腘窝囊肿关节镜下改良切除术39例

Arthroscopic Treatment on Popliteal Cyst by Modified Cystectomy: Clinical Results of 39 Cases

目的探讨腘窝囊肿关节镜下改良切除术的效果。方法选取2014年11月～2016年5月症状性腘窝囊肿39例,术前Rauschning和Lindgren分级0级0例,Ⅰ级11例(28.2%),Ⅱ级23例(59.0%),Ⅲ级5例(12.8%)。先行镜下半月板部分切除、全关节滑膜切除或骨性关节炎关节清理术,经后内侧入路切除单向瓣膜结构,仅清扫囊壁内侧滑膜层及纤维分隔,保留囊肿外壁。术后随访18个月以上。结果术后未见血管损伤等并发症。31例得到随访,平均22.4月(18～26个月)。末次随访时,Rauschning和Lindgren分级0级20例(64.5%),Ⅰ级7例(22.6%),Ⅱ级4例(12.9%),Ⅲ级0例。复查MRI,18例(58.1%)囊肿完全消失,13例(41.9%)囊肿残留,较术前减小(64.7±11.3)%(49.1%～80.6%),未见复发。结论腘窝囊肿关节镜下改良切除术在内引流术基础上仅行囊肿内层滑膜及纤维分隔清扫,也能收到良好的效果。

Objective To investigate the clinical results of arthroscopic modified cystectomy for popliteal cyst. Methods From November 2014 to May 2016,39 patients with symptomatic popliteal cyst in our hospital were enrolled in the study. According to the Rauschning and Lindgren criteria,there were 11 cases of Grade Ⅰ（ 28. 2%）,23 cases of Grade Ⅱ（ 59. 0%）,and 5 cases of Grade Ⅲ（ 12. 8%）. All the patients were given arthroscopic modified cystectomy following internal drainage. After resection of the unidirectional valve structure of the gastrocnemius-semimembrane bursa,the inner layer of the cyst wall and the fibrous septum were debrided through the posteromedial approach,and the outer capsule wall was preserved in order to decrease the risk of vessel injury.All the patients were followed up at least for 18 months. Results No postoperative complications such as vascular injury were seen.A total of 31 cases were followed up successfully for an average of 22. 4 months（ range,18-26 months）. According to the Rauschning and Lindgren criteria,there were 20 cases of Grade 0（ 64. 5%）,7 cases of Grade Ⅰ（ 22. 6%）,4 cases of Grade Ⅱ（ 12. 9%）,and0 case of Grade Ⅲ. The cysts completely disappeared in 18 cases（ 58. 1%）,and remained in 13 cases（ 41. 9%） but obviously smaller than preoperation by（ 64. 7 ± 11. 3） %（ range,49. 1%-80. 6%）. No recurrence was found during the follow-up period.Conclusion Excellent results can be achieved for arthroscopic modified cystectomy for popliteal cyst,which makes a debridement to inner layer of cyst wall and fibrous septum based on internal drainage.