关节镜与开放手术治疗腘窝囊肿的疗效比较

Comparison of arthroscopic and open procedures for treatment of popliteal cyst

[目的]比较采用关节镜技术与传统切开手术治疗腘窝囊肿临床疗效。[方法]回顾分析自2015年1月~2018年10月本院手术治疗腘窝囊肿56例患者的病例资料。依据手术方式不同分为两组:采用膝关节镜下囊肿内引流、囊壁部分切除联合关节内病变处理30例(关节镜组);采用传统切开手术26例(开放组)。比较两组手术时间、切口长度、术后下地时间、住院时间、VAS评分、术后12个月Rauschning和Lindgren分级及术后12个月囊肿复发率。[结果]两组患者均顺利手术,均无血管及神经损伤。关节镜组在切口长度、手术时间、术后下地时间和住院时间方面显著优于开放组,差异有统计学意义(P<0.05)。术后1、3 d,关节镜组VAS评分显著低于开放组,差异有统计学意义(P<0.05)。56例患者随访12个月以上,末次随访时,两组患者的VAS评分均较术前显著降低,差异有统计学意义(P<0.05)。末次随访时,两组患者的Rauschning-Lindgren分级均较术前显著降低,差异有统计学意义(P<0.05)。虽然术前两组间Rauschning-Lindgren分级的差异无统计学意义(P>0.05),但是末次随访时关节镜组的Rauschning-Lindgren分级显著低于开放组,差异有统计学意义(P<0.05)。随访过程中,超声检查显示关节镜组复发1例(3.3%),开放组复发7例(26.9%),两组患者复发率比较差异有统计学意义(P=0.033)。[结论]微创膝关节镜下囊肿内引流、囊壁部分切除联合关节内病变处理,创伤小、疼痛轻、恢复快、复发率低,疗效满意。

[Objective]To compare the clinical outcomes of arthroscopy versus open surgery for treatment of popliteal cyst.[Methods]A retrospective study was conducted on 56 patients who underwent surgical treatment for popliteal cyst in our hospital from January 2015 to October 2018.Based on surgical procedures performed,30 patients received internal drainage of the cyst and partial resection of the cyst wall under arthroscope,while the remaining 26 patients had traditional open cystectomy.The operation time,incision length,ambulation time,hospital stay,VAS scores,Rauschning and Lindgren grades,as well as recurrence rate of cysts at 12 months after surgery were compared between the two groups.[Results]All the patients in both groups had surgical procedures performed smoothly without iatrogenic neurovascular injuries.The arthroscopic group proved significantly superior to the open group regarding operation time,incision length,ambulation time and hospital stay(P<0.05).In addition,the arthroscopic group had significantly less VAS scores than the open group at 1 and 3 days after operation(P<0.05).All the 56 patients were followed up for more than 12 months.At the latest follow up,the VAS scores significantly decreased(P<0.05),whereas the Rauschning-Lindgren grades significantly downgraded in both groups compared those before operation(P<0.05).Although there was no a significant difference between the two groups before operation(P<0.05),the arthroscopic group got significantly lower Rauschning-Lindgren grade than the open group at the latest follow up(P<0.05).During the period of follow up,ultrasound examination revealed that recurrence of cyst was found in only 1 patient(3.3%)of the arthroscopic group,whereas 7 patients(26.9%)of the open group,which was statistically significant(P=0.033).[Conclusion]The arthroscopic cystectomy has benefits of minimal iatrogenic trauma,mild pain,rapid recovery,low recurrence rate over the traditional open cystectomy,and does achieve satisfactory outcomes for popliteal cyst.