多通道关节镜治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的中期疗效

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摘要目的评估分析多通道关节镜下清理治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的中期疗效。方法 2013年7月至2015年12月，收治膝关节弥漫型色素沉着绒毛结节性滑膜炎患者31例，男12例，女19例；年龄6～76岁，平均年龄(49.4±15.4)岁；右膝17例，左膝14例。患者术前均有不同程度的膝关节肿胀、疼痛及活动受限，所有患者均接受多通道关节镜下病灶清理并行组织病理学检查确诊。通过对比患者术前与末次随访时的疼痛视觉模拟评分(visual analogue scale，VAS)、Lysholm膝关节评分、国际膝关节文献委员会(international knee documentation committee，IKDC)评分、膝关节活动度(range of motion，ROM)进行评估。结果所有患者术后创口均I期愈合，平均手术时间(79.0±26.1)min，平均住院时间(5.5±2.3)d，无术后感染及并发症，31例患者均完成随访，随访时间61～90个月，平均(74.0±8.9)个月。所有患者末次随访时无明显肿胀、疼痛，膝关节活动度明显改善，末次随访时VAS由术前(6.5±0.8)分降为(1.3±0.9)分，Lysholm膝关节评分由术前(47.9±6.4)分提高至(88.5±3.0)分，IKDC评分由术前(51.7±4.6)分提高至(89.4±4.5)分，膝关节ROM由术前(88.9±9.7)°改善至(126.1±7.9)°，差异均具有统计学意义(P＜0.001)。31例患者末次随访时4例出现术后复发，复发率12.9%。结论多通道关节镜辅助下滑膜切除是治疗膝关节色素沉着绒毛结节性滑膜炎的一种微创、安全有效的治疗方法，具有创伤小、术后恢复快、并发症少、复发率低的优势。

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关键词 ：多通道, 关节镜, 膝关节, 色素沉着绒毛结节性滑膜炎

Abstract：Objective To evaluate and analyze the mid-term efficacy of multi-channel arthroscopic clearance in the treatment of diffuse pigmented villonodular synovitis of knee joint.Methods From July 2013 to December 2015，31 patients with diffuse pigmentation villonodular synovitis of knee joint were treated，including 12 males and 19 females.The average age was (49.4±15.4) years old.There were17 case of the right knee and 14 case ofthe left knee.All patients had varying degrees of knee swelling，pain and limitation of movement before surgery，and all patients received multi-channel arthroscopic lesion clearance and histopathological examination for diagnosis.The assessment was conducted by comparing the visual analogue score of pain，Lysholm knee score，international knee documentation committee (IKDC) score，and knee range of motion (ROM)before surgery and at the last follow-up.Results All the patients had stage I wound healing，the mean operation time was (79.0±26.1) min，the mean postoperative hospital stay was (5.5±2.3) days，no postoperative infection and complications.All the 31 patients were followed up for 61 to 90 months，the mean follow-up time was (74.0±8.9) months.All patients had no significant Knee swelling and pain at the last follow-up，and the range of motion of the Knee was significantly improved.The visual analogue scale (VAS) of pain decreased from (6.5±0.8) to (1.3±0.9) at the last follow-up，and the Lysholm knee score increased from (47.9±6.4) to (88.5±3.0).The IKDCscore was increased from (51.7±4.6) to (89.4±4.5)，and the ROMof knee joint was improved from (88.9±9.7) ° to (126.1±7.9) °，the differenceswere statistically significant (P＜0.001).In the last follow-up，4 of the 31 patients had postoperative recurrence，with a recurrence rate of 12.9%.Conclusion Multi-channel arthroscopic clearance is a minimally invasive，safe and effective treatment for pigmented villonodular synovitis of the knee joint，which has the advantages of less trauma，quick postoperative recovery，fewer complications and low recurrence rate.

Key words： multi-channel arthroscopy knee joint pigmented villonodular synovitis

基金资助:西南医科大学自然科学(青年基金)资助项目(2018-ZRQN-122)

通讯作者: 刘俊才

作者简介: 陈建(1990－ )，男，研究生在读，西南医科大学附属医院骨科，646000。

引用本文:

陈建 1，陈歌 1，李忠 1，唐宇 1，程宇翔 1，陈畅 1，雷蕾 2，刘俊才 1*. 多通道关节镜治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的中期疗效[J]. 实用骨科杂志, 2021, 27(7): 587-592.
Chen Jian，Chen Ge，Li Zhong，et al. The Mid-term Effect of Multi-channel Arthroscopy in the Treatment of Diffusepigmented Villonodular Synovitis of the Knee. sygkzz, 2021, 27(7): 587-592.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I7/587

