手术联合放疗对色素沉着绒毛结节性滑膜炎的疗效观察

发布时间：2018-03-29 09:23

本文选题：弥漫型色素沉着绒毛结节性滑膜炎　切入点：膝关节　出处：《山东大学》2015年硕士论文

【摘要】：目的：比较关节镜下滑膜切除术联合术后关节腔内放疗与单纯关节镜滑膜切除术治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎(PVNS)的临床疗效,总结有效降低本病复发率的治疗方法。方法：选取自2009年1月至2014年10月于我院住院、经术前膝关节MRI检查、关节镜手术和术后病理学检查确诊为膝关节弥漫型PVNS患者57例,30例进行单纯关节镜下滑膜切除术治疗,其中男16例,女14例,年龄(36.4±13.70)岁；27例行关节镜下滑膜切除术联合术后关节腔内放疗,其中男17例,女10例,年龄(36.6±14.31)岁,所有患者术前均进行Lysholm评分及国际膝关节文献委员会(IKDC)膝关节功能主观评分。术后随访了解膝关节的活动度、肿胀、疼痛等并发症及病情复发等情况,并再次进行Lysholm评分及IKDC 2000评分以判断预后。结果：所有患者平均随访(31.3±17.80)个月。两组患者性别、年龄比较无统计学意义。单纯手术组：术前Lysholm评分(48.8±8.67)分,末次随访时(83.4±5.99)分,比较有统计学意义(t=17.986,p0.05)；术前IKDC膝关节功能主观评分(54.2±6.84)分,末次随访时(84.6±6.63)分,比较有统计学意义(t=17.961,p0.05),术后较术前两种评分均有明显提高；联合放疗组：术前Lysholm评分(49.0±9.11)分,末次随访时(85.1±5.91)分,比较有统计学意义(t=17.283,p0.05)；术前IKDC膝关节功能主观评分(52.3±7.20)分,末次随访时(85.8±6.61)分,比较有统计学意义(t=17.819,p0.05),术后较术前两种评分均有明显提高。膝关节活动度：单纯手术组术前为(54.5±18.82)。,末次随访时为(118.5±12.61)。,比较有统计学意义(t=15.470,p0.05)；联合放疗组术前为(55.3±18.74)。,末次随访时为(119.6±13.37)。,比较有统计学意义(t=14.513,p0.05),两组患者术后患膝关节活动度较术前均有明显改善。单纯手术组复发9例,联合放疗组复发2例,差异有统计学意义(X2=5.747,p0.05),手术联合关节腔内放疗治疗PVNS较单纯关节镜下滑膜切除术明显降低复发率；单纯手术组术后3例患者患膝轻度肿胀,无感染病例；联合放疗组6例患者出现患膝疼痛,3例患者皮肤色素沉着,3例患者患膝肿胀,无感染病例。两组患者并发症发生率行X2检验,差异有统计学意义(X2=6.518,p0.05)。结论：关节镜下滑膜切除术联合术后关节腔内放疗治疗膝关节弥漫型PVNS可显著降低PVNS病的复发率,且功能评分与单纯手术组大致相同。但其并发症的发生率较单纯关节镜下滑膜切除术更高。
[Abstract]:Objective: to compare the clinical effects of arthroscopic synovectomy combined with postoperative intra-articular radiotherapy and arthroscopic synovectomy in the treatment of diffuse pigmented villonodular synovitis of knee joint (PVNSs). Methods: from January 2009 to October 2014, the patients were hospitalized in our hospital and examined with MRI before operation. Thirty patients with diffuse PVNS of knee joint were treated by arthroscopic synovectomy, including 16 males and 14 females. Twenty-seven patients (male 17, female 10, age 36.6 卤14.31) underwent arthroscopic synovectomy combined with postoperative intraarticular radiotherapy. All the patients were evaluated with Lysholm score before operation and the subjective score of the knee joint function by the International knee Joint documentation Committee. The postoperative follow-up was conducted to understand the knee joint motion, swelling, pain and other complications, as well as the recurrence of the disease, etc. Lysholm score and IKDC 2000 score were used to judge prognosis again. Results: all patients were followed up for an average of 31.3 卤17.80 months. There was no significant difference in sex and age between the two groups. In the simple operation group, the preoperative Lysholm score was 48.8 卤8.67, and the last follow-up was 83.4 卤5.99. The subjective score of knee joint function of IKDC was 54.2 卤6.84 before operation and 84.6 卤6.63 at the last follow-up, which was significantly higher than that before operation. The preoperative Lysholm score was 49.0 卤9.11 in combined radiotherapy group. At the last follow-up, the score was 85.1 卤5.91, which was statistically significant, and the subjective score of IKDC knee joint function was 52.3 卤7.20 before operation and 85.8 卤6.61 at the last follow-up. The range of knee motion in the simple operation group was 54.5 卤18.82% before operation, and 118.5 卤12.61g in the last follow-up, which was statistically significant compared with that in the combined radiotherapy group before operation (55.3 卤18.74) and in the combined radiotherapy group before operation (118.5 卤12.61), and in the combined radiotherapy group it was 55.3 卤18.74. The mean time was 119.6 卤13.37, and there was significant difference between the two groups. The range of motion of the knee joint in the two groups was significantly improved compared with that before operation, and 9 cases of recurrence were found in the simple operation group, and there was no significant difference between the two groups. The recurrence rate in combined radiotherapy group was significantly lower than that in arthroscopic synovectomy group (P 0.05, P 0.05), and there were 3 cases with mild swelling of knee and no infection after surgery alone, and the recurrence rate was significantly lower in the combined radiotherapy group than in the simple arthroscopic synovectomy group (P 0.05). In the combined radiotherapy group, there were 6 cases of knee pain and 3 cases of skin pigmentation, 3 cases of knee swelling and no infection. The incidence of complications in both groups was examined by X2 test. Conclusion: arthroscopic synovectomy combined with postoperative intra-articular radiotherapy for diffuse PVNS of knee joint can significantly reduce the recurrence rate of PVNS's disease. The functional score was approximately the same as that in the simple operation group, but the incidence of complications was higher than that of arthroscopic synovectomy alone.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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