Dürr Hans Roland, Capellen Carl Ferdinand, Klein Alexander, Baur-Melnyk Andrea, Birkenmaier Christof, Jansson Volkmar, Tiling Reinhold
Musculoskeletal Oncology, Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
Institute of Radiology, University Hospital, LMU Munich, Munich, Germany.
Arch Orthop Trauma Surg. 2019 May;139(5):623-627. doi: 10.1007/s00402-018-3097-4. Epub 2018 Dec 11.
Tenosynovial giant-cell tumor also known as pigmented villonodular synovitis (PVS) is a benign but aggressive synovial proliferative disease most often affecting the knee joint. The mainstay of therapy is surgical resection. Due to a high rate of local recurrence, radiosynoviorthesis (RSO) is used as an adjuvant method in many cases. The aim of this study was to compare local recurrence (LR) rates after surgical synovectomy with and without adjuvant RSO.
From 1996 to 2014, 37 surgical interventions were performed in 32 patients with diffuse pigmented villonodular synovitis of the knee. All patients underwent open synovectomy. Adjuvant radiosynoviorthesis (RSO) was applied in 26 cases, the control group consists of 11 cases without RSO.
9 (24%) lesions recurred within a median of 19 months after surgery. Of those 9 recurrences, 3 (17%) were seen in primary disease, 6 (32%) in already recurring cases (n.s.). In 26 RSO treated patients 6 (23%) recurred, in 11 patients of the control group, 3 (27%) recurred (n.s.).
RSO is effective in PVS as also shown in some smaller reports in the literature. But surgery is still the mainstay of therapy. RSO is not a method of compensating for an insufficient surgical approach, but it may reduce the high rate of LR in patients with large and even recurrent diffuse forms of the disease.
腱鞘巨细胞瘤也称为色素沉着绒毛结节性滑膜炎（PVS），是一种良性但具有侵袭性的滑膜增生性疾病，最常累及膝关节。治疗的主要方法是手术切除。由于局部复发率高，放射性滑膜切除术（RSO）在许多情况下被用作辅助方法。本研究的目的是比较手术滑膜切除术后辅助RSO与不辅助RSO的局部复发（LR）率。
1996年至2014年，对32例膝关节弥漫性色素沉着绒毛结节性滑膜炎患者进行了37次手术干预。所有患者均接受了开放性滑膜切除术。26例应用了辅助放射性滑膜切除术（RSO），对照组由11例未接受RSO治疗的患者组成。
9个（24%）病变在术后中位19个月内复发。在这9例复发病例中，3例（占原发性疾病的17%），6例（占已复发病例的32%）（无统计学差异）。在26例接受RSO治疗的患者中，6例（23%）复发，在对照组的11例患者中，3例（27%）复发（无统计学差异）。
正如文献中一些较小的报告所示，RSO在PVS中是有效的。但手术仍然是主要的治疗方法。RSO不是一种弥补手术方法不足的方法，但它可能降低患有大面积甚至复发性弥漫性疾病患者的高LR率。
