关节镜治疗合并关节内病变腘窝囊肿22例报道

目的研究关节镜下治疗合并关节内病变腘窝囊肿的方法及其疗效。方法 2010年1月至2014年3月,采用关节镜对22例合并关节内病变的腘窝囊肿患者进行治疗,其中女性14例,男性8例;年龄39~75岁,平均50.3岁。左膝15例,右膝7例。先处理关节内病变,然后找到内侧间室与关节腔之间的通道口,将其处理成新鲜创面并稍扩大引流出囊液。根据Rauschning和Lindgren分级方法和lysholm膝关节评分判定疗效。结果 22例腘窝囊肿患者均伴有关节内疾患,其中骨关节炎11例,内侧半月板撕裂6例,外侧半月板撕裂3例,关节软骨损伤2例。术后3~5d出院。随访时间12~18个月,平均15个月,所有病例囊肿均未复发。Rauschning和Lindgren分级结果:术前Ⅰ级2例,Ⅱ级13例,Ⅲ级7例;术后0级17例,Ⅰ级3例,Ⅱ级2例;与术前相比术后疗效差异有统计学意义(P0.001)。lysholm膝关节评分结果:术前为(64.3±11.5)分,术后为(83.9±12.5)分,与术前相比术后疗效差异有统计学意义(P=0.001)。结论关节镜下治疗合并关节内病变的腘窝囊肿具有微创、恢复快、复发率低的优点。     

关节镜治疗合并关节内病变腘窝囊肿46例体会

目的研究关节镜下治疗合并关节内病变腘窝囊肿的方法及其疗效。方法2014年1月至2015年12月,采用关节镜对46例合并关节内病变的腘窝囊肿患者进行治疗,其中男性14例,女性32例;年龄32~72岁,平均48.5岁。左膝31例,右膝15例。46例均伴有关节内疾患,其中骨关节炎24例,内侧半月板撕裂12例,外侧半月板撕裂6例,关节软骨损伤4例。先处理关节内病变,然后关节镜下处理腘窝囊肿。根据Rausehning和Lindgren分级方法和lysholm膝关节评分评定疗效。结果本组均获随访,随访时间12~24个月,平均15个月,所有病例囊肿均未复发。Rauschning和Lindgren分级结果术前Ⅰ级2例,Ⅱ级21例,Ⅲ级23例;术后0级38例,I级5例,Ⅱ级3例,与术前相比差异有统计学意义(P0.001),lysholm膝关节评分结果:术前为(64.3±11.5)分,术后为(83.9±12.5)分。结论关节镜下切除腘窝囊肿,具有微创、安全、有效、复发率低的优点,同时可处理关节内并发的病变,手术效率高,近期临床疗效优良。     

腘窝囊肿切除联合腓肠肌内侧头腱瓣修补关节囊疝口治疗腘窝囊肿

目的探讨采用腘窝囊肿切除并腓肠肌内侧头腱瓣加强修补关节囊疝口联合关节镜下手术治疗腘窝囊肿的临床疗效。方法 2009年8月-2014年6月,收治140例有临床症状的腘窝囊肿患者。其中男44例,女96例;年龄14~80岁,平均54.68岁。病程20 d~30年,中位病程31个月。术前按Rauschning和Lindgren腘窝囊肿分级法:Ⅰ级4例,Ⅱ级44例,Ⅲ级92例。膝关节Lysholm评分为(68.99±8.23)分。术中先行腘窝囊肿切除,然后采用腓肠肌内侧头腱瓣加强缝合修补腘窝囊肿切除后关节囊疝口,最后在膝关节镜下进行关节内疾病的诊断和相应治疗。结果术后未出现神经、血管损伤以及感染、坏死等并发症。140例均获随访,随访时间6~64个月,平均26个月。随访期间仅1例腘窝囊肿复发,复发率0.71%。术后6个月,按照Rauschning和Lindgren腘窝囊肿分级法:0级37例,Ⅰ级92例,Ⅱ级10例,Ⅲ级1例,与术前比较差异有统计学意义(Z=—14.303,P=0.000);患者膝关节Lysholm评分为(85.51±9.23)分,与术前比较差异有统计学意义(t=—15.798,P=0.000)。结论腘窝囊肿切除联合腓肠肌内侧头腱瓣加强缝合修补关节囊疝口以及关节镜下对症治疗可有效治疗腘窝囊肿。     

