关节镜下腘窝囊肿内引流术与囊壁切除术疗效比较

Comparison of therapeutic effects of arthroscopic popliteal cyst internal drainage and capsular wall resection

目的:探讨关节镜下腘窝囊肿内引流术和囊壁切除术两种手术方式疗效差异。方法:自2013年1月至2021年6月关节镜手术治疗腘窝囊肿54例,年龄44~72(62.67±6.08)岁,病程1~72(15±14)个月。其中24例采用关节镜下腘窝囊肿内引流术(囊内引流组),30例采用关节镜下腘窝囊肿壁切除术(囊壁切除组)。术前主要症状包括膝关节疼痛、肿胀、行走疼痛、膝关节伸屈受限、腘窝酸胀、腘窝肿块等。术后1、3、6个月及1、2年门诊常规复查,对两组手术时间及出血量,术前、术后膝关节疼痛视觉模拟评分(visual anaglue scale,VAS)、膝关节Lysholm评分,并发症等进行观测并比较。结果:54例均获随访,时间6~24(13.89±4.29)个月,术中无相关血管、神经损伤。手术切口皆Ⅰ期愈合,无膝关节感染。两组术中出血量、随访时间比较,差异无统计学意义(P>0.05);两组手术时间比较,差异有统计学意义(P<0.05)。两组间术前、术后1个月膝关节VAS比较,差异无统计学意义(P>0.05);同组术前、术后1个月VAS比较,差异均有统计学意义(P<0.05)。两组间术前、术后6个月膝关节Lysholm评分比较,差异无统计学意义(P>0.05);同组术前与术后6个月术后膝关节Lysholm评分比较,差异均有统计学意义(P<0.05),两组术后膝关节评分皆有明显提高,膝关节功能改善明显。术后3个月囊内引流组4例腘窝囊肿存在,术后12个月2例小囊肿存在;囊壁切除组术后未发现囊肿。结论:两种关节镜下治疗腘窝囊肿疗效满意,在手术出血量、安全性、术后疼痛VAS以及膝关节功能恢复无明显差别。建议技术成熟后以关节镜下囊肿壁切除手术为主,特别对于较大囊肿、有分隔囊肿。

Objective To investigate efficacy between arthroscopic popliteal cyst drainage and arthroscopic popliteal cyst resection.Methods From January 2013 to June 2021,54 patients with popliteal cyst(Rausching-Lindgren gradeⅠtoⅢ)were treated with arthroscopic surgery.There were 24 males and 30 females.The age ranged from 44 to 72 years old,with a mean of(62.67±6.08)years old.The course of the disease ranged from 1 to 72 months,with a mean of(15±14)months.Twenty-four patients(group A)were underwent arthroscopic internal drainage of popliteal cyst.Thirty patients(group B)were underwent arthroscopic resection of popliteal cyst.Preoperative main symptoms included knee pain,swelling,walking pain,popliteal swelling,popliteal mass and so on.After 1,3,6 months and 1,2 years of surgery,routine outpatient follow-up was conducted to observe and compare the surgical time,bleeding volume,preoperative and postoperative visual analog scale(VAS),knee Lysholm score,and complications between two groups.Results All incisions healed at one stage after operation.All 54 patients were followed up,and the duration ranged from 6 months to 2 years,with an average of(13.89±4.29)months.There was no intraoperative vascular or nerve injury.Operation time and intraoperative blood loss of the two groups:group A of(62.08±9.55)min and(8.00±1.69)ml,group B of(69.50±6.99)min and(8.70±2.00)ml.Popliteal pain,swelling,limitation of flexion and extension were significantly relieved after operation.VAS before and one month after operation between two groups:group A of 5.38±1.21 and 2.63±0.71,group B of 5.60±1.26 and 2.80±0.81.Lysholm scores of knee joint before and 6 months after operation:group A of 62.59±4.99 and 89.74±2.90,group B of 63.87±3.23 and 89.02±2.35.Knee joint function improved significantly in both groups.In group A,4 cases had popliteal cyst at 3 months after operation,and 2 cases had small isolated cyst at 1 year after operation.There was no recurrence of cyst in group B.Conclusion The results between two arthroscopic treatments of popliteal cyst are satisfactory,and there is no significant difference in the amount of blood loss,safety,postoperative pain VAS score and knee function recovery.It is suggested that arthroscopic resection of the cyst wall should be performed when the technique is mature,especially for large cysts and septal cysts.