• 四川大學華西醫(yī)院骨科（成都，610041）;

目的 探討關節(jié)鏡下和/ 或切開手術輔以術后關節(jié)外放療治療膝關節(jié)彌漫型色素沉著絨毛結節(jié)性滑膜
炎（pigmented villonodular synovitis，PVNS）的方法和療效。 方法 2000 年9 月－ 2010 年8 月，收治97 例單膝彌漫型
PVNS。男38 例，女59 例；年齡8 ～ 75 歲，中位年齡33 歲。病程1 周～ 30 年；復發(fā)患者10 例。左膝52 例，右膝45 例。
術前膝關節(jié)伸直（1.9 ± 2.3）°，屈曲（122.9 ± 5.6）°；Lysholm 膝關節(jié)評分為（43.2 ± 6.7）分，國際膝關節(jié)文獻委員會（IKDC）
膝關節(jié)功能主觀評分為（53.2 ± 5.7）分。根據是否合并關節(jié)外病變及病變部位，82 例采用關節(jié)鏡下關節(jié)前后病變滑膜切
除術，3 例采用關節(jié)鏡下關節(jié)內病變滑膜切除聯合小切口切除關節(jié)外病灶，9 例采用關節(jié)鏡下關節(jié)內病變滑膜切除及后方
關節(jié)外軟組織內病灶切除術，3 例分期切除病灶并植骨。術后76 例接受關節(jié)外放療。 結果 術中1 例損傷腘動脈，3
例損傷腘靜脈分支；術后3 d 1 例膝關節(jié)血腫形成。其余患者切口均Ⅰ期愈合，無神經損傷等并發(fā)癥發(fā)生。患者均獲隨訪，
隨訪時間1 年3 個月～ 11 年2 個月，中位時間61 個月。89 例患者隨訪期間無復發(fā)，術后15 個月膝關節(jié)伸直（0.2 ± 1.3）°，
屈曲（135.9 ± 6.6）°，Lysholm 膝關節(jié)評分為（89.8 ± 5.8）分，IKDC 膝關節(jié)功能主觀評分為（87.8 ± 5.8）分，與術前比較
差異均有統(tǒng)計學意義（P  lt; 0.05）。8 例于術后6 個月～ 8 年復發(fā)，再次手術后患者膝關節(jié)輕度活動受限，無疼痛、腫脹。
結論 根據膝關節(jié)病變范圍及程度，選擇關節(jié)鏡下和/ 或切開手術輔以關節(jié)外放療治療膝關節(jié)彌漫型PVNS 可取得較好
療效。術后未接受正規(guī)放療是復發(fā)重要因素之一，復發(fā)者病變易導致骨質破壞。

引用本文： 劉東,李棋,蔣勰,唐新,李箭. 關節(jié)鏡下和/ 或切開治療膝關節(jié)彌漫型色素沉著絨毛結節(jié)性滑膜炎療效分析. 中國修復重建外科雜志, 2012, 26(5): 518-521. doi: 復制

