Third Radiotherapy and Chemotherapy Clinic, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102, Gliwice, Poland.
Radiotherapy Department, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102, Gliwice, Poland.
Ann Nucl Med. 2020 Feb;34(2):94-101. doi: 10.1007/s12149-019-01418-w. Epub 2019 Nov 12.
The aim of this study was to assess the treatment results of Y radiation synovectomy for chronic exudative synovitis of knee joints.
The retrospective data consist of 394 consecutive knee radiation synovectomies performed using 6 mCi (222 MBq) of Y. The assessment included 3-point custom pain and joint mobility scale, evaluation of joint's circumference, binary joint's temperature evaluation, patellar ballottement test, indications for puncture and its volume in applicable cases. 21 cases had to be forfeited due to missing data regarding follow-up.
The final analysis of 373 treatment procedures performed in 253 patients yielded following results-at 6 months after treatment, 80.9% of the patients reported at least partial pain relief (including 33.3% with complete pain relief), which increased to 86.7% at one year. The pain intensity decreased over time, however, the outcomes were worse in older patients. The probability of pain recurrence was 15% at 6 months, and 28% at one year. It was highest in post-traumatic synovitis, and lowest in pigmented villonodular synovitis. The circumference of the treated knee joints decreased over the course of follow-up, however, the decrease was significantly lower in older patients. The fraction of patients with full knee joint mobility increased from 34.6 to 40.6% at 6 months and 49.2% at one year. The percentage of patients that required articular puncture decreased from 62.8% at baseline to about 35.6% at 6 months, and 32.8% at one year. Positive patellar ballottement was found in 68.5% before treatment and remained at about 40-50% during the course of follow-up. The increased temperature of the joint was reported in 51.2% at baseline and decreased to 33% at 6 months and 28.3% at one year.
(1) Radiation synovectomy is a safe and effective method of treatment in patients with exudative synovitis, however, the pain recurrence rate is significantly higher in post-traumatic exudative synovitis compared to pigmented villonodular, undifferentiated, and rheumatoid arthritis. (2) Our results suggest that older patients have worse treatment results with radiation synovectomy compared to younger patients.
本研究旨在评估 Y 射线滑膜切除术治疗膝关节慢性渗出性滑膜炎的治疗效果。
回顾性数据包括 394 例连续膝关节 Y 射线滑膜切除术，使用 6mCi（222MBq）Y。评估包括 3 分自定义疼痛和关节活动度量表、关节周长评估、关节温度的二元评估、髌腱弹响试验、有指征时进行穿刺及其体积。由于随访数据缺失，21 例被排除。
对 253 例患者的 373 例治疗过程进行最终分析，结果如下：治疗后 6 个月，80.9%的患者报告至少部分疼痛缓解（包括 33.3%完全疼痛缓解），1 年后增加到 86.7%。疼痛强度随时间降低，但老年患者的结果更差。6 个月时疼痛复发的概率为 15%，1 年后为 28%。创伤后滑膜炎最高，色素绒毛结节性滑膜炎最低。治疗膝关节周长随随访而减小，但老年患者减小幅度明显较低。全膝关节活动度的患者比例从 6 个月时的 34.6%增加到 40.6%，1 年后增加到 49.2%。需要关节穿刺的患者比例从基线时的 62.8%下降到 6 个月时的约 35.6%，1 年后下降到 32.8%。治疗前髌腱弹响阳性率为 68.5%，随访过程中保持在约 40-50%。关节温度升高的报告率为基线时的 51.2%，6 个月时降至 33%，1 年后降至 28.3%。
（1）放射性滑膜切除术是治疗渗出性滑膜炎患者的一种安全有效的方法，但创伤后渗出性滑膜炎的疼痛复发率明显高于色素绒毛结节性、未分化性和类风湿性关节炎。（2）我们的结果表明，与年轻患者相比，老年患者放射性滑膜切除术的治疗效果较差。
