膝关节弥漫性色素沉着绒毛结节性滑膜炎分期联合滑膜切除术及体外放疗后，平均10年随访时功能预后良好且复发率低。

Satisfactory functional outcomes and low recurrence rates at a mean 10-year follow-up after combined staged synovectomy and external radiotherapy for diffuse pigmented villonodular synovitis of the knee.

作者信息

Fahmy Fahmy Samir, ElAttar Mohamed, Farhan Ahmed Hatem, Sadek Sami Ibrahim, Mahmoud Mahmoud Abdo, Mahmoud Hossam Fathi

机构信息

Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Egypt.

出版信息

J ISAKOS. 2025 Aug;13:100907. doi: 10.1016/j.jisako.2025.100907. Epub 2025 May 24.

DOI:10.1016/j.jisako.2025.100907

PMID:40419142

Abstract

INTRODUCTION

Diffuse pigmented villonodular synovitis (PVNS) of the knee is a locally destructive lesion that tends to recur following surgical synovectomy. This study aims to evaluate the long-term functional outcomes and recurrence rates of combined staged synovectomy and external radiotherapy in managing diffuse PVNS of the knee.

METHODS

The data of twenty-three patients who had a diffuse PVNS of the knee between June 2011 and September 2017 were retrospectively collected. The patients underwent combined staged anterior arthroscopic and open posterior synovectomy followed by low-dose external radiotherapy (average 3000 cGy). Functional outcomes were assessed preoperatively and at the final follow-up using the International Knee Documentation Committee (IKDC) score, Musculoskeletal Tumor Society (MSTS) score, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, and SF-36 score, along with the knee motion measurements. Statistical analysis evaluated the changes in functional scores and recurrence rates, with a p-value < 0.05 as the cut-off level of significance.

RESULTS

The mean follow-up time was 121.1 ± 20.2 months, with a minimum of 85 months. At the final follow-up, the mean range of motion (ROM) improved from 84.1 ± 16.2° to 110.4 ± 9.7°. The WOMAC score increased significantly from 44.5 ± 5.1 to 81.5 ± 6.3 (p < 0.00001). The IKDC score improved from 43.7 ± 8.1 to 79.1 ± 7.4 (p < 0.00001), MSTS scores from 6.7 ± 2.1 to 20.3 ± 5.7 (p < 0.00001), and SF-36 scores from 28.6 ± 7.4 to 77.4 ± 11.5 (p < 0.00001). Two recurrent cases were documented at the last follow-up visit (8.6%), with a minor complication rate of 21.7%.

CONCLUSION

Combined staged synovectomy and external radiotherapy is an effective treatment for diffuse PVNS of the knee. It has demonstrated significant functional improvement and low recurrence rates over extended follow-up periods, supporting its role as a durable and reliable treatment strategy.

LEVEL OF EVIDENCE

Level IV, retrospective cohort.

摘要

引言

膝关节弥漫性色素沉着绒毛结节性滑膜炎（PVNS）是一种局部破坏性病变，手术滑膜切除术后易复发。本研究旨在评估分期滑膜切除术联合体外放疗治疗膝关节弥漫性PVNS的长期功能结局和复发率。

方法

回顾性收集2011年6月至2017年9月期间23例膝关节弥漫性PVNS患者的数据。患者接受分期的关节镜前路和开放后路联合滑膜切除术，随后进行低剂量体外放疗（平均3000 cGy）。术前及末次随访时采用国际膝关节文献委员会（IKDC）评分、肌肉骨骼肿瘤学会（MSTS）评分、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分、SF-36评分以及膝关节活动度测量评估功能结局。统计分析评估功能评分和复发率的变化，以p值<0.05作为显著性临界水平。

结果

平均随访时间为121.1±20.2个月，最短85个月。末次随访时，平均活动范围（ROM）从84.1±16.2°改善至110.4±9.7°。WOMAC评分从44.5±5.1显著提高至81.5±6.3（p<0.00001）。IKDC评分从43.7±8.1提高至79.1±7.4（p<0.00001），MSTS评分从6.7±2.1提高至20.3±5.7（p<0.00001），SF-36评分从28.6±7.4提高至77.4±11.5（p<0.00001）。末次随访时有2例复发（8.6%），轻微并发症发生率为21.7%。