膝关节弥漫性色素绒毛结节性滑膜炎的分期滑膜切除术和外放疗后的平均10年随访结果令人满意，复发率低。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2025-05-24 DOI:10.1016/j.jisako.2025.100907

Fahmy Samir Fahmy MD, Mohamed ElAttar MD, Ahmed Hatem Farhan MD, Sami Ibrahim Sadek MD, Mahmoud Abdo Mahmoud MD, Hossam Fathi Mahmoud MD

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引用次数: 0

摘要

膝关节弥漫性色素绒毛结节性滑膜炎（PVNS）是一种局部破坏性病变，易在滑膜切除术后复发。本研究旨在评估分期滑膜切除术和外放疗联合治疗弥漫性膝前神经综合征的长期功能结局和复发率。方法：回顾性收集2011年6月至2017年9月期间23例膝关节弥漫性PVNS患者的资料。患者接受分阶段关节前镜联合开放后滑膜切除术后低剂量外放疗（平均3000 cGy）。术前和最后随访时，使用国际膝关节文献委员会（IKDC）评分、肌肉骨骼肿瘤协会（MSTS）评分、西安大略和麦克马斯特大学骨关节炎（WOMAC）评分和SF-36评分以及膝关节运动测量来评估功能结局。统计分析评估功能评分和复发率的变化，p值小于0.05作为显著性的截止水平。结果：平均随访121.1±20.2个月，最短85个月。在最后随访时，平均ROM从84.1±16.2°改善到110.4±9.7°。WOMAC评分由44.5±5.1分提高至81.5±6.3分（p < 0.00001）。IKDC评分从43.7±8.1提高到79.1±7.4 (p < 0.00001)， MSTS评分从6.7±2.1提高到20.3±5.7 (p < 0.00001)， SF-36评分从28.6±7.4提高到77.4±11.5 （p < 0.00001）。最后一次随访时有2例复发（8.6%），轻微并发症发生率为21.7%。结论：分期滑膜切除术联合外放疗是治疗弥漫性膝前神经痛的有效方法。在延长的随访期间，它已显示出显著的功能改善和低复发率，支持其作为持久和可靠的治疗策略的作用。证据等级：IV级，回顾性队列。

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Satisfactory functional outcomes and low recurrence rates at a mean 10-year follow-up after combined staged synovectomy and external radiotherapy for diffuse pigmented villonodular synovitis of the knee

Introduction

Diffuse pigmented villonodular synovitis (PVNS) of the knee is a locally destructive lesion that tends to recur following surgical synovectomy. This study aims to evaluate the long-term functional outcomes and recurrence rates of combined staged synovectomy and external radiotherapy in managing diffuse PVNS of the knee.

Methods

The data of twenty-three patients who had a diffuse PVNS of the knee between June 2011 and September 2017 were retrospectively collected. The patients underwent combined staged anterior arthroscopic and open posterior synovectomy followed by low-dose external radiotherapy (average 3000 cGy). Functional outcomes were assessed preoperatively and at the final follow-up using the International Knee Documentation Committee (IKDC) score, Musculoskeletal Tumor Society (MSTS) score, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, and SF-36 score, along with the knee motion measurements. Statistical analysis evaluated the changes in functional scores and recurrence rates, with a p-value < 0.05 as the cut-off level of significance.

Results

The mean follow-up time was 121.1 ± 20.2 months, with a minimum of 85 months. At the final follow-up, the mean range of motion (ROM) improved from 84.1 ± 16.2° to 110.4 ± 9.7°. The WOMAC score increased significantly from 44.5 ± 5.1 to 81.5 ± 6.3 (p < 0.00001). The IKDC score improved from 43.7 ± 8.1 to 79.1 ± 7.4 (p < 0.00001), MSTS scores from 6.7 ± 2.1 to 20.3 ± 5.7 (p < 0.00001), and SF-36 scores from 28.6 ± 7.4 to 77.4 ± 11.5 (p < 0.00001). Two recurrent cases were documented at the last follow-up visit (8.6%), with a minor complication rate of 21.7%.

Conclusion

Combined staged synovectomy and external radiotherapy is an effective treatment for diffuse PVNS of the knee. It has demonstrated significant functional improvement and low recurrence rates over extended follow-up periods, supporting its role as a durable and reliable treatment strategy.