Departamento do Aparelho Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Arthroscopy. 2012 Sep;28(9):1271-4. doi: 10.1016/j.arthro.2012.02.007. Epub 2012 May 2.
The objective of this study was to evaluate the effectiveness and long-term outcome of the treatment of patients with diffuse pigmented villonodular synovitis (PVNS) of the knee with subtotal arthroscopic and open synovectomy and subsequent external-beam radiotherapy.
Eight patients diagnosed with diffuse PVNS by clinical and magnetic resonance imaging were treated surgically with subtotal arthroscopic synovectomy and an additional posterior incision for extra-articular lesions, followed by local adjuvant radiotherapy. These patients were followed up for a mean of 8.6 years to monitor remaining lesions and to detect new occurrences of the condition.
None of the patients presented with major postoperative complications or have had radiotherapeutic late effects. In no case was radiographic arthritis progression detected. Three patients exhibited late minor complications (peripatellar pain, articular effusion, and persistent quadricipital muscle atrophy). Only 1 patient (12.5%) presented with recurrence of the disease during the follow-up period.
On the basis of our limited study, subtotal arthroscopic and open synovectomy with subsequent local external-beam radiotherapy had a recurrence rate of 12.5% at 8.6 years of follow-up for the treatment of diffuse PVNS of the knee joint.
Level IV, therapeutic case series.
本研究旨在评估膝关节弥漫性色素绒毛结节性滑膜炎（PVNS）患者行关节镜下和开放性滑膜部分切除术联合术后局部外照射放疗的有效性和长期疗效。
8 例经临床和磁共振成像诊断为弥漫性 PVNS 的患者接受了手术治疗，行关节镜下滑膜部分切除术和额外的后入路关节外病变切除术，随后进行局部辅助放疗。这些患者平均随访 8.6 年，以监测残留病变并发现新的发病情况。
无患者出现重大术后并发症或放射治疗后出现迟发性效应。无一例出现放射影像学关节炎进展。3 例患者出现晚期轻微并发症（髌周疼痛、关节积液和持续股四头肌萎缩）。仅 1 例（12.5%）患者在随访期间出现疾病复发。
根据我们的有限研究，膝关节弥漫性 PVNS 患者行关节镜下和开放性滑膜部分切除术联合术后局部外照射放疗，8.6 年的随访复发率为 12.5%。
IV 级，治疗性病例系列。
