Total knee replacement and arthroscopic treatment for pigmented villonodular synovitis of the knee joint

doi:10.3969/j.issn.2095-4344.2013.52.022

Abstract

Abstract:

BACKGROUND: Surgical treatment for pigmented villonodular synovitis can maximize the excision of synovial lesions and recovery of joint function.

OBJECTIVE: To investigate the knee joint function and relapse rate following treatment of pigmented villonodular synovitis with total knee replacement and arthroscopic synovectomy.

METHODS: We retrospectively analyzed 34 cases of knee pigmented villonodular synovitis admitted for surgical treatment in the Department of Orthopedics, Xiangya Hospital of Central South University, China from December 2006 to December 2011. In these cases, 24 patients received arthroscopic synovectomy and 10 patients were subjected to total knee replacement. Adjuvant radiotherapy was conducted according to postoperative patient’sconditions. Lysholm scoring was employed in the arthroscopic synovectomy group, and American Knee Society scoring was used in the total knee replacement group. Knee function in two groups was compared before and after treatment. Follow-up observation was performed to compare knee function recovery and relapse rate between two groups.

RESULTS AND CONCLUSION: Thirty-four patients were effectively followed up for 12-66 months, mean 41.3 months. Statistical analysis showed that in the arthroscopic synovectomy group, the postoperative Lysholm score was (86.3± 10.3) points, significantly higher than the preoperative score which was (55.5±13.2) points (t=3.81, P=0.016, P < 0.05). In the total knee arthroplasty group, the American Knee Society score was increased from (40.7±2.2) points preoperatively to (90.2±1.1) points postoperatively (t=6.27, P < 0.01). In the arthroscopic synovectomy group, the American Knee Society score was increased from (34.2±3.9) points preoperatively to (80.8±1.9) points postoperatively (t=16.58, P < 0.01). Arthroscopic synovectomy combined with adjuvant radiotherapy can achieve better outcomes in pigmented villonodular synovitis patients, while the total knee replacement for advanced with advanced knee diffuse pigmented villonodular synovitis is better to restore knee function and the recurrence rate is low.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: knee joint, knee, prosthesis, arthroplasty, replacement, knee, synovitis, pigmented villonodular

CLC Number:

R318

Lei Peng-fei, Xie Jie, Wen Ting, Zhong Da, Wang Long, Yang Xu-cheng, Hu Yi-he. Total knee replacement and arthroscopic treatment for pigmented villonodular synovitis of the knee joint[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(52): 9077-9082.

