVNS）中，有些病例会复发并进展为骨软骨破坏。本研究旨在根据 PVNS 在临床过程中的位置，明确骨软骨破坏的发生情况。
72 例 PVNS 患者（43 例女性，29 例男性），平均年龄 40 岁（范围 3-87 岁），曾被转诊至我们的机构。研究了影响骨软骨破坏发生的因素。
平均随访时间为 60 个月（范围 12-190 个月）。在首次就诊时，对 57 例可评估患者中的 24 例（42%）出现了邻近骨改变。9 例髋关节病变患者中，有 8 例（89%）最初存在骨病变，显著高于其他病变患者（p=0.038）。弥漫性膝关节病变的症状持续时间与骨病变的发生显著相关（p=0.005）。在随访期间，膝关节病变患者发生骨关节炎改变的发生率明显高于足部和踝关节病变患者（p=0.027）。由于复发率高（32%），膝关节病变患者更需要再次手术。在随访期间，需要再次手术的患者膝关节骨关节炎改变明显更严重（p=0.001）。
膝关节 PVNS 反复发作并再次手术导致骨关节炎改变进展。髋关节、足部和踝关节的 PVNS 最初出现骨病变，可能是由于这些关节的容积有限。对于复发性膝关节病变的再次手术适应证，需要仔细考虑骨关节炎改变的进展情况。
