镜下双后内入路腘窝囊肿全切除术

Arthroscopic total resection of popliteal cyst through double posteromedial portals

[目的]介绍镜下双后内入路腘窝囊肿全切除术的手术技术和初步临床结果。[方法] 2017年11月~2019年11月,对12例腘窝囊肿患者采用关节镜双后内入路行囊肿全切术,建立后内侧标准入路,于后内侧标准入路的近端2~3 cm处利用针刺定位方法建立后内侧高位入路。标准入路为观察入路,高位入路为操作入路。在后关节囊薄弱区或裂隙,探查囊肿。通过双后侧入路,使用刨削器打开囊壁,直视下完整切除囊肿内壁,当见脂肪组织时,停止操作。[结果]所有患者手术均顺利完成,无血管、神经损伤等并发症。Lysholm评分由术前的(69.75±8.37)分显著增加至术后6个月的(90.25±4.86)分,差异有统计学意义(P<0.05)。术后6个月,Rauschning-Lindgren分级为0级9例,Ⅰ级2例,Ⅱ级1例。至末次随访时,所用患者均无腘窝囊肿复发。[结论]关节镜下双后内入路腘窝囊肿全切术具有手术创伤小、恢复快的优点,短期内及可改善症状。

[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopic total resection of popliteal cyst through double posteromedial portals. [Methods] From November 2017 to November 2019, 12 patients received arthroscopic total cystectomy through double posteromedial portals for popliteal cyst. After establishing the standard posteromedial portal, a high posteromedial portal 2-3 cm proximal to the standard posteromedial portal was created by using a spinal needle following position of transparent area. The standard posteromedial portal was used as observation approach, while the high posteromedial portal was used as working approach. The popliteal cyst was explored in the weak area or fissure of the posterior capsule. Through the bilateral posteromedial portals, the cyst wall was opened by using shaver, and the inner wall of the cyst was completely removed under direct vision as far as fat tissue was seen. [Results] All patients had operation finished smoothly without complications such as vascular and nerve injury. The Lysholm score increased significantly from(69.75±8.37) preoperatively to(90.25±4.86) 6 months after operation, which was statistically significant(P<0.05). At 6 months after the operation, the Rauschning-Lindgren classification was of grade 0 in 9 cases, grade Ⅰ in 2 cases, and grade Ⅱ in 1 case. To the latest follow-up, no popliteal cyst recurring was noticed in anyone of them. [Conclusion] Arthroscopic total resection of popliteal cystectomy through double posteromedial portals has the advantages of minimizing surgical trauma and recovering quickly, and does improve symptoms in a short time.