腘窝囊肿关节镜下内引流联合囊肿硬化治疗的效果

Clinical effect of arthroscopic internal drainage combined with cyst sclerotherapy in treatment of popliteal cyst

目的探讨腘窝囊肿关节镜下内引流联合囊肿硬化治疗的效果。方法回顾性选取2019-08至2021-07于海军军医大学附属第一医院骨科住院治疗的腘窝囊肿患者41例,男15例,女26例,年龄45~72岁,平均(62.5±5.38)岁。左膝16例,右膝23例,双膝2例。术前膝关节MRI证实伴有关节内疾病存在。先俯卧位后路经皮穿刺抽取囊液并注入硬化剂,后选取前内、前外侧常规关节镜入路处理相应关节内病变,术中切除关节腔-腘窝囊肿交通口处活瓣组织,行囊液内引流治疗。术后及随访期间根据Rausching和Lindgren膝关节腘窝囊肿分级法、膝关节MRI及腘窝处浅表软组织超声评估手术的效果。结果41例均顺利手术,术中及术后无并发症;随访6~18个月,平均(9.45±3.47)个月,所有患者均未出现囊肿复发。手术前Rausching和Lindgren膝关节腘窝囊肿分级显示,0级0例,Ⅰ级16例,Ⅱ级22例,Ⅲ级3例;手术后6个月Rausching和Lindgren膝关节腘窝囊肿分级显示,0级32例,Ⅰ级7例,Ⅱ级2例,Ⅲ级0例;手术前后差异有统计学意义(Z=-3.896,P<0.05)。结论关节镜下活瓣切除内引流联合经皮囊内硬化治疗腘窝囊肿疗效确切,无复发。

Objective To observe the clinical effect of arthroscopic internal drainage combined with cyst sclerotherapy in the treatment of popliteal cyst.Methods Forty-one patients with popliteal cysts treated in the Department of Orthopaedics,the first affiliated Hospital of Naval Medical University from 2019 to 2021 were selected retrospectively.There were 15 males and 26 females,aged from 45 to 72 years,with an average of(62.5±5.38)years.There were 16 cases of left knee,23 cases of right knee and 2 cases of both knees.Preoperative knee joint MRI confirmed the presence of intra-articular diseases.In the prone position,the cystic fluid was extracted by percutaneous puncture and injected with sclerosing agent,then the anterior medial and anterolateral arthroscopic approach was selected to treat the corresponding intra-articular lesions,and the valve tissue at the communicating orifice of articular cavity-popliteal cyst was removed during the operation.The effect of operation was evaluated according to Rausching and Lindgren classification of popliteal cyst,MRI of knee joint and superficial soft tissue ultrasound of popliteal fossa during postoperative and follow-up.Results Forty-one patients underwent successful operation without intraoperative and postoperative complications,and all the patients were followed up for 6 to 18 months,with an average of(9.45±3.47)months.The preoperative Rausching and Lindgren classification of popliteal cysts of the knee joint showed that there were 0 cases of grade 0,16 cases of gradeⅠ,22 cases of gradeⅡand 3 cases of gradeⅢ.Six months after operation,Rausching and Lindgren knee popliteal cysts were graded as grade 0(n=32),gradeⅠ(n=7),gradeⅡ(n=2)and gradeⅢ(n=0).There was significant difference before and after operation(Z=-3.896,P<0.05).Conclusions Arthroscopic valve resection and internal drainage combined with percutaneous intracapsular sclerotherapy is effective in the treatment of popliteal cyst with no recurrence,which is worthy of clinical application.