关节镜下双后内侧入路与后方直接入路治疗腘窝囊肿疗效观察

Curative effect of arthroscopy through double posterior interior approach and direct posterior approach in the treatment of popliteal cysts

目的比较关节镜下双后内侧入路与后方直接入路治疗腘窝囊肿的疗效。方法选取2016年1月至2020年12月于西安市第四医院骨科收治的208例腘窝囊肿患者作为研究对象,采用随机数表法将患者分为双后内侧入路组和后方直接入路组,每组104例。双后内侧入路组患者采用经双后内侧入路囊肿切除治疗,后方直接入路组患者采用经后方直接入路囊肿切除治疗,术后随访6个月。比较两组患者围手术期指标及术后恢复情况,术前和术后6个月的Lysholm评分、疼痛视觉模拟评分(VAS)、Rauschning-Lindgren分级情况,以及随访期间的并发症和囊肿复发情况。结果双后内侧入路组患者的手术时间为(49.01±4.30)min,明显长于对照组的(46.45±3.12)min,差异有统计意义(P<0.05);术后6个月,双后内侧入路组Rauschning-Lindgren分级0~Ⅰ级率、Lysholm评分分别为94.23%、(87.27±5.42)分,明显高于后方直接入路组的85.58%、(82.45±4.67)分,差异均具有统计学意义(P<0.05);双后内侧入路组术后6个月Rauschning-Lindgren分级Ⅱ~Ⅲ级率、VAS评分、囊肿复发率分别为5.77%、(1.70±0.29)分、1.92%;明显低于后方直接入路组的14.42%、(3.25±0.86)分、8.65%,差异均具有统计学意义(P<0.05);随访期间,双后内侧入路组并发症发生率为2.88%,略低于后方直接入路组的4.81%,但差异无统计学意义(P>0.05)。结论关节镜下双后内侧入路治疗腘窝囊肿相比于后方直接入路治疗虽手术时间稍长,但患者术后疼痛感较轻,膝关节功能恢复效果更好,其复发率更低。

Objective To compare the curative effect of arthroscopy through double posterior interior approach and direct posterior approach in the treatment of popliteal cysts.Methods A total of 208 patients with popliteal cysts admitted to Department of Orthopaedics,the Fourth Hospital of Xi’an City between January 2016 and December 2020were enrolled as the research objects.According to random number table method,they were divided into double posterior interior approach group and direct posterior approach group,with 104 cases in each group.The double posterior interior approach group underwent cystectomy through double posterior interior approach,while direct posterior approach group underwent cystectomy through direct posterior approach.The patients were all followed up for 6 months after surgery.The perioperative indexes and postoperative recovery,Lysholm score,Visual Analogue Scale(VAS)score,and Rauschning-Lindgren grading before surgery and at 6 months after surgery,complications,and recurrence of cysts during follow-up were compared between the two groups.Results The operation time in double posterior interior approach group was significantly longer than that in direct posterior approach group:(49.01±4.30)min vs(46.45±3.12)min,P<0.05.At 6months after surgery,rate of Rauschning-Lindgren grading at grade 0-Ⅰand Lysholm score in double posterior interior approach group were 94.23%and(87.27±5.42)points,significantly higher than 85.58%and(82.45±4.67)points in direct posterior approach group(P<0.05).The rate of Rauschning-Lindgren grading at gradeⅡ-Ⅲ,VAS score,and recurrence rate of cysts were 5.77%,(1.70±0.29)points,1.92%,significantly lower than 14.42%,(3.25±0.86)points,8.65%in direct posterior approach group(P<0.05).During follow-up,there was no significant difference in the incidence of postoperative complications between double posterior interior approach group and direct posterior approach group(2.88%vs 4.81%,P>0.05).Conclusion Compared with arthroscopy through direct posterior approach,although arthroscopy through double posterior interior approach has longer operation time in the treatment of popliteal cysts,it results in milder postoperative pain,better recovery of knee function and lower recurrence rate.