局部麻醉全关节镜下腘窝囊肿摘除联合膝关节清理术的疗效观察

ARTHROSCOPIC TREATMENT OF POPLITEAL CYST EXCISION IN COMBINATION WITH DEBRIDEMENT OF THE KNEE UNDER LOCAL ANESTHESIA

目的通过与持续硬膜外麻醉比较，探讨局部麻醉全关节镜下腘窝囊肿摘除联合膝关节清理术治疗腘窝囊肿的疗效。 方法2002年6月－2013年1月，对145例腘窝囊肿患者采用局部麻醉全关节镜下腘窝囊肿摘除联合膝关节清理术治疗（局麻组）；以2000年2月－2005年8月，采用持续硬膜外麻醉全关节镜下手术治疗的51例腘窝囊肿患者作为对照组。两组患者性别、年龄、侧别、病程以及囊肿大小比较，差异均无统计学意义（P 〉 0.05），具有可比性。比较两组麻醉时间、镇痛效果、麻醉满意度、手术时间、术中出血量、术后麻醉并发症发生情况，根据Rauschning和Lindgren 腘窝囊肿分级标准评定疗效，记录随访期间囊肿复发情况。 结果两组术后切口均Ⅰ期愈合，无血管、神经损伤等并发症发生。两组患者均获随访，局麻组随访时间1年1个月～8年，平均3.7年；对照组随访8年～13年7个月，平均10.8年。与对照组相比，局麻组麻醉时间缩短、疼痛视觉模拟评分（VAS）增高、手术时间缩短、术中出血量减少（P 〈 0.05）；麻醉满意度降低，但两组差异无统计学意义（χ^2=0.071，P=1.000）。术后对照组8例（15.7%）发生麻醉并发症，发生率显著高于局麻组（0）（P=0.000）。随访期间局麻组12例囊肿复发，治愈率91.7%；对照组5例复发，治愈率90.2%；两组治愈率比较差异无统计学意义（χ^2=0.111，P=0.774）。末次随访时，根据Rauschning和Lindgren 分级标准：局麻组0 级131例、Ⅰ级13例、Ⅱ级1例，与术前比较差异有统计学意义（Z= —10.683，P=0.000）；对照组0 级37例、Ⅰ级12例、Ⅱ级2 例，与术前比较差异有统计学意义（Z= —6.385，P=0.000）；两组术后分级比较差异有统计学意义（Z= —3.145，P=0.002）。结论与持续硬膜外麻醉相比，局部麻醉全关节镜下腘窝囊肿摘除联合膝关节清理术治疗腘窝囊肿效果更好，可实时动态观察患肢血管、神经情况，且创伤小、复发率低，临床疗效满意。

Objective To evaluate the arthroscopic treatment effectiveness of popliteal cyst excision in combination with debridement of the knee under local anesthesia by comparing with continuous epidural anesthesia. Methods Between June 2002 and January 2013, 145 patients with popliteal cyst underwent arthroscopic popliteal cyst excision in combination with debridement of the knee under local anesthesia （local anesthesia group）. In addition, 51 patients with popliteal cyst were treated with the same surgery under continuous epidural anesthesia between February 2000 and August 2005 served as control group. No significant difference was found in gender, age, side, disease duration, or cyst size between 2 groups （P 〉 0.05）. Then, anesthesia time, analgesia effect, anesthesia satisfaction, operation time, bleeding volume, and anesthesia complication were compared between 2 groups. The guidelines of Rauschning and Lindgren were used to assess the effectiveness, and recurrence rate was recorded. Results All incisions healed primarily, no neurological or vascular injury was found. The patients were followed up 1 year and 1 month to 8 years （mean, 3.7 years） in local anesthesia group, and 8 years to 13 years and 7 months （mean, 10.8 years） in control group. Local anesthesia group had shorter anesthesia time, higher visual analogue scale （VAS） score, shorter operation time, and lower bleeding volume （P 〈 0.05） than control group. Anesthesia satisfaction was reduced in local anesthesia group, but there was no significant difference （χ^20.071, P=1.000）. The anesthesia complication incidence of control group （15.7%, 8/51） was significantly higher than that of local anesthesia group （0） （P=0.000）. Recurrence was found in 12 patients of local anesthesia group （curative ratio 91.7%） and in 5 patients of control group （curative ratio 90.2%）, showing no significant difference （χ^20.111, P=0.774）. According to the guidelines of Rauschning and Lindgren, there were 131 cases of grade 0, 13 cases of grade I, and 1 case of grade II in local anesthesia group, and 37 cases of grade 0, 12 cases of grade I, and 2 cases of grade II in control group; significant differences in grading were shown between at pre- and post-operation in 2 groups （Z= — 10.683, P=0.000; Z= — 6.385, P=0.000）, and between 2 groups at post-operation （Z= — 3.145, P=0.002）. Conclusion Compared with under continuous epidural anesthesia, arthroscopic treatment of popliteal cyst excision under local anesthesia can obtain better results. Under local anesthesia, the condition of nerve and vessel can be timely and dynamically observed. Arthroscopic treatment of popliteal cyst excision in combination with debridement of the knee has the advantages of less trauma, lower recurrence rate, and satisfactory results.