Figures/Tables 1

资料来源：采用检索万方数据库和Pubmed数据库的方法获取资料[10-11]。资料检索公式：检索时间范围2003至2013年，中文检索词为“色素沉着绒毛结节性滑膜炎；关节置换；滑膜切除；关节镜；关节功能”，英文检索词为“pigment villonodular；arthroplasty；synovial membrane excision；arthroscopy；joint function”，共检索出相关文献59篇。其中，万方数据库文献19篇，Pubmed数据库40篇。最终纳入结果分析的文献共12篇[12-23]。入选标准：①检索结果中排除与研究目的不相关的文献。②文献的内容与关节置换和滑膜切除治疗色素沉着绒毛结节性滑膜炎相关。③排除无全文的文献。④同一研究团队以及同一作者的相似研究，只选取其中1篇纳入分析。⑤检索文献体例为论著和病例报告等，均为一次性文献，排除综述类文献。 2.1 人工膝关节置换对色素沉着绒毛结节性滑膜炎患者关节功能改善情况国内关于人工全膝关节置换治疗色素沉着绒毛结节性滑膜炎的病例研究并不是很多。张廷玖等[12]选取12例晚期膝关节色素沉着绒毛结节性滑膜炎患者采用膝关节表面置换治疗，男5例，女7例，年龄45-65岁，平均年龄51.8岁，病程2.5-6.0年，平均病程4.1年，均为单膝发病，左膝7例，右膝5例。患者均获随访，随访时间为3-48个月，平均时间26个月，12例晚期膝关节色素沉着绒毛结节性滑膜炎患者经过治疗关节功能评分获优7例，良3例，可2例，优良率为83.3%。经过膝关节表面置换治疗晚期膝关节色素沉着绒毛结节性滑膜炎，可以达到预期的功能恢复，疗效明显，值得推广。周爱国等[13]观察11例晚期膝关节弥漫型色素沉着绒毛结节性滑膜炎患者，男3例，女8例，年龄42-63岁，平均年龄51.2岁，病程2.5-10.0年，平均病程5.2年。均为单膝发病，左膝7例，右膝4例。9例有膝关节外伤史，2例无明显诱因。治疗前关节活动度为(90.1±17.2)°，膝关节功能按照美国特种外科医院评分为(68.9±8.7)分。患者均于滑膜清除后行人工膝关节表面置换。治疗后12个月1例复发，二次手术后未见复发。X射线片检查显示未见假体周围透亮线、假体松动、下沉及骨溶解等迹象。末次随访时，关节活动度为(109.1±18.6)°，美国特种外科医院评分为(86.7±9.3)分，与治疗前比较差异均有显著性意义(P < 0.05)。关节功能评分获优6例，良3例，可1例，差1例，优良率为81.8%。人工膝关节表面置换同时行滑膜彻底切除治疗晚期膝关节弥漫型色素沉着绒毛结节性滑膜炎可较好恢复膝关节功能，复发率较低，临床疗效可靠。 2.2 人工髋关节置换对色素沉着绒毛结节性滑膜炎患者关节功能改善情况杨永良等[14]观察全关节置换治疗色素沉着绒毛结节性滑膜炎的可行性及临床效果，对经病理检查证实的8例色素沉着绒毛结节性滑膜炎患者实施全关节置换，其中髋关节置换3例，膝关节置换5例，治疗前均行X射线检查。6例弥漫型色素沉着绒毛结节性滑膜炎患者行滑膜全切和全关节置换，2例局限型色素沉着绒毛结节性滑膜炎患者行滑膜部分切除和全关节置换。治疗后均进行系统的康复训练。随访1.5-12.0年，8例患者假体位置良好并获得了满意的关节活动度。所有病例均无复发。可见，全关节置换治疗反复复发导致关节骨软骨破坏或者并发骨性关节炎的色素沉着绒毛结节性滑膜炎患者可获得良好的临床效果。雷鸣等[15]观察金属对金属全髋关节表面置换治疗髋关节色素沉着绒毛结节性滑膜炎的可行性及早期临床效果。选取7例经影像学检查及病理检查确诊的色素沉着绒毛结节性滑膜炎患者，行滑膜切除和全髋关节表面置换。治疗后均进行康复锻炼。治疗前后行Harris髋关节功能评分。7例患者均获得随访，时间12-20(14.6±2.4)个月。患者假体位置良好，无松动、股骨颈骨折及明显骨溶解等并发症，关节活动度90°-130°，未出现复发症状。Harris髋关节功能评分由治疗前(45.2±7.8)分改善至治疗后(95.8±2.6)分。可见，全髋关节表面置换结合滑膜切除早期能有效改善髋关节色素沉着绒毛结节性滑膜炎患者的临床症状，改善关节活动度，提高生活质量。对于弥漫型色素沉着绒毛结节性滑膜炎患者的关节置换治疗，陈宜等[16]研究人工全髋关节置换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的疗效，对13例晚期髋关节色素沉着绒毛结节性滑膜炎患者行髋关节切开滑膜清理加人工髋关节置换治疗，其中8例患者为局限型色素沉着绒毛结节性滑膜炎，5例为弥漫型色素沉着绒毛结节性滑膜炎，患者年龄在21-65岁，平均年龄为33.7岁。治疗前活动受限症状明显，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。10例患者治疗后随访0.5-10.3年，平均随访5.6年，未出现复发，假体稳定，Harris评分从治疗前的47.6分提高到90.8分。3例出现复发，其中1例再次行切开清理，治疗后良好；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。可见，人工全髋关节置换结合增生滑膜切除是治疗局限型色素沉着绒毛结节性滑膜炎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。"

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