关节镜下单纯内引流术与联合囊壁切除术治疗腘窝囊肿的前瞻性对比研究

Clinical prospective comparative study on short-term effectiveness of arthroscopic treatment of popliteal cyst between cyctectomy and internal drainage combined with cyctectomy

目的对关节镜下单纯内引流术与联合囊壁切除术的近期疗效进行前瞻性对比研究。方法以2014年3月—2017年3月收治的腘窝囊肿患者作为研究对象,其中56例符合选择标准纳入研究,随机分为试验组和对照组,每组28例。试验组行关节镜下腘窝囊肿内引流术联合囊壁切除,对照组行关节镜下腘窝囊肿内引流术。排除未获得完整随访及术后因其他疾病接受手术者,最终试验组26例、对照组27例纳入研究。两组患者性别、年龄、侧别、病程、腘窝囊肿最大直径及分级、合并疾病等一般资料比较,差异均无统计学意义(P>0.05)。记录两组手术时间及术后腘窝淤斑持续时间、小腿中段后方压痛持续时间;术后1 d及1、2周测量小腿周径,计算观测时间点与术前差值;术后1周采用下肢血管彩色多普勒超声观察下肢静脉血栓形成情况。术后1年行Rauschning和Lindgren分级;MRI检查腘窝囊肿是否消失或减小,并测量其最大直径。结果两组患者均获随访,随访时间12~14个月,平均12.5个月。试验组手术时间、腘窝淤斑持续时间、小腿中段后方压痛持续时间均较对照组延长,术后1 d及1、2周小腿周径差值亦大于对照组,比较差异均有统计学意义(P<0.05)。术后1周下肢彩超检查发现,试验组术后2例发生肌间静脉血栓形成,对照组无下肢血栓形成,比较差异无统计学意义(P=0.236)。术后1年Rauschning和Lindgren分级,试验组0级16例、1级6例、2级4例,对照组为0级17例、1级4例、2级6例,比较差异无统计学意义(Z=–1.872,P=0.078)。MRI检查示,试验组9例(34.62%)、对照组13例(48.15%)仍有残余囊肿,最大直径均未超过2 cm;两组其余患者囊肿均消失,随访期间无复发。两组囊肿残留率比较,差异无统计学意义(χ~2=2.293,P=0.852)。结论与关节镜下单纯内引流术相比,联合囊壁切除术治疗腘窝囊肿近期疗效无明显提升,且手术时间延长,术后并发症明显增多。

Objective To compare the short-term effectiveness between arthroscopic cystectomy and internal drainage combined with cystectomy in popliteal cyst. Methods Between March 2014 and March 2017, 56 patients with symptomatic popliteal cyst were enrolled in the study, randomized block design was used to divided the patients into trial group（arthroscopic cystectomy combined with internal drainage group, n=28） and control group（arthroscopic internal drainage group, n=28）. Excluding those who had incomplete follow-up and received surgery for other diseases postoperatively, 26 patients in the experimental group and 27 patients in the control group were finally enrolled in the study. There was no significant difference in gender, age, side, course of disease, maximum diameter and grade of popliteal cyst, and associated diseases between two groups（P〈0.05）. The operation time, duration of popliteal ecchymosis and the middle back of calf tenderness were observed postoperatively. The circumference of calf at 1 day, 1 week, and 2 weeks after operation were measured and the differences were calculated with the measurement before operation. Lower extremity venous thrombosis was observed by color doppler ultrasonography at 1 week after operation. The effectiveness was evaluated by Rauschning and Lindgren grading criteria. And MRI was used to observe whether the popliteal cyst disappeared or decreased and measured its maximum diameter at 1 year after operation. Results Patients in both groups were followed up 12-14 months, with an average of 12.5 months. The operation time, duration of popliteal ecchymosis,and the middle back of calf tenderness of the trial group were all longer than those in the control group（P〈0.05）, the differences of circumference of calf at 1 day, 1 week, and 2 weeks after operation of the trial group were greater than those in the control group（P〈0.05）. Color doppler ultrasonography of the lower extremity at 1 week after operation found that the intermuscular venous thrombosis occurred in 2 cases of the trial group, while no lower extremity thrombosis was found in the control group; and the difference between two groups was not significant（P=0.236）. According to the Rauschning and Lindgren grading criteria, there were 16 cases of grade 0, 6 cases of grade 1, and 4 cases of grade 2 in the trial group, and 17 cases of grade 0, 4 cases of grade 1, and 6 cases of grade 2 in the control group at 1 year after operation.There was no significant difference between 2 groups（Z=–1.872, P=0.078）. Nine cases（34.62%） of the trial group and 13 cases（48.15%） of the control group still have residual cysts by MRI, the maximum diameter of which was less than 2 cm.The cysts disappeared in the remaining patients in both groups, and there was no recurrence during the follow-up. There was no significant difference in cyst residual rate between 2 groups（χ~2=2.293, P=0.852）. Conclusion Compared with arthroscopic internal drainage, the short-term effectiveness of the arthroscopic internal drainage combined with cystectomy had no significant improvement, and the operation time was prolonged, the postoperative complications were obviously increased.