Results and recurrence of pigmented villonodular synovitis of the ankle: does diffuse PVNS with extra-articular extension tend to recur more often?
Results and recurrence of pigmented villonodular synovitis of the ankle: does diffuse PVNS with extra-articular extension tend to recur more often?
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DOI：
10.1007/s00167-017-4488-8
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发表时间：
2018-10-01
影响因子：
3.8
通讯作者：
Hu, YueLin
中科院分区：
文献类型：
--
作者：
Guo, QinWei;Shi, WeiLi;Hu, YueLin
目的分析踝关节色素沉着绒毛结节性滑膜炎（Pigmented Villonodular Synovitis，PVNS）的滑膜切除术后复发情况。方法回顾性分析2004年至2015年我院收治的31例PVNS患者，其中局限性PVNS 5例，弥漫性PVNS 26例。中位年龄为35岁（范围18-63岁）。5例局限性PVNS患者行部分滑膜切除术（I组）; 10例局限于关节内滑膜的弥漫性PVNS患者行关节镜下综合滑膜切除术（II组）; 16例弥漫性PVNS扩散至关节外腱鞘的患者行关节镜下联合开放性滑膜切除术（III组）。第II组和第III组接受辅助放疗。结果27例患者随访时间15-108个月，平均54个月。在三组中，平均AOFAS评分从术前的75分（所有三组）提高到术后的100分（I组）、97分（II组）和90分（III组）。Ⅰ、Ⅱ组优良率为100%，Ⅲ组优良率为73.3%。结论踝部弥漫性PVNS可通过手术切除滑膜及辅助放疗获得成功。局部PVNS不需要放射治疗。伴关节外侵犯的PVNS患者复发率较高。
Purpose The aim of this study was to provide the outcomes and to analyze the recurrence of Pigmented Villonodular Synovitis (PVNS) of the ankle joint treated by surgical synovectomy.Methods Thirty-one PVNS cases of the ankle, including 5 localized PVNS cases and 26 diffuse PVNS cases, were treated in our institute between 2004 and 2015. The median age was 35 (range 18-63) years. The 5 localized PVNS cases were treated with partial synovectomy (group I); 10 diffuse PVNS cases limited to intra-articular synovium received arthroscopic comprehensive synovectomy (group II); and 16 cases with diffuse PVNS spreading to extra-articular tendon sheaths underwent combined arthroscopic and open synovectomy (group III). Adjuvant radiotherapy was provided in groups II and III. The American Orthopaedic Foot and Ankle Society (AOFAS) score and subjective grading of procedure were used to evaluate the results.Results Twenty-seven patients were followed with a median of 54 (range 15-108) months. In the three groups, the average AOFAS score improved from 75 (in all three groups) points preoperatively to 100 (group I), 97 (group II), and 90 points (group III) postoperatively. The rate of good-to-excellent result was 100% in group I and II and 73.3% in group III. Only in group III, recurrence occurred in five cases.Conclusions Diffuse PVNS of the ankle can be successfully managed with surgical synovectomy and adjuvant radiotherapy. Radiotherapy is not needed for localized PVNS. The recurrence rate in PVNS patients with extra-articular extension is higher.