关节镜下与开放手术治疗腘窝囊肿的临床疗效对比研究

Comparison of the clinical efficacy between arthroscopic and open surgery in the treatment of popliteal cyst

目的:比较关节镜下和开放手术两种治疗方法对腘窝囊肿的临床疗效。方法:回顾性收集2018年10月至2021年12月于南京市江宁医院骨科治疗的58例(男21例,女37例)腘窝囊肿病例资料。根据治疗方法分为开放组和关节镜组,开放组采用囊肿摘除+交通口结扎术,关节镜组采用关节镜下囊肿剥除+交通口扩大术,并根据关节内病变采用相应的治疗。比较两组患者术后视觉模拟评分法(VAS)评分、切口大小、手术时间、术中出血量、术后负压引流时间、住院时间、并发症发生率、复发率及术后12个月Lysholm评分。结果:开放组38例,关节镜组20例,两组患者的手术年龄、身体质量指数(BMI)、囊肿大小、软骨损伤等级和关节内病变类型等基线资料均差异无统计学意义(P>0.05)。关节镜组患者术中出血量、切口大小、术后VAS评分和住院时间低于开放组,而手术时间、术后负压引流时间和术后12月Lysholm评分高于开放组,差异均有统计学意义(P<0.05)。关节镜组术后出现并发症1例,复发1例;而开放组术后出现并发症3例,复发4例。关节镜组术后并发症发生率和复发率均低于开放组,但差异无统计学意义(P>0.05)。结论:关节镜下治疗腘窝囊肿创伤小、恢复快,同时针对关节内病变进行相应处理,能够减少腘窝囊肿复发。

Objective:To compare the clinical effect of arthroscopy and open surgery for popliteal cyst.Methods:A total of 58 patients(male:21 cases;female:37 cases)diagnosed with popliteal cyst in the orthopedics department of Nanjing Jiangning Hospital from October 2018 to December 2021 were retrospectively collected as the study object.According to the treatment methods,the patients were divided into open group and arthroscopic group,the open group used cyst removal and traffic port ligortion,and the arthroscopic group used arthroscopic cyst stripping and traffic port enlargement,and corresponding treatment was given according to intraarticular lesions.Visual analog scale(VAS)score,incision size,operation time,intraoperative blood loss,postoperative negative pressure drainage time,hospital stay,complication rate,recurrence rate and Lysholm score 12 months after surgery were compared.Results:A total of 38 cases in the open group and 20 cases in the arthroscopic group were conected,there were no difference of age,BMI,cyst size,grade of cartilage damage and type of intra-articular lesion between two groups(P>0.05).The intraoperative blood loss,incision size,postoperative VAS score and length of hospital stay in the arthroscopic group were significantly lower than those in the open group,while the operative time,postoperative negative pressure drainage time and Lysholm score of 1 year after surgery were higher(P<0.05).Postoperative complications occurred in 1 case and recurred in 1 case in the arthroscopic group,while the open group had 3 cases of postoperative complications occurrence and 4 cases of recurrence.The incidence rate of postoperative complications and recurrence in the arthroscopic group were lower than those in the open group,but with no statical significance(P>0.05).Conclusion:Arthroscopic minimally invasive treatment for popliteal cyst can reduce the recurrence and has advantages as small trauma,fast recovery and finding intraarticular lesions,which can be repaired by the corresponding treatment at the same time.