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膝关节镜下关节囊瓣膜切除术治疗腘窝囊肿

[Knee arthroscopic resection of articular capsule valvular treat popliteal cysts].

作者信息

He Rui, Guo Lin, Yang Liu, Chen Guang-xing, Duan Xiao-jun, Luo Chon-fu

机构信息

Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2013 May 1;51(5):417-20.

Abstract

OBJECTIVE

To retrospective study the results of arthroscopic resection of articular capsule valvular treated popliteal cysts and examined the incidence of complication.

METHODS

From July 2007 to July 2010, 45 patients with symptomatic popliteal cysts such as knee pain and limitation of motion were treated with arthroscopic technique to resect the connecting valvular mechanism at posteromedial compartment of articular capsule. Through the posteromedial viewing portal and cyst resection working portal, resected the valvular mechanism by shaver and plasma cutter, associated intra-articular pathology was treated simultaneously. The functional outcome was evaluated by employed Rauschning and Lindgren score before the surgery and the last follow-up. By using of Wilcoxon rank sum test to statistics analyze the clinic outcome.

RESULT

In all cases, 40 patients were found the associated intra-articular pathology, the incidence was 88.9%.The intra-articular pathology was medial meniscus tear (27 cases, 60.0%), lateral meniscus tear (20 cases, 44.4%), cartilage lesion (28 cases, 62.2%), which composed with patellofemoral joint (12 cases, 26.7%),medial condyles of femur (10 cases, 22.2%),lateral condyles of femur (6 cases, 13.3%). The anterior cruciate ligment injury was found in 2 cases, the incidence was 4.4%. All the patients achieved symptoms relief postoperative, such as posterior knee discomfort and swelling after activities.The Rauschning and Lindgren score was improved 1-2 grade in average (Z = -6.092, P = 0.00). The recurrence rate was 2.2%. All the incision healed good. No major complications were encountered such as saphenous nerve, great saphenous vein, blood vessel in popliteal injury.

CONCLUSIONS

Arthroscopic resection of articular capsule valvular treatment of popliteal cyst and treatment of associated intra-articular pathology are effective and safe. This surgery technique has more minimally trauma and lower recurrence rate.The clinic results in short term are excellent.

摘要

目的

回顾性研究关节镜下切除关节囊瓣膜治疗腘窝囊肿的效果,并观察并发症的发生率。

方法

2007年7月至2010年7月,对45例有膝关节疼痛、活动受限等症状的腘窝囊肿患者采用关节镜技术切除关节囊后内侧间室的连接瓣膜结构。经后内侧观察通道和囊肿切除工作通道,用刨削器和等离子刀切除瓣膜结构,同时处理相关的关节内病变。采用Rauschning和Lindgren评分在术前及末次随访时评估功能结果。用Wilcoxon秩和检验对临床结果进行统计学分析。

结果

所有病例中,发现40例存在相关的关节内病变,发生率为88.9%。关节内病变为内侧半月板撕裂(27例,60.0%)、外侧半月板撕裂(20例,44.4%)、软骨损伤(28例,62.2%),其中涉及髌股关节(12例,26.7%)、股骨内侧髁(10例,22.2%)、股骨外侧髁(6例,13.3%)。发现前交叉韧带损伤2例,发生率为4.4%。所有患者术后症状均缓解,如膝关节后方活动后不适及肿胀。Rauschning和Lindgren评分平均提高1 - 2级(Z = -6.092,P = 0.00)。复发率为2.2%。所有切口愈合良好。未出现如隐神经、大隐静脉、腘窝血管损伤等严重并发症。

结论

关节镜下切除关节囊瓣膜治疗腘窝囊肿及处理相关关节内病变有效且安全。该手术技术创伤更小、复发率更低。短期临床效果良好。

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