Nazal Mark R, Parsa Ali, Martin Scott D
Sport Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, U.S.A.
Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Arthrosc Tech. 2019 Jun 2;8(6):e641-e646. doi: 10.1016/j.eats.2019.02.007. eCollection 2019 Jun.
Pigmented villonodular synovitis (PVNS) is a monoarticular, benign tumor arising from the synovium. Although classically treated with open synovectomy, arthroscopic treatment has demonstrated good clinical outcomes. The arthroscopic management of hip PVNS has been described as technically challenging due to difficulty obtaining the appropriate exposure. The purpose of this technical report is to describe a novel technique that allows for sound excision of PVNS during hip arthroscopy using a puncture capsulotomy. Full visualization throughout the central and peripheral compartments is key to achieving meticulous surgical excision and ablation, with careful attention to the medial and lateral synovial folds and gutters. It is important to avoid chondral injury by using a high outflow rate of irrigation to maintain a constant temperature, to ablate the blood supply of nodular lesions, and to not use a shaver as this may disseminate tumor cells. Multifactorial advancements in hip arthroscopy have permitted adequate visualization and exposure of PVNS lesions, making them amenable to arthroscopic synovectomy. Puncture capsulotomy does not require capsular closure, preserves the iliofemoral ligament, and minimizes exposure of extra-articular structures to the hip joint environment. Recurrence rates are lower in arthroscopic management compared with open management, at 7.7% and 17.8%, respectively.
色素沉着绒毛结节性滑膜炎（PVNS）是一种起源于滑膜的单关节良性肿瘤。虽然传统上采用开放性滑膜切除术治疗，但关节镜治疗已显示出良好的临床效果。由于难以获得合适的暴露，髋关节PVNS的关节镜治疗在技术上具有挑战性。本技术报告的目的是描述一种新技术，该技术可在髋关节镜检查期间使用穿刺关节囊切开术对PVNS进行可靠切除。在中央和外周间隙实现完全可视化是实现细致手术切除和消融的关键，要仔细关注内侧和外侧滑膜皱襞及沟。通过使用高冲洗流速以维持恒定温度、消融结节性病变的血供以及不使用刨削器（因为这可能会播散肿瘤细胞）来避免软骨损伤很重要。髋关节镜检查的多因素进展使得能够充分可视化和暴露PVNS病变，使其适合进行关节镜滑膜切除术。穿刺关节囊切开术不需要缝合关节囊，保留了髂股韧带，并最大限度地减少了关节外结构暴露于髋关节环境。与开放手术相比，关节镜治疗的复发率较低，分别为7.7%和17.8%。
