| 左凯,王文玲,董洪敏,等.膝关节弥漫性色素沉着绒毛结节性滑膜炎术后辅助放射治疗长期疗效观察[J].中华放射医学与防护杂志,2025,45(12):1253-1258.Zuo Kai,Wang Wenling,Dong Hongmin,et al.Long-term efficacy observation of postoperative adjuvant radiotherapy for diffuse pigmented villonodular synovitis of the knee joint[J].Chin J Radiol Med Prot,2025,45(12):1253-1258 |
| 膝关节弥漫性色素沉着绒毛结节性滑膜炎术后辅助放射治疗长期疗效观察 |
| Long-term efficacy observation of postoperative adjuvant radiotherapy for diffuse pigmented villonodular synovitis of the knee joint |
| 投稿时间：2025-03-30 |
| DOI：10.3760/cma.j.cn112271-20250330-00114 |
| 中文关键词: 膝关节 色素性绒毛结节性滑膜炎 放疗 功能 安全性 |
| 英文关键词:Knee joint Pigmented villonodular synovitis (PVNS) Radiotherapy Function Safety |
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| 中文摘要: |
| 目的 评估分析关节镜下清理术后联合三维适行放疗治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎(DPVNS)的长期疗效及对关节功能的影响。方法 回顾性分析2011年4月至2023年12月贵州医科大学附属肿瘤医院收治的60例膝关节DPVNS患者的临床资料，手术至放疗开始的时间间隔平均为(2.1±0.8)个月。所有患者均接受关节镜下清理并行组织病理学检查确诊。60例患者术后均接受辅助放射治疗(30.6或36.0 Gy)。通过中文版西安大略省和麦克马斯特大学(WOMAC)骨关节炎指数评估疗效及患膝关节功能状况，采用常见不良事件评价标准第5版(CTCAE V5.0)对患者急性和长期不良反应进行评估。结果 所有患者术后创口均一期愈合，无术后感染发生。中位随访时间(85.0±46.7)个月。局部复发率为3.3%(2例)，2例患者复发发生于放疗结束后第3年及第5年。放疗结束时患膝关节与放疗前、放疗结束后1、3、5、7年相比，WOMAC总分、疼痛、僵硬及躯体功能评分差异均无统计学意义(P>0.05)，表明放疗对患膝关节短期和长期功能无明显影响。30.6与36.0 Gy两组术后辅助放疗结束时，WOMAC总分、疼痛、僵硬和躯体功能与放疗结束后1、3、5、7年相比差异亦无统计学意义(P>0.05)。60例行术后辅助放疗的急性不良反应均为1级皮肤反应(7例，11.67%)，经长期随访未观察到膝关节局部皮肤纤维化、毛细血管扩张、软组织水肿、关节疼痛、僵硬及活动受限的情况，没有2级或以上的长期皮肤反应。结论 关节镜下膝关节滑膜切除术联合术后辅助放疗治疗膝关节DPVNS提供了良好的局部控制，同时保持了良好的患膝关节功能，是一种安全可靠的治疗方法。 |
| 英文摘要: |
| Objective To evaluate and analyze the long-term efficacy of arthroscopic debridement combined with postoperative three-dimensional conformal radiotherapy (3 D-CRT) in the treatment of diffuse pigmented villonodular synovitis (DPVNS) of knee joints, along with the safety of joint functions.Methods A retrospective analysis was conducted on the clinical data of 60 patients with DPVNS in their knee joints who were admitted to the Affiliated Cancer Hospital of Guizhou Medical University from April 2011 to December 2023. All patients underwent arthroscopic debridement, followed by histopathological examination for definitive diagnosis. Then, these patients received postoperative adjuvant radiotherapy (POART: 30.6 or 36.0 Gy), with an average interval between the surgery and radiotherapy of (2.1 ± 0.8) months. The treatment efficacy and the functions of the affected knee joints were assessed using the validated Chinese version of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). In addition, the acute and long-term adverse events were examined using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.Results The primary healing of the surgical wounds was observed in all patients, with no postoperative infection occurring. The median follow-up durations were (85.0 ± 46.7) months, and the local recurrence rate of the patients was determined at 3.3% (2 cases), with recurrence observed at 3 and 5 years post-radiotherapy. Comparisons of the affected knee joints before radiotherapy, at the end of radiotherapy, and at 1, 3, 5, and 7 years post-radiotherapy revealed no statistically significant differences in the total WOMAC score, pain, stiffness, and physical function scores (P > 0.05). This suggests that radiotherapy exerts no significant effect on the short- and long-term functions of the affected knee joints. In addition, comparisons between the two groups receiving 30.6 and 36.0 Gy POART at the end of radiotherapy and at 1, 3, 5, and 7 years post-radiotherapy also revealed no statistically significant difference (P > 0.05) in the total WOMAC scores, pain, stiffness, and physical function scores. The acute adverse events that the patients suffered were all grade-1 cutaneous adverse reactions (CARs) (7 cases, 11.67%). The subsequent long-term follow-up revealed the absence of CARs of grades ≥ 2, including local skin fibrosis, telangiectasia, soft tissue oedema, joint pain, stiffness, or restricted mobility.Conclusions Arthroscopic synovectomy combined with POART provides effective local control over DPVNS by while preserving good joint functions of patients, proving safe and reliable for the treatment of DPVNS. |
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