双后侧入路膝关节镜手术与传统开放手术在腘窝囊肿治疗中的疗效对比

Comparison of arthroscopic surgery via double posteromedial approach and traditional open surgery in treatment of Baker’s cyst

目的探讨双后侧入路膝关节镜手术在腘窝囊肿临床治疗中的应用效果。方法选取2013年1月-2019年1月在该院进行治疗的30例腘窝囊肿患者作为研究对象,随机分为实验组(15例)与对照组(15例)。实验组予以双后侧入路膝关节镜手术治疗,对照组予以传统开放手术治疗。对比两组患者的手术时间、切口长度、下床活动时间、住院时间及术后7 d疼痛视觉模拟评分(VAS)。此外,通过Lysholm评分和Rauschning-Lindgren分级比较两种治疗方式对膝关节功能的改善情况和对腘窝囊肿的治疗效果。术后随访1年,评估两组患者术后腘窝囊肿的复发情况。结果实验组在手术时间、切口长度、下床活动时间、住院总时间方面均优于对照组[(48.24±7.21)和(67.97±11.62)min、(6.27±0.90)和(9.23±1.17)cm、(1.04±0.21)和(2.86±0.86)d、(4.63±1.23)和(7.30±2.51)d;均P<0.05]。此外,术后24 h实验组疼痛VAS评分也较对照组有所降低[(3.27±1.21)和(6.72±2.18)分;P<0.05]。在膝关节功能评分方面,两组患者术后Lysholm评分均较术前明显改善,但实验组患者术后Lysholm评分明显优于对照组[(88.23±4.27)和(79.27±4.07)分;P<0.05]。实验组术后Rauschning-Lindgren分级有效率明显优于对照组(93.3%和60.0%;P<0.05)。术后随访1年,实验组复发1例、对照组复发2例,但两组复发率比较,差异无统计学意义(P>0.05)。结论双后侧入路膝关节镜手术用于腘窝囊肿的临床治疗,具有手术创伤小、患者恢复快和临床疗效好等特点,可在临床工作中广泛推广应用。

Objective To study the application effect of arthroscopic surgery via double posteromedial approach in clinical treatment of Baker’s cyst.Methods 30 patients with Baker’s cyst were recruited from Jan 2013 to Jan 2019.All the patients were randomly divided into experimental group(15 patients)and control group(15 patients).The patients in experimental group were treated with arthroscopic surgery via double posteromedial approach,and the patients in control group were treated with traditional open surgery.The total operation time,length of incision,leaving bed time,length of hospital stay and VAS score were compared between the two groups.Besides,the improvement of function of knee and therapeutic effect of Baker’s cyst were also compared between the experimental group and the control group through Lysholm score and Rauschning-Lindgren classification.The recurrences of the two groups were evaluated one year after surgery.Results The total operation time(48.24±7.21)vs(67.97±11.62),length of incision(6.27±0.90)vs(9.23±1.17),leaving bed time(1.04±0.21)vs(2.86±0.86)and length of hospital stay(4.63±1.23)vs(7.30±2.51)were significantly reduced in the experimental group than that in control group(P<0.05).Besides,the VAS scores in 24 hours after surgery in the experimental group were also lower than that in the control group[(3.27±1.21)vs(6.72±2.18),P<0.05].In the evaluation of the function of knee,the Lysholm score of the two groups were markedly improved after treatments,but the Lysholm score of the experimental group was higher than that of the control group after surgery[(88.23±4.27)vs(79.27±4.07),P<0.05].In addition,the effective rate of Rauschning-Lindgren classification in the experimental group was 93.3%,which was significantly higher than 60.0%of the control group(P<0.05).With a follow-up visit one year after the treatment,1 case in the experimental group and 2 cases in the control group recurred,but the rate of recurrences have no significant difference between the two groups(P>0.05).Conclusion Because of the advantages in surgical trauma,postoperative recovery and clinical effects,arthroscopic surgery via double posteromedial approach could be used for clinical treatment of Baker’s cyst,which should be widely promoted in clinic.