Department of Orthopedics, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China.
China Medical University, Shenyang, Liaoning Province, China.
BMC Musculoskelet Disord. 2022 Jul 30;23(1):732. doi: 10.1186/s12891-022-05658-2.
The purpose of this study was to introduce the arthroscopic internal drainage with anterior-anteromedial approach for the treatment of popliteal cysts in children. To compare its clinical efficacy with open surgery.
This was a retrospective case-control study of 102 patients diagnosed with popliteal cysts from January 2018 to February 2020 who received surgery. The study included 27 cases with minimally invasive group (MI group) and 75 cases with open surgery group (OS group). The MI group included 21 males and 6 females, age 6.71 ± 2.16 years who received arthroscopic internal drainage of the cysts to adequately widen the valve opening between the cyst and the articular cavity, excised the fibrous diaphragm without complete excision of the cyst wall. The OS group included 57 males and 18 females, age 6.21 ± 1.67 years who received open excision. The clinical parameters regarding the preoperative characteristics and surgical results were compared. Ultrasound or MRI was used to identify the recurrence of the popliteal cysts. Rauschning-Lindgren grade was recorded to evaluate the clinical outcome.
All patients were followed up for at least 24 months. There were no significant differences between the two groups in age, gender, left and right sides, disease time, cyst size, length of hospitalization, preoperative Rauschning-Lindgren grade (p > 0.05). At the last follow-up, the preoperative and postoperative Rauschning-Lindgren grade was improved in both groups. Compared with the OS group, operation time was significantly shortened in the MI group (28.89 ± 4.51 min vs 52.96 ± 29.72 min, p < 0.05). The MI group was superior to the OS group in terms of blood loss and plaster fixation, with statistical significance (p < 0.05). There was obvious difference in recurrence rate between the two groups (0% vs 17.33%, p = 0.018). No postoperative complications occurred during the follow-up period.
Compared with open excision, the treatment of popliteal cyst in children by arthroscopic internal drainage to expand the articular cavity and eliminate the "one-way valve" mechanism between the cyst and the articular cavity exhibits better clinical outcomes and significantly reduces the recurrence rate, which is worthy of further clinical promotion.
本研究旨在介绍经关节镜前内侧入路治疗儿童腘窝囊肿的方法。并将其与开放性手术的疗效进行比较。
这是一项回顾性病例对照研究，纳入 2018 年 1 月至 2020 年 2 月期间接受手术治疗的 102 例腘窝囊肿患者。研究包括微创组（MI 组）27 例和开放性手术组（OS 组）75 例。MI 组 21 例男性，6 例女性，年龄 6.71±2.16 岁，行关节镜下囊肿内引流，充分扩大囊肿与关节腔之间的瓣膜开口，切除纤维性膈，不完整切除囊肿壁。OS 组 57 例男性，18 例女性，年龄 6.21±1.67 岁，行开放性切除。比较两组术前特点和手术结果的临床参数。超声或 MRI 用于识别腘窝囊肿的复发。Rauschning-Lindgren 分级用于评估临床疗效。
所有患者均随访至少 24 个月。两组在年龄、性别、左右侧、疾病时间、囊肿大小、住院时间、术前 Rauschning-Lindgren 分级等方面差异均无统计学意义（p＞0.05）。末次随访时，两组患者术前和术后 Rauschning-Lindgren 分级均有改善。与 OS 组相比，MI 组手术时间明显缩短（28.89±4.51min vs 52.96±29.72min，p＜0.05）。MI 组在出血量和石膏固定方面优于 OS 组，差异有统计学意义（p＜0.05）。两组复发率差异有统计学意义（0% vs 17.33%，p=0.018）。随访期间无术后并发症发生。
与开放性切除相比，关节镜下扩大关节腔并消除囊肿与关节腔之间的“单向阀”机制治疗儿童腘窝囊肿具有更好的临床疗效，显著降低复发率，值得进一步临床推广。
