关节镜下经关节腔入路治疗成人腘窝囊肿

Arthroscopic treatment of adult popliteal cyst

目的 探讨关节镜下经关节腔入路治疗成人胭窝囊肿的方法及临床疗效.方法 2004年10月至2006年10月,采用关节镜下经关节腔入路治疗成人腘窝囊肿15例.男5例,女10例;年龄45～60岁,平均50.5岁.胭窝囊肿均为单侧,其中右膝8例,左膝7例,术前均行MR检查,观察胭窝囊肿与膝关节腔是否相通.术中在扩大腓肠肌一半膜肌滑囊与关节腔后内侧室裂隙样结构的同时,处理关节腔内病变,全部手术均在关节镜下完成,并根据Rausohning和Lindgren评价方法评定手术效果.结果 术中发现15例胭窝囊肿患者均伴有不同程度的膝关节内病变,其中内侧半月板撕裂6例,外侧半月板撕裂3例,骨关节炎9例(4例合并内侧半月板撕裂,2例合并外侧半月板损伤),类风湿关节炎2例,前十字韧带损伤1例.术中及术后未出现重要血管和神经损伤.随访时间12～48个月,平均18.5个月,术后14例未出现囊肿复发.Rauschning和Lindgren评价方法:术前,Ⅰ级1例,Ⅱ级5例,Ⅲ级9例;术后,0级13例,Ⅰ级1例,Ⅱ级1例.随访结果满意.结论 成人腘窝囊肿是一种继发性疾病,治疗胭窝囊肿的同时应处理关节内的病变.关节镜下经关节腔入路治疗成人胭窝囊肿,具有创伤小、恢复快、复发率低、并发症发生率低等优点.

Objective To evaluate the effect of arthroscopic treatment of adult popliteal cyst.Methods From October 2004 to October 2006,15 patients with popliteal cysts were treated by arthroscopy method,including 5 males and 10 females with average age of 50.5 years old,ranged from 45 to 60 years old.The popliteal cysts were unilateral,including 8 right knees and 7 left knees.Before operation,MR examination was used to determine the communication between the joint cavity and the gastrocnemiussemimembranosus bursa(GSB).During operation,the intra-articular disorders were treated and the connecting path between GSB and knee joint cavity were enlarged.Postoperative effect was evaluated according to critera of popliteal cyst of Ranschning and Lindgren.Results All patients showed intra-articular pathology,including medial meniscus tears in 6 cases,lateral meniscus tears in 3 cases,osteoarthritis in 9 cases [The osteoarthritis was isolated in 3 cases(33%),associated with medial meniscus tears in 4 cases(45%),associated with lateral meniscus tears in 2 cases(22%)],rheumatoid arthritis in 2 cases and anterior cruciate ligament tears in 1 case.There are no blood vessel and nerve injuries intraoperatively and postoperatively.All patients were followed up for 18.5 months averagely (12 to 48 months).According to the guidelines of Rauschning and Lindgren,there were 1 ease of grade Ⅰ,5 caes of grade Ⅱ and 9 cases of grade Ⅲ before surgery.After surgery,there were 13 cases of grade 0,1 case of grade Ⅰ and 1 case of grade Ⅱ.During the follow up,93.3% of the patients reported satisfaction postoperatively.Conclusion The arthroscopic treatment of adult popliteal cyst has the advantages of mini-invasive,quick-recovery,low complication and low recurrence rate.