双后内入路关节镜下切除腘窝囊肿临床研究

Clinical application of double posteromedial approach by arthroscopic cut off popliteal cyst

目的探讨应用双后内入路全关节镜下腘窝囊肿切除的手术方法及临床效果。方法选取自2016年1月至2017年3月在全关节镜下行腘窝囊肿切除术的23例患者为观察组,选取同期行传统开放手术的16例患者为常规组。比较两组患者的手术时间、血红蛋白差值、住院时间、切口长度及复发情况,采用Rauschning和Lindgren腘窝囊肿分级评分标准、Lysholm膝关节评分、疼痛视觉模拟评分(VAS)判定患者的治疗效果。结果观察组患者的手术时间长于常规组,血红蛋白差值、住院时间及切口总长度均小于常规组,组间比较,差异均有统计学意义(P <0. 05)。观察组术后复发率为8. 7%(2/23),低于常规组的31. 3%(5/16),组间比较,差异有统计学意义(P <0. 05)。术后12个月,常规组Rauschning和Lindgren分级0或Ⅰ级的患者比例低于观察组,Ⅱ、Ⅲ级患者的比例高于观察组,组间比较,差异有统计学意义(P <0. 05)。两组患者术后12个月的VSA评分、Lysholm评分比较,差异均无统计学意义(P> 0. 05)。结论双后内入路关节镜下切除腘窝囊肿,患者创伤小、出血少,操作方便,术后随访效果良好,复发率较开放手术低。

Objective To investigate the application and clinical effect of double posteromedial approach method used by arthroscopic to cut off popliteal cyst.Methods A retrospective study was performed on 23 cases of patients who were admitted and underwent arthroscopic cut off popliteal cyst from January 2016 to March 2017.The 23 cases of patients undergoing arthroscopic cut off popliteal cyst were divided into the observation group,another 16 cases of patients who underwent conventional open operation were in the conventional group.The operation time,hemoglobin difference,length of hospital stay,length of incision,and recurrence were compared between the two groups.Rauschning and Lindgren popliteal cyst grading scale,Lysholm knee score and pain visual analogue score（VAS）were used to determine the treatment effect of the patients.Results The operation time of the patients in the observation group was longer than that in the conventional group,and the difference of hemoglobin,hospitalization time and incision length were all smaller than that in the conventional group,and the difference was statistically significant（ P 〈0.05）.The postoperative recurrence rate in the observation group was 8.7%（2/23）,lower than 31.3%（5/16）in the conventional group,and the difference was statistically significant（ P 〈0.05）.After 12 months of surgery,the ratio of patients with Rauschning and Lindgren grade 0 or grade I was lower than that in the observation group,and the patients with Rauschning and Lindgren class II or III was higher than that in the observation group,and the difference was statistically significant（ P 〈0.05）.The VSA and Lysholm scores of the two groups at 12 months after surgery showed no statistically significant difference（ P 〈0.05）.Conclusion The application of double posteromedial approach of arthroscopic resection popliteal cyst surgery is minimally invasive,less bleeding,the view is clear and eliminate the pathological mechanism of cyst formation,the effect of arthroscopy group follow-up is significant,and the recurrence rate is significantly lower than open surgery.