Katz R S, Zizic T M, Arnold W P, Stevens M B
Medicine (Baltimore). 1977 Mar;56(2):151-64. doi: 10.1097/00005792-197703000-00005.
Sixty-two patients with popliteal or calf synovial cysts defined by arthrography are presented, of whom 34 had the pseudothrombophlebitis (PTP) syndrome. While the clinical manifestations of PTP may closely mimic thrombophlebitis, including the presence of calf pain, swelling and warmth, and a positive Homans' sign, the helpful descriminating features include the presence of inflammatory joint disease (91%), concomitant pain and swelling of the knee (94%), a demonstrable knee effusion (91%) and the absence of deep venous tenderness or cord. Except for seven patients with large intact Baker's cysts, the PTP syndrome was associated with synovial cyst dissection (18 patients), rupture (5 patients), or both (4 patients). Of those with arthrographically demonstrated Baker's cysts, only 27 (44%) had a palpable mass in the popliteal fossa and another 4 (12%) a mass in the calf. Popliteal fossa pain was noted in 22 (35%). Thus, clinical features are far less sensitive than arthrography in the diagnoses of both synovial cysts and pseudothrombophlebitis. Among patients with rheumatoid arthritis there were no differences in the severity or duration of disease or the extra-articular features in patients with and without synovial custs or the PTP syndrome. The therapeutic implications of pseudothrombophlebitis are of major significance with respect to the avoidance of anti-coagulation and the prompt response to intra-articular corticosteroids. Possible mechanisms of synovial cyst formation and unusual presentations of synovial cysts are discussed, and the literature is reviewed.
本文报告了62例经关节造影确诊为腘窝或小腿滑膜囊肿的患者，其中34例患有假性血栓性静脉炎（PTP）综合征。虽然PTP的临床表现可能与血栓性静脉炎极为相似，包括小腿疼痛、肿胀、发热以及霍曼斯征阳性，但有助于鉴别的特征包括存在炎性关节疾病（91%）、膝关节同时出现疼痛和肿胀（94%）、可证实的膝关节积液（91%）以及无深部静脉压痛或条索状物。除7例完整的大贝克囊肿患者外，PTP综合征与滑膜囊肿破裂（18例）、破裂（5例）或两者皆有（4例）有关。在经关节造影证实有贝克囊肿的患者中，只有27例（44%）在腘窝处可触及肿块，另有4例（12%）在小腿处可触及肿块。22例（35%）有腘窝疼痛。因此，在滑膜囊肿和假性血栓性静脉炎的诊断中，临床特征远不如关节造影敏感。在类风湿关节炎患者中，有无滑膜囊肿或PTP综合征的患者在疾病严重程度、病程或关节外表现方面并无差异。假性血栓性静脉炎的治疗意义在于避免抗凝以及对关节内注射皮质类固醇的迅速反应。本文讨论了滑膜囊肿形成的可能机制以及滑膜囊肿的不寻常表现，并对相关文献进行了综述。
