The dissertation is devoted to solving the urgent scientific problem of traumatology and orthopedics - to improve the diagnosis and results of treatment of pigmented villonodular synovitis of the knee joint.
The basis of this work is the analysis of the results of diagnosis and treatment of 77 patients with pathohistologically verified diagnosis of pigmented villonodular synovitis of the knee joint, which from 2010 to 2019 were treated at the departments of the State Institution «Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine». Kyiv. The mean age of the patients was 34,4 years. There were 32 males (42 %) and 45 females (58 %). The distribution of patients by groups, by age, was estimated by Pearson's criterion (χ2) and was the same (p> 0.05). All patients were divided into two clinical groups. In the main group there were 52 (67,53 %) patients, diagnosis and treatment which were performed according to our proposed diagnostic and therapeutic algorithm. In the control group, 25 (32,47 %) patients were diagnosed and treated with other commonly used methods and techniques.
A diagnostic and therapeutic algorithm has been developed that aims to improve the diagnosis and treatment of patients with pigmented villonodular synovitis of the knee. The existing surgical methods have been improved, which helped us to significantly reduce the likelihood of recurrence in the postoperative period to 7,7 %.
On the basis of the existing functional-prognostic evaluation scale, which allows to evaluate not only the functional condition of the joint, but also the quality of the performed treatment and to monitor the possibility of recurrence.
It has been investigated that determining the level of vascular endothelial growth factor (VEGF) in the serum and synovial fluid of patients with pigmented villonodular synovitis after surgery may serve as one of the likely prognostic markers for the detection of early manifestations of relapse.
For the first time, the condition of the regenerated inner layer of the articular capsule in a patient with a diffuse form of pigmented villonodular synovitis was investigated and analyzed in the long term after successful total arthroscopic synovectomy.
We have identified and analyzed the causes and errors in the treatment of patients with pigmented villonodular synovitis of the knee joint before admission to the clinic. Analyzing the data, we found 498 errors, including: diagnostic – 134 (26,91 %) cases, tactical – 193 (38,76 %) and 171 (34,33 %) medical. It was found that on average one patient had 7,01 errors.
The structure of the knee joint synovitis was first investigated and the proportion of pigmented villonodular synovitis, which was 1,6 %, was determined.
The use of our proposed diagnostic and therapeutic algorithm for the treatment of patients in the main group allowed to obtain on the Lysholm scale 27 % of excellent results (in the control group 12 %), 56 % of good results (in the control group 20 %), 13 % satisfactory results (36 %), and only 4 % were unsatisfactory (32 %). In our opinion, this was one of the factors that in the main recurrence group was in 7,7 % of cases and in the control group – 40 %.
