膝关节弥漫性色素沉着绒毛结节性滑膜炎行关节镜下与切开滑膜切除术联合治疗是否能降低复发率？
Does combined open and arthroscopic synovectomy for diffuse PVNS of the knee improve recurrence rates?
机构信息
Division of Orthopedic Oncology, Department of Orthopedic Surgery, The University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
出版信息
Clin Orthop Relat Res. 2013 Mar;471(3):883-90. doi: 10.1007/s11999-012-2589-8.
BACKGROUND
Diffuse-type pigmented villonodular synovitis (PVNS) has a high local recurrence rate and as such can lead to erosive destruction of the involved joint. Multiple surgical modalities exist, but it is unknown which technique best minimizes local recurrence and surgical morbidity.
QUESTIONS/PURPOSES: We compared recurrence rates, arthritis progression, and complications between arthroscopic and open modalities for diffuse PVNS of the knee.
METHODS
We retrospectively identified 103 patients with PVNS treated between 1993 and 2011. Of these, 48 had diffuse-type PVNS of the knee treated by all-arthroscopic, open posterior with arthroscopic anterior, or open anterior and open posterior synovectomy. We recorded patient demographics, treatment profiles, recurrence rates, and arthritic progression. Minimum followup was 3 months (median, 40 months; range, 3-187 months).
RESULTS
Recurrence rates were lower in the open/arthroscopic group compared with the arthroscopic or open/open groups: 9% versus 62% versus 64%, respectively. Arthritic progression occurred in 17% of the total study group with 8% going onto total knee arthroplasty within the followup period. We detected no difference between groups with regard to arthritic progression or progression to arthroplasty. The most common complication was hemarthrosis, which we drained in three patients (6% of the total study group), but there were no detectable differences between groups.
CONCLUSION
Open posterior with arthroscopic anterior synovectomy is a viable, comprehensive approach to diffuse PVNS of the knee and provides both low recurrence rates and a low postoperative complication profile. Greater numbers of recurrences may be partially explained in the arthroscopic group by technical challenges associated with posterior arthroscopic synovectomy and in the open/open group by selection bias toward more aggressive disease.
LEVEL OF EVIDENCE
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
弥漫型色素绒毛结节性滑膜炎（PVNS）具有较高的局部复发率，因此可能导致受累关节的侵蚀性破坏。目前存在多种手术方式，但尚不清楚哪种技术能最大限度地降低局部复发率和手术并发症。
问题/目的：我们比较了膝关节弥漫性 PVNS 关节镜和开放手术方式的复发率、关节炎进展和并发症。
方法
我们回顾性地确定了 1993 年至 2011 年间接受治疗的 103 例 PVNS 患者。其中，48 例膝关节弥漫型 PVNS 患者接受了全关节镜、开放后联合关节镜前、或开放前联合开放后滑膜切除术。我们记录了患者的人口统计学资料、治疗方案、复发率和关节炎进展情况。最短随访时间为 3 个月（中位数，40 个月；范围，3-187 个月）。
结果
开放/关节镜组的复发率低于关节镜组或开放/开放组：9%比 62%比 64%。在整个研究组中，17%的患者出现关节炎进展，在随访期间有 8%的患者需要进行全膝关节置换术。我们未发现各组在关节炎进展或进展为关节炎方面存在差异。最常见的并发症是关节积血，我们在 3 例患者（占总研究组的 6%）中进行了引流，但各组之间没有明显差异。
结论
开放后联合关节镜前滑膜切除术是治疗膝关节弥漫性 PVNS 的一种可行的、全面的方法，既能降低复发率，又能降低术后并发症发生率。关节镜组中复发率较高可能部分归因于后关节镜下滑膜切除术的技术挑战，开放/开放组中复发率较高可能部分归因于更具侵袭性疾病的选择偏倚。
证据水平
III 级，治疗研究。有关作者完整的证据水平描述，请参见指南。
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