Rettori R, Boespflug O
Service de Chirurgie, Hôpital Corentin Celton, Issy-Les-Moulineaux.
J Mal Vasc. 1990;15(2):182-7.
The popliteal fossa is a relatively small, muscle-bound strategic anatomical area where is found, on the posterior aspect of the knee, a vasculonervous pedicle and where both vascular and pseudovascular disease may develop, the latter originating from wall-constituting parts. Among non-typical popliteal diseases, the authors have singled out four rare syndromes. The popliteal vein may be trapped due to fibrous strangulation or, more often, to compression by the hypertrophied gastrocnemius muscle. This requires proper diagnosis and surgical management prior to thrombosis onset. Synovial cysts raise no diagnostic problems, unless they mimic an episode of phlebitis; echotomography has now become essential for diagnosis. Desmoid tumors for which predominant extra-abdominal occurrence sites are the popliteal fossa, the leg and thigh, are difficult to excise completely, especially at the popliteal level, and are a major technical challenge because of the inclusion of the vasculonervous pedicle. Lastly, in sports pathology, one must be able to recognize the painful fabella syndrome (osteochondritis of sesamoid fibrocartilage in lateral head of gastrocnemius), so as not to mistakenly implicate vascular disease. New developments in imaging (namely, real time CT-echography) are of major help to clinicists, who should, nonetheless, remain chiefly responsible for detecting these diseases.
腘窝是一个相对较小、有肌肉包绕的重要解剖区域,在膝关节后方可找到一个血管神经蒂,并且血管疾病和假性血管疾病都可能在此处发生,假性血管疾病起源于构成血管壁的部分。在非典型腘窝疾病中,作者挑选出了四种罕见综合征。腘静脉可能因纤维绞窄而受阻,或者更常见的是,受到肥厚的腓肠肌压迫。这需要在血栓形成之前进行正确诊断和手术处理。滑膜囊肿一般不存在诊断问题,除非它们类似静脉炎发作;超声断层扫描现在已成为诊断的关键手段。硬纤维瘤主要发生在腹部以外,腘窝、小腿和大腿是其常见部位,很难完全切除,尤其是在腘窝水平,并且由于包含血管神经蒂,这是一项重大的技术挑战。最后,在运动病理学中,必须能够识别疼痛性籽骨综合征(腓肠肌外侧头籽骨纤维软骨骨软骨炎),以免误诊为血管疾病。影像学的新进展(即实时CT超声)对临床医生有很大帮助,不过,临床医生仍应主要负责这些疾病的检测。