Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France; Université de Versailles Saint-Quentin-en-Yvelines, nité de Formation et de Recherche des Sciences de la Santé, Versailles, France.
Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France; Institut de l'Appareil Locomoteur Nollet, Paris, France; Clinique du Sport Paris V, Paris, France.
Arthroscopy. 2014 Oct;30(10):1327-41. doi: 10.1016/j.arthro.2014.04.101. Epub 2014 Jul 4.
We aimed to determine the rate of local recurrence, the rate of postoperative complications, and the functional outcome at final follow-up of surgical and nonsurgical treatment approaches for pigmented villonodular synovitis (PVNS) of the knee.
Medline, Embase, and the Cochrane Library were systematically searched for studies that reported the results of treatment for any type of PVNS between January 1, 1950, and August 1, 2013. Two authors extracted the data independently using predefined data fields including study quality indicators.
Sixty studies (1,019 patients) met the inclusion criteria. Thirty-five presented data on the treatment of localized pigmented villonodular synovitis (LPVNS), 40 on diffuse pigmented villonodular synovitis (DPVNS), 1 on extra-articular LPVNS, and 7 on DPVNS with extra-articular involvement. Many therapeutic options were reported. Depending on these options, DPVNS recurred in 8% to 70% of the series and LPVNS recurred in 0% to 8% of the series. For LPVNS, the 2 most-reported options were open localized synovectomy and arthroscopic local synovectomy. Between these 2 courses of treatment, no difference was found in terms of local recurrence (8.7% for open synovectomy and 6.9% for arthroscopic synovectomy) and postoperative complications (<1% for open synovectomy and 0% for arthroscopic synovectomy). For DPVNS, the 2 most-reported options were open total synovectomy and arthroscopic total synovectomy. Between these 2 courses of treatment, no difference was found in terms of local recurrence (22.6% for open synovectomy and 16.1% for arthroscopic synovectomy). However, we found a lower rate of reported complications between open synovectomy (19.3%) and arthroscopic synovectomy (0%). Internal irradiation or external beam radiation as an adjuvant treatment to surgical synovectomy seemed to decrease the rate of local recurrence in DPVNS cases with a high risk of recurrence. Finally, we found a great heterogeneity in the way the functional results were reported, and no valid conclusion could be made based on the data we extracted.
We found no difference in local recurrence rates after open or arthroscopic surgery for either LPVNS or DPVNS. However, a lower rate of postoperative complications was reported after arthroscopic surgery for DPVNS.
Level IV, systematic review of Level IV therapeutic studies.
我们旨在确定膝关节色素绒毛结节性滑膜炎（PVNS）手术和非手术治疗方法的局部复发率、术后并发症发生率和最终随访时的功能结果。
系统检索了 Medline、Embase 和 Cochrane 图书馆，以获取 1950 年 1 月 1 日至 2013 年 8 月 1 日期间报道任何类型 PVNS 治疗结果的研究。两位作者使用预定义的数据字段独立提取数据，包括研究质量指标。
60 项研究（1019 例患者）符合纳入标准。35 项研究报告了局限性色素绒毛结节性滑膜炎（LPVNS）的治疗数据，40 项研究报告了弥漫性色素绒毛结节性滑膜炎（DPVNS）的治疗数据，1 项研究报告了关节外 LPVNS 的治疗数据，7 项研究报告了关节外 DPVNS 的治疗数据。报告了许多治疗选择。根据这些选择，DPVNS 系列中复发率为 8%至 70%，LPVNS 系列中复发率为 0%至 8%。对于 LPVNS，最常报告的两种治疗选择是开放性局限性滑膜切除术和关节镜下局限性滑膜切除术。在这两种治疗方法之间，局部复发率没有差异（开放性滑膜切除术为 8.7%，关节镜下滑膜切除术为 6.9%），术后并发症也无差异（开放性滑膜切除术<1%，关节镜下滑膜切除术为 0%）。对于 DPVNS，最常报告的两种治疗选择是开放性全滑膜切除术和关节镜下全滑膜切除术。在这两种治疗方法之间，局部复发率没有差异（开放性滑膜切除术为 22.6%，关节镜下滑膜切除术为 16.1%）。然而，我们发现开放性滑膜切除术后并发症的报告率较低（19.3%），而关节镜下滑膜切除术后为 0%。作为手术滑膜切除的辅助治疗，内部照射或外部束辐射似乎降低了 DPVNS 高复发风险病例的局部复发率。最后，我们发现报告功能结果的方式存在很大的异质性，我们无法根据提取的数据得出有效的结论。
我们发现开放性或关节镜下手术治疗 LPVNS 或 DPVNS 后的局部复发率没有差异。然而，关节镜下治疗 DPVNS 后的术后并发症发生率较低。
IV 级，对 IV 级治疗研究的系统评价。
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