CAJ | 학술논문

目的总结一期前后双入路行滑膜切除术及术后辅助放疗治疗膝关节弥漫性色素绒毛结节性滑膜炎(PVNS)的临床疗效.方法采用回顾性研究方法,从2007年10月至2009年6月,我院收治11位膝关节弥漫性色素绒毛结节性滑膜炎患者并进行分析.纳入标准为组织病理学确诊的膝关节内外弥漫性PVNS.男4例,女7例;年龄19~51岁,平均31岁.手术方式采用一期前后双入路滑膜切除术,术后给予局部放疗并进行随访.疗效评定包括:疾病复发情况、手术并发症、膝关节活动度、膝关节功能采用膝关节外科学会评分方法.结果平均手术时间3.5h (2.8-4.5h),术中出血平均800ml (500~1200ml).所有患者切口愈合良好,未出现感染、血管神经损伤等并发症.所有患者得到随访,平均随访时间是48个月(37-56个月).10例患者治愈,1例患者出现关节外非进展性局部复发.随访期间膝关节弯曲范围达90°~130°,其中3例患者出现5°的弯曲挛缩,膝关节等级和功能等级评分显著性地改善,从术前的63.2~70分到术后的94.7~95.6分,所有患者取得良好的临床疗效.结论一期前后双入路滑膜切除术结合术后膝关节外放射治疗的治疗方法,能够良好地控制膝关节弥漫性色素绒毛结节性滑膜炎,其复发率低,膝关节活动度恢复良好,膝关节功能结果满意.
목적총결일기전후쌍입로행활막절제술급술후보조방료치료슬관절미만성색소융모결절성활막염(PVNS)적림상료효.방법채용회고성연구방법,종2007년10월지2009년6월,아원수치11위슬관절미만성색소융모결절성활막염환자병진행분석.납입표준위조직병이학학진적슬관절내외미만성PVNS.남4례,녀7례;년령19~51세,평균31세.수술방식채용일기전후쌍입로활막절제술,술후급여국부방료병진행수방.료효평정포괄:질병복발정황、수술병발증、슬관절활동도、슬관절공능채용슬관절외과학회평분방법.결과평균수술시간3.5h (2.8-4.5h),술중출혈평균800ml (500~1200ml).소유환자절구유합량호,미출현감염、혈관신경손상등병발증.소유환자득도수방,평균수방시간시48개월(37-56개월).10례환자치유,1례환자출현관절외비진전성국부복발.수방기간슬관절만곡범위체90°~130°,기중3례환자출현5°적만곡련축,슬관절등급화공능등급평분현저성지개선,종술전적63.2~70분도술후적94.7~95.6분,소유환자취득량호적림상료효.결론일기전후쌍입로활막절제술결합술후슬관절외방사치료적치료방법,능구량호지공제슬관절미만성색소융모결절성활막염,기복발솔저,슬관절활동도회복량호,슬관절공능결과만의.
Objective To summarize the clinical efficacy of the treatment of diffuse pigmented villonodu-larsynovitis (PVNS) of the knee with one-staged anterior and posterior two incision synovectomy and postoperative adjuvant radiotherapy. Methods A retrospective study was done to assess the clinical outcomes in11 patients with diffuse PVNS of the knee treated in our hospital from October 2007 to June 2009. Inclusion criteria:patients who were histopathologically proven to have diffuse PVNS inside and outside the knee. There were 4 males and 7 females, with an average age of 31 years old (range;19-51 years). The surgical methods were one-staged anterior and posterior two incision synovectomy, postoperative local radiotherapy and follow-up after surgery. Efficacy evaluation included tumor recurrence, surgical complications, range of motion of the knee, and functional results that were measured using the Knee Society function score. Results The average operation time was 3.5 hours (range;2.8-4.5 hours), and the mean intraoperative blood loss was 800ml (range;500-1200ml). All incisions were primary healing, and there was no complication of infection, neurovascular injuries and so on for all patients. All patients were followed up, and the mean follow-up period was 48 months (range;37-56 months). 10 patients were disease free and 1 patient had local recurrence, which was extra-articular and non-progressive. The knee flexion ranged from 90° to 130° during the follow-up, and there were 3 patients who developed flexion contractures of 5°. The mean knee rating and functional rating had significantly improved from 63.2-70 points preoperatively to 94.7-95.6 points postoperatively respectively. All patients achieved satisfactory clinical outcomes. Conclusions The treatment method of one-staged anterior and posterior two incision synovectomy, in conjunction with postoperative extra-articular radiotherapy can effectively control diffuse PVNS of the knee, with low recurrence rate, good recovery of knee range of motion and satisfactory results of knee function.