单纯膝关节镜手术与联合术后放疗治疗弥漫性色素沉着绒毛结节性滑膜炎的临床研究

Clinical study of diffuse pigmented villonodular synovitis arthroscopic using simple knee arthroscopy operation combined with post-operation radiotherapy

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.

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.