膝关节镜下双后内侧入路治疗腘窝囊肿疗效分析

Clinical Effect of Treatment of Popliteal Cyst by Double Posteromedial Portals Under Arthroscopy.

目的评价屈曲90°位膝关节镜下双后内侧入路治疗腘窝囊肿的临床疗效。方法选取我院2017年5月至2020年5月行关节镜手术治疗膝关节腘窝囊肿的30例病人,均于屈曲90°膝关节位行双后内侧入路,刨除后关节囊反折,使单向活瓣变为双向通道,并对囊壁进行清理。通过术后1周内及末次随访时复查的MRI来检验腘窝囊肿的复发情况;通过比较手术前后的Rauschning⁃Lindgren腘窝囊肿分级标准来评估临床疗效。结果关节镜探查发现,所有病人都合并关节内损伤,其中大部分为半月板退变性损伤(70%)。平均随访10个月(8~13个月),术后1周及末次随访时的MRI都未显示囊肿复发;术后1个月和末次随访的Rauschning⁃Lindgren分级均较术前明显改善,差异有统计学意义(P<0.05)。结论屈膝90°位固定,关节镜下双后内侧入路治疗腘窝囊肿,疗效确切,安全可靠。

Objective To evaluate the clinical effect of the treatment of popliteal cyst by using a 90°flexion position and double posteromedial portals under arthroscopy.Methods From May 2017 to May 2020,30 patients with symptomatic popliteal cysts treated under arthroscopy were collected.Double posteromedial portals using a 90°flexion position were used to achieve adequate enlargement of the posteromedial valvular opening between the cyst and the joint cavity and complete excision of the cyst wall.MRI was used to detect the recurrence of the popliteal cyst one week and final follow⁃up after surgery,and the Rauschning and Lindgren score was recorded to evaluate the clinical outcome.Results Associated intra⁃articular lesions were found and treated in all cases.Degenerative meniscuc tears were the most common pathology,which affected 70%of the cases.All patients were followed up with a mean period of 10 months(range,8 to 13 months).The Rauschning and Lindgren score was improved significantly after surgery,and no evidence of recurrence was found from MRI in any case.Conclusion Our modified arthroscopic treatment technique,using a 90°flexion position and double posteromedial portals,is effective and safe for treating popliteal cyst.