Ustinova V F, Podliashuk E L, Rodionova S S
Med Radiol (Mosk). 1986 Mar;31(3):27-31.
Pigmented villonodular synovitis is a specific lesion of the synovial membrane of the joint and bursal mucosa. In recent years it is frequently regarded as tumor like disease. The problem of therapy of the diffuse form of the disease is yet to be solved. Recurrence rates after partial synovial capsulectomy remain high (33-46%) as well as after operation combined with radiation therapy. The authors summed up their experience in combined therapy of pigmented villonodular synovitis. The method was used in 24 patients with the diffuse form of the disease, ranging in age from 15 to 62. In 18 of 24 patients the process affected the knee joint, in 6 patients the articular bones were involved in the process. Partial synovial capsulectomy with subsequent development of recurrences was recorded in 14 patients' history. Total synovial capsulectomy was performed at the first stage; in knee joint involvement the operation was supplemented by meniscectomy. gamma-beam therapy followed operation in 3-4 weeks. Radiotherapy was necessitated by the fact that elements of the affected synovial sheath could not be completely removed even in total synovial capsulectomy. Irradiation was given from 2 fields, a single focal dose being 1.2-1.5 Gy, 5 fractions a week; a summary focal dose reached 16-20 Gy. A follow up period lasted from 6 mos to 6 yrs. Complete convalescence was noted in 23 patients. Occupational rehabilitation was achieved in 21 patients. In 2 patients the functional outcome was considered to be satisfactory. The data obtained indicated to a high efficacy of combined therapy of the diffuse form of pigmented villonodular synovitis and the appropriateness of the use of radiotherapy in the postoperative period.
色素沉着绒毛结节性滑膜炎是关节滑膜和滑囊黏膜的一种特殊病变。近年来，它常被视为肿瘤样疾病。弥漫型该病的治疗问题尚未解决。部分滑膜囊切除术以及手术联合放射治疗后的复发率仍然很高（33%-46%）。作者总结了他们在色素沉着绒毛结节性滑膜炎联合治疗方面的经验。该方法用于24例弥漫型该病患者，年龄在15至62岁之间。24例患者中有18例病变累及膝关节，6例关节骨也受累。14例患者既往有部分滑膜囊切除术后复发的记录。第一阶段进行全滑膜囊切除术；膝关节受累时，手术辅以半月板切除术。术后3-4周进行γ射线治疗。由于即使在全滑膜囊切除术中，受累滑膜鞘的成分也无法完全切除，因此需要进行放射治疗。从2个野进行照射，单次局部剂量为1.2-1.5 Gy，每周5次；总局部剂量达到16-20 Gy。随访期为6个月至6年。23例患者完全康复。21例患者实现职业康复。2例患者的功能结果被认为是满意的。获得的数据表明弥漫型色素沉着绒毛结节性滑膜炎联合治疗具有很高的疗效，以及术后使用放射治疗的合理性。
