Büchler Lorenz, Hosalkar Harish, Weber Martin
Department of Orthopaedic Surgery, University of Bern, Inselspital, 3010, Bern, Switzerland.
Clin Orthop Relat Res. 2009 Nov;467(11):2925-31. doi: 10.1007/s11999-009-0771-4. Epub 2009 Mar 10.
Intraosseous ganglia of the distal tibia are rare. We evaluated the feasibility of surgically treating these lesions with an arthroscopically assisted technique. Five patients with symptomatic distal tibial ganglia underwent surgical curettage and excision with this technique. All patients underwent débridement of the chondral lesion and hypertrophied synovial lining when present, probing of the portal to the ganglion, and subsequently thorough curettage with bone grafting performed through a cortical window made from a separate small incision. Biopsy confirmed the diagnosis in all patients. All patients had eventual relief of symptoms with good integration of bone graft at final followup. There were no recurrences at a minimum followup of 19 months (mean, 38.6 months; range, 19-69 months). Mean time for return to full function was 15.4 weeks (range, 8-17 weeks). There were no intraoperative or postoperative complications. The mean American Orthopaedic Foot and Ankle Society scores increased from 73 points (range, 67-77 points) preoperatively to 94 points (range, 90-100 points) postoperatively. Arthroscopically assisted surgical treatment of ganglia of the distal tibia in the appropriate patient is a reasonably simple technique that relieves symptoms and helps the patient to regain normal gait and full function with no recurrence (in our small series).
Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
胫骨远端的骨内腱鞘囊肿较为罕见。我们评估了采用关节镜辅助技术手术治疗这些病变的可行性。5例有症状的胫骨远端腱鞘囊肿患者接受了该技术的手术刮除和切除。所有患者在存在软骨损伤和滑膜增生时均进行了清创，探查腱鞘囊肿的入口，随后通过一个单独小切口制作的皮质骨窗进行彻底刮除并植骨。活检在所有患者中均证实了诊断。所有患者在末次随访时症状最终缓解，植骨融合良好。在至少19个月（平均38.6个月；范围19 - 69个月）的随访中无复发。恢复至完全功能的平均时间为15.4周（范围8 - 17周）。无术中或术后并发症。美国矫形足踝协会评分平均从术前的73分（范围67 - 77分）提高到术后的94分（范围90 - 100分）。对于合适的患者，关节镜辅助手术治疗胫骨远端腱鞘囊肿是一种相当简单的技术，可缓解症状，帮助患者恢复正常步态和完全功能且无复发（在我们的小样本系列中）。
IV级，病例系列。有关证据水平的完整描述，请参见作者指南。