关节镜前后路联合手术囊外切除腘窝囊肿

目的：探讨应用关节镜技术前后路联合手术囊外切除腘窝囊肿的方法及临床疗效.方法：自2010年1月至2012年12月收治腘窝囊肿20例,其中男14例,女6例;年龄45～65岁,平均49.5岁;左膝12例,右膝8例.发现腘窝肿块4～18个月,平均12个月,囊肿大小体表纵径3～7 cm,平均4.5 cm.主要临床表现为腘窝部肿块,膝关节肿痛,并伴有不同程度的功能障碍.由MRI确诊为腘窝囊肿,并均与关节腔相通.先后路行关节镜下囊肿囊壁剥除术,后前路关节镜下处理关节内疾患.术前Rauschning和Lindgren腘窝囊肿分级：Ⅰ级2例,Ⅱ级6例,Ⅲ级12例.通过比较手术前后Rauschning和Lindgren腘窝囊肿分级情况对术后临床疗效进行评定.结果：20例术后均未出现并发症,切口均Ⅰ期愈合.所有患者获随访,时间8 ～24个月,平均16个月,膝关节疼痛症状明显好转,囊肿无复发.术后8个月按Rauschning和Lindgren腘窝囊肿分级法分级：0级14例,Ⅰ级6例,术后腘窝囊肿分级情况明显改善.结论：应用关节镜技术前后路联合手术治疗腘窝囊肿临床疗效满意,囊肿囊壁剥除,同时处理关节腔内疾患,可降低囊肿的复发率.     

腘窝囊肿的关节镜下治疗

目的 探讨关节镜下治疗腘窝囊肿的方法及其临床疗效.方法 回顾性分析2005年11月至2010年1月,在关节镜下治疗42例腘窝囊肿患者资料,男13例,女29例;年龄11～68岁,平均43.2岁,其中6例为儿童病例;腘窝囊肿均为单侧,右膝14例,左膝28例.其中11例为复发病例,初次手术时均采用开放囊肿摘除,初次手术至再次复发时间为6～35个月,平均18个月.根据Rauschning和Lindgren分级:Ⅰ级3例,Ⅱ级18例,Ⅲ级21例.术前MRI测量囊肿大小为4.2～7.9 cm(长径)×2.1～2.5cm(横径)×1.6～2.2 cm(前后径),平均5.4 cm×2.3 cm×2.0 cm,均位于膝关节后内部位,其中11例囊肿与关节腔相通.术前囊肿内注入美蓝1～2 ml,术中根据美蓝流出位置确定通道部位;经后内侧室扩大腘窝囊肿与关节腔之间的通道口清理囊肿内壁的同时,彻底处理关节内疾患.结果 42例腘窝囊肿患者在术中均可发现伴有关节内疾患,其中内侧半月板撕裂28例,外侧半月板撕裂9例,外侧盘状半月板4例.术后未出现血管、神经或手术切口并发症.术后2～3 d出院.42例患者均获得随访,随访时间10～30个月,平均18个月;无一例患者囊肿复发.术后Rauschning和Lindgren分级:0级38例;Ⅰ级4例.结论 关节镜下治疗腘窝囊肿具有创伤小、恢复快、复发率低、切除彻底的优点.     

