三种术式治疗腘窝囊肿的比较

Comparison of three surgical procedures for popliteal cyst

[目的]比较关节镜下囊肿切除(arthroscopic cystectomy,AC)、镜下内引流术(arthroscopic internal drainage,AID)及传统开放切除(traditional open cytectomy,TOC)治疗腘窝囊肿的临床疗效。[方法]回顾性分析2015年3月—2019年3月本科手术治疗108例腘窝囊肿患者的临床资料。依据术前医患沟通结果,38例采用镜下AC,35例采用AID,35例采用TOC。比较三组围手术期、随访及影像等资料。[结果]108例患者均顺利完成手术,无神经、血管损伤等并发症。AC与AID组切口长度、手术时间、失血量、下地时间、切口愈合等级及住院时间均显著优于TOC组(P<0.05);AID组手术时间显著优于AC、TOC组(P<0.05)。所有患者随访时间均12个月以上。随时间推移,三组VAS评分显著降低(P<0.05),而Lysholm评分明显增加(P<0.05)。末次随访时,AC组与AID组VAS评分显著低于TOC组(P<0.05);AC组的Lysholm评分显著优于AID与TOC组(P<0.05)。至末次随访时,影像学显示,AC组与AID组腘窝囊肿复发率显著低于TOC组(P<0.05)。相应时间点三组间膝关节退变Kellgren-Lawrence评级的差异无统计学意义(P>0.05)。[结论]与开放切除相比,镜下囊肿切除术与镜内引流术具有复发率低的优势。其中,镜下囊肿切除术膝关节功能恢复疗效更为满意。

[Objective]To compare the clinical outcomes of arthroscopic cystectomy(AC),arthroscopic internal drainage(AID)and traditional open cystectomy(TOC)for popliteal cyst.[Methods]A retrospective analysis was performed on 108 patients who underwent surgical treatment for popliteal cyst in our department from March 2015 to March 2019.According to preoperative doctor-patient communication,38 patients underwent AC,the other 35 patients underwent AID,while the remaining 35 received TOC.The perioperative,follow-up and imaging data of the three groups were compared.[Results]All the 108 patients had the corresponding procedure performed successfully without neurovascular injury and other complications.The AC and AID groups were significantly superior to the TOC group in terms of incision length,operation time,blood loss,postoperative ambulation,incision healing and hospital stay(P<0.05).The AID group had significantly shorter operation time than the AC and TOC groups(P<0.05).As time went in follow-up period lasted for more than 12 months,the VAS score significantly decreased(P<0.05),while the Lysholm score significantly increased in all the 3 groups(P<0.05).At last follow-up,the AC and AID groups got significantly lower VAS scores than the TOC group(P<0.05),while the AC group was marked significantly higher Lysholm score than the AID and TOC groups(P<0.05).Radiographically,the AC and AID groups had significantly lower recurrence of popliteal cyst than the TOC group(P<0.05).However,there were no significant differences in Kellgren-Lawrence grade of knee degeneration among the three groups at any corresponding time points(P>0.05).[Conclusion]The arthroscopic cystectomy and arthroscopic internal drainage have the advantage of low cyst recurrence over the traditional open cystectomy.Among them,arthroscopic cystectomy does achieve more satisfactory knee function recovery.