1. Ofluoglu O. Pigmented villonodular synovitis. Orthop Clin North Am, 2006, 37(1): 23-33.
2. 楊洪彬, 李忠, 張忠杰, 等. 膝關節(jié)色素沉著絨毛結節(jié)性滑膜炎的關節(jié)鏡治療探討. 現代預防醫(yī)學, 2009, 36(9): 1757-1759.
3. Miquel A, Lesavre A, Menu Y, et al. Pigmented villonodular synovitis of the knee. Presse Med, 2006, 35(1 Pt 1): 67-68.
4. Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis of the foot and ankle: Forty years of experience from the Scottish bone tumor registry. J Foot Ankle Surg, 2006, 45(5): 329-336.
5. Rhee PC, Sassoon AA, Sayeed SA, et al. Arthroscopic treat ment of localized pigmented villonodular synovitis: long-term functional results. Am J Orthop (Belle Mead NJ), 2010, 39(9): E90-94.
6. Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis: Diagnostic pitfalls and management strategy. Cur Orthop, 2005, 19(3): 215-222.
7. Murphey MD, Rhee JH, Lewis RB, et al. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics, 2008, 28(5): 1493-1518.
8. Kramer DE, Frassica FJ, Frassica DA, et al. Pigmented villonodular synovitis of the knee: diagnosis and treatment. J Knee Surg, 2009, 22(3): 243-254.
9. 段小軍, 楊柳, 陳光興, 等. 膝關節(jié)色素沉著絨毛結節(jié)性滑膜炎的微創(chuàng)治療. 中國微創(chuàng)外科雜志, 2008, 8(7): 648-650.
10. 孫笑非, 林建寧, 阮狄克, 等. 關節(jié)鏡下診治膝關節(jié)色素絨毛結節(jié)性滑膜炎. 中國微創(chuàng)外科雜志, 2009, 9(2): 128-130.
11. Wu CC, Pritsch T, Bickels J, et al. Two incision synovectomy and radiation treatment for diffuse pigmented villonodular synovitis of the knee with extra-articular component. Knee, 2007, 14(2): 99-106.
12. Chen WM, Wu PK, Liu CL. Simultaneous anterior and posterior synovectomies for treating diffuse pigmented villonodular synovitis. Clin Orthop Relat Res, 2012. [Epub ahead of print].
13. Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis: diagnostic pitfalls and management strategy. Curr Orthop, 2005, 19: 215-222.
14. Nishida Y, Tsukushi S, Nakashima H, et al. Osteochondral destruction in pigmented villonodular synovitis during the clinical course. J Rheumatol, 2012, 39(2): 345-351.
15. Berger B, Ganswindt U, Bamberg M, et al. External beam radiotherapy as postoperative treatment of the diffuse pigmente villonodular synovitis. Int J Radiat Oncol Biol Phys, 2007, 67(4): 1130-1134.
16. Ottaviani S, Ayral X, Dougados M, et al. Pigmented villonodular synovitis: a retrospective single-center study of 122 cases and review of the literature. Semin Arthritis Rheum, 2011, 40(6): 539-546.
17. Nassar WA, Bassiony AA, Elghazaly HA. Treatment of diffuse pigmented villonodular of the knee with combined surgical and radiosynovectomy. HSS J, 2009, 5(1): 19-23.
18. Horoschak M, Tran PT, Bachiredd P, et al. External beam radiation therapy enhances local control in pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys, 2009, 75(1): 183-187.
  1. 1. Ofluoglu O. Pigmented villonodular synovitis. Orthop Clin North Am, 2006, 37(1): 23-33.
  2. 2. 楊洪彬, 李忠, 張忠杰, 等. 膝關節(jié)色素沉著絨毛結節(jié)性滑膜炎的關節(jié)鏡治療探討. 現代預防醫(yī)學, 2009, 36(9): 1757-1759.
  3. 3. Miquel A, Lesavre A, Menu Y, et al. Pigmented villonodular synovitis of the knee. Presse Med, 2006, 35(1 Pt 1): 67-68.
  4. 4. Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis of the foot and ankle: Forty years of experience from the Scottish bone tumor registry. J Foot Ankle Surg, 2006, 45(5): 329-336.
  5. 5. Rhee PC, Sassoon AA, Sayeed SA, et al. Arthroscopic treat ment of localized pigmented villonodular synovitis: long-term functional results. Am J Orthop (Belle Mead NJ), 2010, 39(9): E90-94.
  6. 6. Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis: Diagnostic pitfalls and management strategy. Cur Orthop, 2005, 19(3): 215-222.
  7. 7. Murphey MD, Rhee JH, Lewis RB, et al. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics, 2008, 28(5): 1493-1518.
  8. 8. Kramer DE, Frassica FJ, Frassica DA, et al. Pigmented villonodular synovitis of the knee: diagnosis and treatment. J Knee Surg, 2009, 22(3): 243-254.
  9. 9. 段小軍, 楊柳, 陳光興, 等. 膝關節(jié)色素沉著絨毛結節(jié)性滑膜炎的微創(chuàng)治療. 中國微創(chuàng)外科雜志, 2008, 8(7): 648-650.
  10. 10. 孫笑非, 林建寧, 阮狄克, 等. 關節(jié)鏡下診治膝關節(jié)色素絨毛結節(jié)性滑膜炎. 中國微創(chuàng)外科雜志, 2009, 9(2): 128-130.
  11. 11. Wu CC, Pritsch T, Bickels J, et al. Two incision synovectomy and radiation treatment for diffuse pigmented villonodular synovitis of the knee with extra-articular component. Knee, 2007, 14(2): 99-106.
  12. 12. Chen WM, Wu PK, Liu CL. Simultaneous anterior and posterior synovectomies for treating diffuse pigmented villonodular synovitis. Clin Orthop Relat Res, 2012. [Epub ahead of print].
  13. 13. Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis: diagnostic pitfalls and management strategy. Curr Orthop, 2005, 19: 215-222.
  14. 14. Nishida Y, Tsukushi S, Nakashima H, et al. Osteochondral destruction in pigmented villonodular synovitis during the clinical course. J Rheumatol, 2012, 39(2): 345-351.
  15. 15. Berger B, Ganswindt U, Bamberg M, et al. External beam radiotherapy as postoperative treatment of the diffuse pigmente villonodular synovitis. Int J Radiat Oncol Biol Phys, 2007, 67(4): 1130-1134.
  16. 16. Ottaviani S, Ayral X, Dougados M, et al. Pigmented villonodular synovitis: a retrospective single-center study of 122 cases and review of the literature. Semin Arthritis Rheum, 2011, 40(6): 539-546.
  17. 17. Nassar WA, Bassiony AA, Elghazaly HA. Treatment of diffuse pigmented villonodular of the knee with combined surgical and radiosynovectomy. HSS J, 2009, 5(1): 19-23.
  18. 18. Horoschak M, Tran PT, Bachiredd P, et al. External beam radiation therapy enhances local control in pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys, 2009, 75(1): 183-187.