CAJ | 학술논문

目的探讨单纯膝关节镜手术与联合术后放疗治疗膝关节弥漫性色素绒毛结节性滑膜炎(DPVNS)的临床疗效和安全性.方法武汉市中心医院及北京军区总医院于2009年1月至2014年1月收治的30例膝关节DPVNS患者,平均病程为35.6个月(4～121个月).按患者治疗意愿分为手术联合术后放射治疗(联合治疗)组16例,单纯手术组14例.联合治疗组行关节镜下滑膜切除联合术后局部放射治疗,总剂量40 Gy,每次2 Gy.所有患者治疗后平均随访时间38.7个月(12 ～72个月),比较两组术后复发率、KSS临床评分和功能评分.结果联合治疗组优良率(14/16)明显高于单纯手术组(11/14)(x2 =9.87,P＜0.05),且复发率(1/16)明显低于单纯手术组(3/14)(x2=1.83,P＜0.05),治疗后KSS临床评分和功能评分改善明显优于单纯手术组(x2=15.00、15.78,P＜0.05).放疗的不良反应为白细胞下降、肢体浮肿、皮肤出现色素沉着,联合治疗组患者均能较好地耐受.结论关节镜术后放疗治疗膝关节DPVNS是一种安全有效的治疗手段,值得临床推广应用.
목적 탐토단순슬관절경수술여연합술후방료치료슬관절미만성색소융모결절성활막염(DPVNS)적림상료효화안전성.방법 무한시중심의원급북경군구총의원우2009년1월지2014년1월수치적30례슬관절DPVNS환자,평균병정위35.6개월(4～121개월).안환자치료의원분위수술연합술후방사치료(연합치료)조16례,단순수술조14례.연합치료조행관절경하활막절제연합술후국부방사치료,총제량40 Gy,매차2 Gy.소유환자치료후평균수방시간38.7개월(12 ～72개월),비교량조술후복발솔、KSS림상평분화공능평분.결과 연합치료조우량솔(14/16)명현고우단순수술조(11/14)(x2 =9.87,P＜0.05),차복발솔(1/16)명현저우단순수술조(3/14)(x2=1.83,P＜0.05),치료후KSS림상평분화공능평분개선명현우우단순수술조(x2=15.00、15.78,P＜0.05).방료적불량반응위백세포하강、지체부종、피부출현색소침착,연합치료조환자균능교호지내수.결론 관절경술후방료치료슬관절DPVNS시일충안전유효적치료수단,치득림상추엄응용.
Objective To explore the clinical efficacy and safety of using simple arthroscopic operation combined with post-operative radiotherapy in the treatment of knee joint diffuse pigmented villonodular synovitis (DPVNS).Methods A total of 30 cases with knee DPVNS in Wuhan Central Hospital and General Hospital of Beijing Military Region from January 2009 to January 2014 were enrolled,including 18 males and 12 females with average age of 42.5 years (28-64 years).The average duration was 35.6 months(4-121 months).According to the decision of the patients,16 cases treated with operation combined with postoperative radiotherapy and the other 14 cases with operation alone.The treatment group accepted arthroscopic synovial excision and received local radiotherapy,the total dose of radiotherapy was 40 Gy,2 Gy/fraction.While the control group received arthroscopic operation alone.Patients were followed up,which the average time of 38.7 months (12-72 months).The recurrence rate,clinical KSS score and function score were compared between the two groups.Results The efficiency of treatment group (14/16) was significantly higher than the control group (11/14) (x2 =9.87,P ＜ 0.05),and the recurrence rate of the former(1/16) was significantly lower than that latter (3/14) (x2 =1.83,P ＜ 0.05).Furthermore the KSS clinical score and function score were improved significantly in the treatment group(x2 =15.00,15.78,P ＜ 0.05).The main side effect of radiation therapy were leucopenia,limb edema,skin pigmentation and so on,meanwhile the treatment group was well tolerated.Conclusions Arthroscopic operation combined with postoperative radiotherapy is safe and effective in treatment of DPVNS,and it is worthy of clinical application.