文章摘要
陈建,刘俊才,叶苏娟,等.关节镜下清理联合调强放疗治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的临床研究.骨科,2021,12(6): 529-534.
关节镜下清理联合调强放疗治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的临床研究
Clinical Study of Arthroscopic Debridement and Postoperative Intensity-Modulated Radiotherapy in the Treatment of Diffuse Pigmented Villonodular Synovitis of Knee
投稿时间:2021-07-25  
DOI:10.3969/j.issn.1674-8573.2021.06.009
中文关键词: 关节镜  调强放疗  弥漫型色素沉着绒毛结节性滑膜炎
英文关键词: Arthroscopy  Intensity modulated radiotherapy  Diffuse pigmented villous nodular synovitis
基金项目:
作者单位E-mail
陈建 西南医科大学附属医院骨科四川泸州 646000  
刘俊才 西南医科大学附属医院骨科四川泸州 646000  
叶苏娟 西南医科大学附属医院肿瘤科四川泸州 646000  
黎红霞 西南医科大学附属医院肿瘤科四川泸州 646000  
李忠 西南医科大学附属医院骨科四川泸州 646000  
唐宇 西南医科大学附属医院骨科四川泸州 646000  
程宇翔 西南医科大学附属医院骨科四川泸州 646000  
雷蕾 西南医科大学附属医院康复科四川泸州 646000  
陈歌 西南医科大学附属医院骨科四川泸州 646000 drchenge@163.com 
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中文摘要:
      目的 评估分析关节镜下清理联合术后调强放疗治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎(diffuse pigmented villonodular synovitis,DPVNS)的疗效与安全性。方法 回顾性分析2013年7月至2018年12月我院收治的59例膝关节DPVNS病人的临床资料,其中男19例,女40例,右膝28例,左膝31例,年龄为(45.7±17.7)(18~65岁)岁,病程为1~120个月。所有病人均接受关节镜下清理并行组织病理学检查确诊。术后接受调强放疗病人21例(联合放疗组),单纯手术治疗病人38例(单纯手术组)。随访时记录病人疼痛视觉模拟量表(visual analogue scale,VAS)、Lysholm膝关节评分、国际膝关节文献委员会(the international knee documentation committee,IKDC)膝关节评估表、膝关节活动度(ROM)、术后复发及并发症情况。结果 病人术后随访时间为(54.3±19.5)个月(24~89个月)。所有病人术后创口均一期愈合,无术后感染。末次随访时联合放疗组复发率(0%)低于单纯手术组(18.4%),差异有统计学意义(P<0.05)。两组病人末次随访时VAS评分、Lysholm评分、IKDC评分、膝关节ROM与术前比较,差异均有统计学意义(P均<0.05)。而两组末次随访时VAS评分、Lysholm评分、IKDC评分、膝关节ROM的组间比较,差异均无统计学意义(P均>0.05)。单纯手术组中1例病人(2.1%)出现膝关节僵硬,联合放疗组中4例病人(19.0%)出现局部皮肤色素沉着。结论 关节镜下清理治疗膝关节DPVNS是一种安全有效的手术方法,在本研究中术后联合调强放疗复发率更低,但远期复发率需进一步随访观察。
英文摘要:
      Objective To evaluate and analyze the efficacy and safety of arthroscopic debridement combined with postoperative intensity-modulated radiotherapy in the treatment of diffuse pigmented villonodular synovitis (DPVNS) of the knee. Methods A retrospective analysis was performed on the clinical data of 59 patients with knee DPVNS admitted to our hospital from July 2013 to December 2018, including 19 males and 40 females, 28 cases at the right knee and 31 cases at the left knee, aged (45.7±17.7) (18-65) years old, with the course of disease ranging from 1 to 120 months. All patients underwent arthroscopic debridement and histopathological examination to confirm the diagnosis. A total of 21 patients received intensity-modulated radiotherapy after surgery (combined radiotherapy group), and 38 patients received surgical treatment alone (simple surgery group). During the follow-up, the patient's pain visual analogue scale (VAS) score, Lysholm knee score, and International Knee Documentation Committee (IKDC) score, knee range of motion (ROM), postoperative recurrence and complications were recorded. Results The patients were followed up for (54.3±19.5) months (24-89 months). All patients had stage I wound healing without postoperative infection. At the last follow-up, the recurrence rate of the combined radiotherapy group (0%) was lower than that of the simple surgery group (18.4%), and the difference was statistically significant (P<0.05). VAS score, Lysholm score, IKDC score, knee joint ROM at the last follow-up of two groups were compared with those before surgery, and the difference was statistically significant (all P<0.05). There was no significant difference in VAS score, Lysholm score, IKDC score, and knee ROM between two groups at the last follow-up two groups (all P>0.05). One case (2.1%) in the simple surgery group had knee stiffness. In the combined radiotherapy group, 4 patients (19.0%) had local skin pigmentation. Conclusion Arthroscopic debridement for the treatment of DPVNS of knee joint is a safe and effective surgical method. In this study, the recurrence rate of DPVNS of the knee by postoperatively combined intensity-modulated radiotherapy is lower, but the long-term recurrence rate requires further follow-up observation.
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