色素沉着绒毛结节性滑膜炎行全髋关节置换术治疗的临床评估

Total hip arthroplasty for pigmented villonodular synovitis of hip

目的回顾性研究全髋关节置换术结合滑膜切除治疗晚期髋关节色素沉着绒毛结节性滑膜炎(PVNS)的临床效果。方法对2000年10月至2010年6月间行髋关节切开滑膜清理加人工髋关节置换术治疗的13例晚期髋关节PVNS感染性患者进行回顾性研究,其中8例为局限型,5例为弥漫型,平均年龄33.7岁(21～65岁)。患者术前活动受限症状明显,术前检查提示关节面破坏,关节间隙狭窄,严重的伴有股骨头变形。术中采用关节切开滑膜广泛清理人工髋关节置换。随访分析患者功能恢复情况,比较术前、术后Harris评分及复发情况。结果 10例患者平均术后随访5.6年(0.5～10.3年),未出现复发,假体稳定,Harris评分从术前的47.6分提高到90.8分,能进行日常活动。3例出现复发,其中1例再次行切开清理术,术后良好;1例目前暂时行放射治疗;1例因复发面积广泛压迫下肢血液循环,减容手术无效最终行髋关节离断术。结论全髋关节置换结合增生滑膜切除是治疗局限型PVNS伴有骨质破坏的合适手术方式,能极大改善临床症状,复发率较低。对于弥漫型的治疗,复发率较高,仍待观察。

Objective To evaluate the efficacy of total hip arthroplasty （THA） combined with synovectomy on patients with late-stage pigmented villonodular synovitis （PVNS） of the hip. Methods From October 2000 to June 2010, 13 cases of PVNS were retrospectively reviewed, of which eight cases were localization type and five cases were diffusion type. The mean age was 33.7 years （ range, 21 - 65 years）. All cases had activity limitation and damage in articular surface before operation. THA combined with synovectomy was performed in all cases. Pre-and post-operative Harris Hip Scoe and recurrence rate were analyzed. Results 10 patients were followed up for an average time of 5.6 years （ range, 0. 5 - 10. 3 years） with no recurrence. Mean preoperative Harris hip scores improved from 47.6 to 90. 8 points; all patients were able to perform moderate daily living activities. Three cases recurred, of which one case had hip disarticulation because of severe leg dysemia. Conclusions THA combined with synovectomy is an adequate therapeutic choice for local PVNS with end-stage joint destruction and it appears to be effective for improving clinical results and preventing recurrence. In diffusive PVNS, the recurrence rate is high, which needs more observation.