［1］Temponi EF，Barros AAG，Paganini VO，et al.Diffuse pigmented villonodular synovitis in knee joint：diagnosis and treatment ［J］.Rev Bras Ortop，2017，52(4)：450-457.
［2］Bernthal NM，Ishmael CR，Burke ZDC.Management of Pigmented Villonodular Synovitis (PVNS)：an Orthopedic Surgeon's Perspective ［J］.Curr Oncol Rep，2020，22(6)：63.
［3］Fang Y，Zhang Q.Recurrence of pigmented villonodular synovitis of the knee：A case report with review of literature o n the risk factors causing recurrence ［J］.Medicine (Baltimore)，2020，99(16)：e19856.
［4］陈锦伦，冯文俊，曾建春，等.股骨远端良性纤维组织细胞瘤术后继发膝关节色素沉着绒毛结节性滑膜炎1例报告［J］.实用骨科杂志，2020，26(1)：89-91.
［5］Fiocco U，Sfriso P，Lunardi F，et al.Molecular pathways involved in synovial cell inflammation and tumoral proliferation in diffuse pigmen ted villonodular synovitis ［J］.Autoimmun Rev，2010，9(11)：780-784.
［6］Cao C，Wu F，Niu X，et al.Cadherin-11 cooperates with inflammatory factors to promote the migration and invasion of fibroblast-like synoviocytes in pigmented villonodular synovitis ［J］.Theranostics，2020，10(23)：10573-10588.
［7］Gouin F，Noailles T.Localized and diffuse forms of tenosynovial giant cell tumor (formerly giant cell tumor of the tendon sheath and pigmented villonodular synovitis) ［J］.Orthop Traumatol Surg Res，2017，103(1s)：S91-S97.
［8］Turkucar S，Makay B，Tatari H，et al.Pigmented villonodular synovitis：Four pediatric cases and brief review of literature ［J］.J Postgrad Med，2019，65(4)：233-236.
［9］Patel KH，Gikas PD，Pollock RC，et al.Pigmented villonodular synovitis of the knee：A retrospective analysis of 214 cases at a UK tertiary referral centre ［J］.Knee，2017，24(4)：808-815.
［10］Jha SC，Nishisho T，Matsuura T，et al.Pigmented villonodular synovitis of the knee joint in a 5-year-old girl treated with combined open an d arthroscopic surgery：a case report ［J］.J Pediatr Orthop B，2016，25(6)：564-569.
［11］Stephan SR，Shallop B，Lackman R，et al.Pigmented Villonodular Synovitis：A Comprehensive Review and Proposed Treatment Algorithm ［J］.JBJS Rev，2016，4(7)：e3.
［12］Quaresma MB，Portela J，Soares do Brito J.Open versus arthroscopic surgery for diffuse tenosynovial giant-cell tumours of the knee：a systemati c review ［J］.EFORT Open Rev，2020，5(6)：339-346.
［13］Mastboom MJL，Palmerini E，Verspoor FGM，et al.Surgical outcomes of patients with diffuse-type tenosynovial giant-cell tumours：an international，re trospective，cohort study ［J］.Lancet Oncol，2019，20(6)：877-886.
［14］Gu HF，Zhang SJ，Zhao C，et al.A comparison of open and arthroscopic surgery for treatment of diffuse pigmented villonodular synovit is of the knee ［J］.Knee Surg Sports Traumatol Arthrosc，2014，22(11)：2830-2836.
［15］Rodriguez-Merchan EC.Review article：Open versus arthroscopic synovectomy for pigmented villonodular synovitis of the knee ［J］.J Orthop Surg (Hong Kong)，2014，22(3)：406-408.
［16］Keyhani S，Kazemi SM，Ahn JH，et al.Arthroscopic Treatment of Diffuse Pigmented Villonodular Synovitis of the Knee：Complete Synovectomy and Septum Removal-Midterm Results ［J］.J Knee Surg，2019，32(5)：427-433.
［17］Van Der Heijden L，Piner SR，van de Sande MA.Pigmented villonodular synovitis：a crowdsourcing study of two hundred and seventy two patients ［J］.Int Orthop，2016，40(12)：2459-2468.
［18］Mollon B，Griffin AM，Ferguson PC，et al.Combined arthroscopic and open synovectomy for diffuse pigmented villonodular synovitis of the knee ［J］.Knee Surg Sports Traumatol Arthrosc，2016，24(1)：260-266.
［19］曹忠书，田家祥，江海良，等.膝关节色素绒毛结节性滑膜炎治疗方法的选择［J］.实用骨科杂志，2017，23(6)：503-506；518.
［20］Capellen CF，Tiling R，Klein A，et al.Lowering the recurrence rate in pigmented villonodular synovitis：A series of 120 resections ［J］.Rheumatology (Oxford)，2018，57(8)：1448-1452.
［21］Mollon B，Lee A，Busse JW，et al.The effect of surgical synovectomy and radiotherapy on the rate of recurrence of pigmented villonodul ar synovitis of the knee：an individual patient meta-analysis ［J］.Bone Joint J，2015，97-B(4)：550-557.
［22］Duan Y，Qian J，Chen K，et al.Necessity of adjuvant postoperative radiotherapy for diffuse pigmented villonodular synovitis of the knee：A case report and literature review ［J］.Medicine (Baltimore)，2018，97(3)：e9637.
［23］Miszczyk M，Jochymek B，Miszczyk L，et al.The results of 394 consecutive cases of knee joint radiation synovectomy (radiosynoviorthesis) using 90Y ［J］.Ann Nucl Med，2020，34(2)：94-101.
［24］Tap WD，Gelderblom H，Palmerini E，et al.Pexidartinib versus placebo for advanced tenosynovial giant cell tumour (ENLIVEN)：a randomised phase 3 trial ［J］.Lancet，2019，394(10197)：478-487.
［25］Brahmi M，Cassier P，Dufresne A，et al.Long term term follow-up of tyrosine kinase inhibitors treatments in inoperable or relapsing diffuse type tenosynovial giant cell tumors (dTGCT) ［J］.PLoS One，2020，15(5)：e0233046.