关节镜下双后侧入路活瓣扩大切除联合囊壁切除术治疗腘窝囊肿疗效分析

Arthroscopic Enlarged Flap Resection Combined with Cyst Wall Resection by Double Posterior Approaches for Popliteal Cyst

目的探讨关节镜下双后侧入路行活瓣扩大切除联合囊壁切除术治疗腘窝囊肿的疗效。方法回顾性分析我院2018年1月至2020年6月收治的52例腘窝囊肿患者的临床资料,分别行传统开放囊肿切除术(A组,n=26例)和关节镜下活瓣扩大切除联合镜下囊壁切除术(B组,n=26例)。所有患者术前MRI证实为腘窝囊肿,囊肿直径3~8 cm,平均(4.52±2.31)cm。记录并比较两组围术期指标、VAS评分及Lysholm评分。结果两组患者均顺利完成手术治疗。组间比较,B组患者手术出血量、切口大小、住院时间均明显少于A组,差异有统计学意义(P<0.05);而两组手术时间比较无统计学差异(P>0.05)。术后两组患者均获随访,随访时间6~30个月,平均(11.32±4.47)个月。患者症状及关节功能较术前均明显改善。两组患者术后末次随访VAS评分、Lysholm评分均较术前明显改善(P<0.05),且B组VAS评分及Lysholm评分均优于A组,差异均有统计学意义(P<0.05)。随访期间,A组2例分别于术后12个月和18个月囊肿复发,B组无一例复发。结论关节镜下活瓣扩大切除联合镜下囊壁切除术治疗腘窝囊肿安全、有效、微创,值得临床推广应用。

Objective To investigate the curative effect of arthroscopy of enlarged flap resection combined with cyst wall resection by double posterior approaches in the treatment of popliteal cyst.Methods The clinical data of 52 popliteal cyst cases admitted from January 2018 to June 2020 were analyzed retrospectively.According to surgical procedure,all cases were divided into group A and B with 26 cases for each group.Open surgery of popliteal cystectomy was performed in group A,and arthroscopic enlarged flap resection combined with cyst wall resection was in group B.MRI showed the popliteal cyst sized from 3 to 8 cm with an average of(4.52±2.31)cm.The peri-operative index,VAS score and Lysholm score was compared between the two groups.Results All surgical interventions were complete successfully in both groups.The blood loss volume,length of incision and hospital stays were less in group B than those in group A,and all differences were significantly(P<0.05);while there was no statistical difference in operation time between the two groups(P>0.05).All cases were followed up for 6 to 30 months with(11.32±4.47)months averagely.The symptoms and joint function were improved than before the surgery in all cases.The VAS score and Lysholm was improved after the surgery than before the surgery in both groups(P<0.05),and both index were better in group B than those in group A(P<0.05).Popliteal cyst recurrence was found in 2 cases of group A and was not in group B.Conclusion Arthroscopic enlarged flap resection combined with endoscopic cystectomy by double posterior approaches is a safe,effective and mini-invasive treatment for popliteal cyst.