Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, 49 North Garden Rd, Haidian District, 100191, Beijing, PR China.
BMC Musculoskelet Disord. 2022 Mar 2;23(1):192. doi: 10.1186/s12891-022-05141-y.
Though radiotherapy has been widely used for knee pigmented villonodular synovitis (PVNS), there is few literatures about radiotherapy for the treatment of PVNS hip. Thus, the purpose of this study was to analyze the clinical outcomes of endoscopic synovectomy with/without radiotherapy postoperatively of PVNS hip.
We performed a retrospective study of patients who underwent endoscopy in our hospital from November 2010 to January 2021. Inclusion criteria was patients with magnetic resonance image (MRI) signs, endoscopic findings and/or histological evidence of PVNS. Exclusion criteria was patients lost follow-up. All patients underwent synovectomy endoscopically and were divided into two groups depending on receiving postoperative radiotherapy or not. The primary outcome measurements were the recurrence of PVNS, receiving revision, and/or converting to total hip arthroplasty (THA). The secondary outcome measurements were the patient-reported outcome (PRO) collected at pre- and post-operation, which consist of Hip Outcome Score Activities of Daily Living (HOS-ADL), modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (IHOT-12), Non-arthritic Hip Scale (NAHS), and visual analog scale (VAS).
In a case series of 16 patients (8 cases of male, 50%), 4 (25%) cases were localized type and 12 (75%) cases were diffuse type. The average follow-up was 44.8 ± 38.2 months (range,3 to 110). 8 (50%) cases (6 diffuse cases and 2 localized cases) received radiotherapy postoperatively, and the rest (6 diffuse cases and 2 localized cases) received endoscopic treatment alone. At the latest follow-up, 3 (18.75%) cases (2 diffuse cases and 1 localized case) who did not receive radiotherapy converted to arthroplasty. The preoperative HOS-ADL, mHHS, IHOT-12, NAHS, VAS scores of remaining 13 patients were 63.1 ± 19.1 (range,32.0 to 98.8), 54.8 ± 20.1 (range, 10.0 to 77.0), 50.9 ± 15.4 (range, 31.0 to 76.6),51.6 ± 15.9 (range, 20.0 to 84.4), 6.0 ± 1.4 (range,4.0 to 8.0) points, respectively. The latest HOS-ADL, mHHS, IHOT-12, NAHS, VAS scores of the 13 patients were 79.7 ± 10.8 (range, 58.0 to 97.6), 78.6 ± 9.1 (range,55.0 to 87.0), 74.7 ± 9.7 (range, 55.6 to 91.0), 78.9 ± 18.7 (range,20.0 to 92.5), 3.1 ± 1.2 (range,2.0 to 6.0) points respectively.
Endoscopic synovectomy can achieve satisfactory PRO in PVNS hip patients. Besides, postoperative adjuvant radiotherapy can achieve higher hip survivability than synovectomy alone in this present study.
尽管放疗已广泛用于膝关节色素绒毛结节性滑膜炎（PVNS），但关于放疗治疗髋关节 PVNS 的文献很少。因此，本研究的目的是分析髋关节 PVNS 患者内镜滑膜切除术后联合/不联合放疗的临床结果。
我们对 2010 年 11 月至 2021 年 1 月在我院接受内镜治疗的患者进行了回顾性研究。纳入标准为磁共振成像（MRI）征象、内镜检查结果和/或组织学证据符合色素绒毛结节性滑膜炎。排除标准为失访患者。所有患者均行内镜滑膜切除术，根据术后是否接受放疗分为两组。主要观察指标为 PVNS 复发、需要翻修和/或转为全髋关节置换术（THA）。次要观察指标为术前和术后患者报告的结果（PRO），包括髋关节功能评分日常生活活动（HOS-ADL）、改良 Harris 髋关节评分（mHHS）、国际髋关节结局工具-12（IHOT-12）、非关节炎髋关节评分（NAHS）和视觉模拟评分（VAS）。
在一项 16 例患者（男性 8 例，50%）的病例系列研究中，4 例（25%）为局限性，12 例（75%）为弥漫性。平均随访时间为 44.8±38.2 个月（范围为 3 至 110 个月）。8 例（50%）患者（6 例弥漫性病例和 2 例局限性病例）术后接受放疗，其余 6 例（6 例弥漫性病例和 2 例局限性病例）仅接受内镜治疗。在末次随访时，3 例（18.75%）未接受放疗的患者转为关节置换。其余 13 例患者术前 HOS-ADL、mHHS、IHOT-12、NAHS、VAS 评分分别为 63.1±19.1（范围为 32.0 至 98.8）、54.8±20.1（范围为 10.0 至 77.0）、50.9±15.4（范围为 31.0 至 76.6）、51.6±15.9（范围为 20.0 至 84.4）、6.0±1.4（范围为 4.0 至 8.0）分。13 例患者的最新 HOS-ADL、mHHS、IHOT-12、NAHS、VAS 评分分别为 79.7±10.8（范围为 58.0 至 97.6）、78.6±9.1（范围为 55.0 至 87.0）、74.7±9.7（范围为 55.6 至 91.0）、78.9±18.7（范围为 20.0 至 92.5）、3.1±1.2（范围为 2.0 至 6.0）分。
内镜滑膜切除术可使髋关节色素绒毛结节性滑膜炎患者获得满意的 PRO。此外，与单纯滑膜切除术相比，术后辅助放疗可提高髋关节的存活率。
