Güray TOĞRAL, Murat ARIKAN, Meftun KARATAŞ, Erdem AKTAŞ, Şafak GÜNGÖR

Diffüz Pigmente Villonodüler Sinovite Cerrahi Yaklaşım

AMAÇ: Diz ekleminde diffüz pigmente villonodüler sinovit tanısı alan biri bilateral 16 olgu klinik, histopatolojik bulgular ve cerrahi tedavi sonuçları açısından incelenmiştir.YÖNTEMLER: Diffüz pigmente villonodüler sinovit (DPVNS) tanısı alan 16 olgunun 4 yıllık takip sonuçları retrospektif olarak incelenmiştir. Yaş aralığı 16 ile 44 (ortalama 30) olan hastaların 10'u erkek, 6'sı kadındı. 9 hastada sol, 7 hastada sağ diz eklem tutulumu mevcuttu. Ağrı, şişlik ve kitle etkisi ile oluşan bası semptomları varlığı en sık görülen semptomlardı.BULGULAR: Fizik muayenede en sık bulgu (%40) özellikle suprapatellar bölgede görülen şişlik idi. Hastaların %95'inde klinik olarak diz ekleminde efüzyon mevcuttu. Hastaların 11'inde ortalama 1.5 cm olarak ölçülen uyluk atrofisi vardı. Oniki hastada ise tutulan eklemde 10 dereceye varan fleksiyon kontraktürü mevcuttu. 8 hastaya başvuru öncesi tanı amaçlı diz eklem içi aspirasyon yapılmıştı ve sadece 3 hastada aspirasyonda karakteristik sero-hemorojik sıvı içeriği gözlendi.SONUÇ: Biz DPVNS'de hastaların tanısında fizik muayene bulguları ve anamnezlerinin çok önemli olduğunu düşünmekteyiz. Ayrıca bu hastalarda öncelikli olarak hastalığın akla getirilmesi ve ön planda artrosenteze başvurulmaması gerektiği kanısındayız. PVNS'nin hala günümüzde primer tedavisi açık veya artroskopik olarak yapılan sinovyektomidir.

Anahtar Kelimeler:

Pigmente villonodüler sinovit, Hemorajik efüzyon; Diz; Sinovyal membran

Surgical Assessment of Diffuse Pigmented Villonodular Synovitis

OBJECTIVE: One bilateral totally 16 diffuse pigmented villonodular synovitis of the knee cases was examined in terms of clinical presentations, histopathological findings and surgical outcome.METHODS: 16 patients with the diagnosis of DPVNS were retrospectively analyzed with a period of 4 years. The mean age was 30 years (16-44). 10 patients were male and 6 patients were female. Nine patients left and 7 patients right knees were affected. Pain, swelling and pressure symptoms caused by mass effect were the most common clinical findings.RESULTS: The most common physical examination finding was suprapatellar swelling (40%). Effusion in the knee joint was detected in 95% of the patients. There was mean of 1.5 cm thigh atrophy in 11 patients. Flexion contracture about 10 degrees in the affected knee was noted in 12 patients. Three of 8 patients that knee aspiration was performed have characteristic sero-hemorrhagic fluid.CONCLUSION: We think that physical examination and history is very important in diagnosis of patients with PVNS. Aspiration of the joint should be avoided. Open or arthroscopic syneviectomy is the primary treatment of PVNS.

Keywords:

Pigmented villonodular synovitis, Hemorrhagic effusion; Knee; Synovial membrane,

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