髋关节色素沉着绒毛结节性滑膜炎关节镜滑膜切除术的中期结果。
Mid-Term Results of Arthroscopic Synovectomy for Pigmented Villonodular Synovitis of the Hip.
机构信息
Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, U.S.A.
Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, U.S.A.; Orthopedic Research Center, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran.
出版信息
Arthroscopy. 2020 Jun;36(6):1587-1598. doi: 10.1016/j.arthro.2020.01.059. Epub 2020 Feb 13.
PURPOSE
To analyze mid-term outcomes after arthroscopic synovectomy of both diffuse and nodular hip pigmented villonodular synovitis (PVNS).
METHODS
This is a retrospective case series of patients that underwent hip arthroscopy for hip PVNS with a single senior surgeon between 2007 and 2016. Inclusion criteria were magnetic resonance imaging evidence, arthroscopic visualization, and/or histologic confirmation of PVNS; and a minimum of 3 years of follow-up. Concomitant pathology such as femoroacetabular impingement also was treated at the time of surgery. Primary outcome measures were recurrence of hip PVNS and the rate of revision hip surgery. Secondary outcomes were complications, visual analog scale pain score, pain relief, and patient satisfaction, and 6 patient-reported outcome measures were collected at latest follow-up.
RESULTS
In a case series of 14 patients consisting of 6 (42.9%) male and 8 (57.1%) female patients, the mean operative age was 32.69 ± 12.73 years with a mean follow-up was 6.66 ± 1.87 years. PVNS type was determined intraoperatively: 5 (35.7%) patients had diffuse hip PVNS and 9 (64.3%) had nodular type. There was only 1 case (7.14%) of recurrence that was treated arthroscopically and no cases (0%) progressed to revision open synovectomy or arthroplasty. Mean patient-reported outcome measure scores were notable for a modified Harris Hip Score of 74.08 ± 16.84. The mean visual analog scale pain score decreased by 4.9 ± 1.7, which was significant with a P < .001, with a larger decrease in patients with localized type.
CONCLUSIONS
This study presents a large case series of hip PVNS managed arthroscopically with mid-term follow-up of slightly over 6.5 years. The survival rate was 93%, with only 1 (7%) recurrence and 0 (0%) progression to revision open synovectomy or arthroplasty with 0 (0%) complications. We conclude that arthroscopic synovectomy is a reliable and effective treatment of hip PVNS.
LEVEL OF EVIDENCE
Case Series, Level IV.
目的
分析关节镜下双侧弥漫性和结节性髋色素绒毛结节性滑膜炎（PVNS）滑膜切除术的中期结果。
方法
这是一项回顾性病例系列研究，纳入了 2007 年至 2016 年间由一位资深外科医生行髋关节镜检查的髋关节 PVNS 患者。纳入标准为磁共振成像（MRI）证据、关节镜下观察到的和/或组织学证实的 PVNS；且随访时间至少 3 年。同时也对髋关节撞击综合征等伴随病变进行了治疗。主要观察指标为髋关节 PVNS 的复发率和髋关节翻修手术率。次要观察指标为并发症、视觉模拟评分（VAS）疼痛评分、疼痛缓解和患者满意度，并在末次随访时收集了 6 项患者报告的结果测量指标。
结果
在一项由 14 例患者组成的病例系列研究中，包括 6 例（42.9%）男性和 8 例（57.1%）女性，平均手术年龄为 32.69 ± 12.73 岁，平均随访时间为 6.66 ± 1.87 年。术中确定 PVNS 类型：5 例（35.7%）为弥漫性髋部 PVNS，9 例（64.3%）为结节型。仅 1 例（7.14%）复发，行关节镜治疗，无病例（0%）进展为开放式滑膜切除术或关节置换术。改良 Harris 髋关节评分平均为 74.08 ± 16.84，患者报告的结果测量指标评分显著。VAS 疼痛评分平均降低了 4.9 ± 1.7，差异具有统计学意义（P<0.001），且局限性病变患者的疼痛缓解更为明显。
结论
本研究报告了一项大型髋关节 PVNS 病例系列研究，关节镜治疗后的随访时间略超过 6.5 年。生存率为 93%，仅 1 例（7%）复发，0 例（0%）进展为开放式滑膜切除术或关节置换术，并发症发生率为 0（0%）。我们得出结论，关节镜下滑膜切除术是一种可靠有效的髋关节 PVNS 治疗方法。
证据等级
病例系列研究，IV 级。
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