关节镜下内引流联合囊壁切除治疗腘窝囊肿

Arthroscopic internal drainage combined resection of the cystic wall for popliteal cyst

[目的]通过与镜下单纯内引流相比较,评价关节镜下内引流联合囊壁切除治疗腘窝囊肿的早期临床疗效。[方法]2015年1月~2018年12月,腘窝囊肿83例患者(95膝)随机分为两组。其中,42例(49膝)采用单纯关节镜下切除关节腔与囊肿间活瓣建立内引流;41例(46膝)采用关节镜下活瓣切除内引流,联合囊壁切除术。比较两组围手术期、随访与超声检查资料。[结果]两组患者均顺利完成手术,术中均未发生血管、神经损伤等严重并发症。内引流组的手术时间显著短于引流切除组(P<0.05)。内引流组5例患者出现内侧切口渗液,引流切除组所有患者切口愈合良好。随时间推移,两组患者VAS评分显著减少,而Lysholm评分显著增加(P<0.05)。两组患者术后1、3、7 d的VAS评分差异均无统计学意义(P>0.05)。但术后1个月和末次随访时,引流切除组的Lysholm评分均显著优内引流组(P<0.05)。末次随访时腘窝超声检查显示残余囊肿,内引流组为15例(30.61%),引流切除组为2例(4.34%),差异有统计学意义(P<0.05)。[结论]关节镜下活瓣切除内引流联合囊壁切除治疗腘窝囊肿近期临床效果优于单纯活瓣切除内引流。

[Objective]To evaluate the early clinical outcomes of arthroscopic internal drainage combined with resection of the cystic wall for popliteal cyst by comparison with the arthroscopic internal drainage alone.[Methods]From January 2015 to December 2018,a total of 83 patients(95 knees)with popliteal cyst were randomly divided into two groups.Of them,42 patients(49 knees)had the valve between the joint cavity and cysts resected arthroscopically only to form internal drainage(the ID group),while the remaining 41 patients(46 knees)had the arthroscopic internal drainage combined with resection of the cystic wall performed(the IDRC group).The perioperative,follow-up and ultrasound imaging were compared between the two groups.[Results]All the patients in both groups had operation performed successfully without serious complications,such as iatrogenic injury to blood vessels and nerves.The ID group consumed significantly less operation time than IDRC group(P<0.05).However,5 patients in the ID group suffered from wound extravasating of the medial incision after operation,whereas all patients in the IDRC group got primary incision healing.As time went,the VAS score significantly decreased,while the Lysholm score significantly increased in both groups(P<0.05).Although no statistically significant differences in VAS score at 1,3 and 7 days after operation were proved between the two groups(P>0.05),the IDRC group was significantly superior to the ID group regarding to Lysholm score at 1 month after operation and the latest follow-up(P<0.05).The residual cysts revealed by the ultrasound at the latest follow-up were of 15 cases(30.61%)in the ID group,whereas 2 cases(4.34%)in the IDRC group,which proved of statistical significance(P<0.05).[Conclusion]The arthroscopic internal drainage combined with resection of the cystic wall achieves superior early clinical outcomes to the internal drainage alone for popliteal cysts.