关节镜下后内侧入路切除胭窝囊肿的临床研究

目的 探讨关节镜下后内侧入路切除腘窝囊肿的手术方法与疗效.方法 2012年1月至2013年3月,采用关节镜下后内侧入路切除腘窝囊肿41例（均为单侧腘窝囊肿）,男17例、女24例,年龄40～55岁.左膝19例、右膝22例,术前均行膝关节MRI检查,来观察膝关节内病变及囊肿与周围组织关系.术中处理膝关节腔内病变后,探查腓肠肌内侧头-半膜肌滑液囊与膝关节腔之间的裂隙样结构并扩大通道或建立双通道,同时刨削切除囊壁,所有操作均在关节镜下操作.本组使用 Rauschning 和 Lindgren标准来评价术后临床效果.结果 术中发现内侧半月板损伤14例、外侧半月板损伤9例、骨关节炎15例（4例合并内侧半月板损伤、3例合并外侧半月板损伤）、关节内游离体5例、髌股关节软骨损伤5例.术中及术后均无感染及重要血管神经损伤,术后随访6～8个月,1例复发.结论 腘窝囊肿并非独立存在,应重视关节内病变的治疗,关节镜下后内侧入路切除腘窝囊肿方法可行,安全可靠,疗效满意.     

腘窝囊肿的关节镜治疗

目的探讨后内侧入路关节镜手术治疗腘窝囊肿的临床疗效。方法 2012年1月~2014年12月采用后内侧入路关节镜手术治疗腘窝囊肿49例,前外侧探查通道,后内侧的工作通道打开后关节囊行腘窝囊肿囊壁切除术。术后功能恢复采用Rauschning和Lindgren评分标准进行评分。结果 45例随访8~36个月(平均17.8月)。术后Rauschning和Lindgren评分0级25例,Ⅰ级16例,Ⅱ级4例。术后MRI显示33例囊肿彻底消失,12例囊肿缩小[(7.1±0.3)cm缩小到(0.8±0.2)cm],无复发。结论后内侧入路关节镜手术治疗腘窝囊肿疗效满意。     

关节镜下经关节腔入路治疗成人腘窝囊肿

目的 探讨关节镜下经关节腔入路治疗成人胭窝囊肿的方法及临床疗效.方法 2004年10月至2006年10月,采用关节镜下经关节腔入路治疗成人腘窝囊肿15例.男5例,女10例;年龄45～60岁,平均50.5岁.胭窝囊肿均为单侧,其中右膝8例,左膝7例,术前均行MR检查,观察胭窝囊肿与膝关节腔是否相通.术中在扩大腓肠肌一半膜肌滑囊与关节腔后内侧室裂隙样结构的同时,处理关节腔内病变,全部手术均在关节镜下完成,并根据Rausohning和Lindgren评价方法评定手术效果.结果 术中发现15例胭窝囊肿患者均伴有不同程度的膝关节内病变,其中内侧半月板撕裂6例,外侧半月板撕裂3例,骨关节炎9例(4例合并内侧半月板撕裂,2例合并外侧半月板损伤),类风湿关节炎2例,前十字韧带损伤1例.术中及术后未出现重要血管和神经损伤.随访时间12～48个月,平均18.5个月,术后14例未出现囊肿复发.Rauschning和Lindgren评价方法:术前,Ⅰ级1例,Ⅱ级5例,Ⅲ级9例;术后,0级13例,Ⅰ级1例,Ⅱ级1例.随访结果满意.结论 成人腘窝囊肿是一种继发性疾病,治疗胭窝囊肿的同时应处理关节内的病变.关节镜下经关节腔入路治疗成人胭窝囊肿,具有创伤小、恢复快、复发率低、并发症发生率低等优点.     

关节镜下微创治疗腘窝囊肿的体会

目的探讨关节镜下微创治疗腘窝囊肿的手术方式及临床疗效。方法回顾性分析2011年6月至2013年1月柳州市工人医院关节骨病科收治的28例腘窝囊肿患者的临床资料。男11例,女17例;年龄6~65岁,平均年龄48岁,全部为单膝。术前通过彩色B超或MRI检查确诊,按Rauschning和Lingdgren分级法,其中Ⅰ级3例、Ⅱ级19例、Ⅲ级6例,均采取关节镜下前路关节清理+后路囊肿切除术治疗。结果 28例腘窝囊肿患者在术中均可发现伴有关节内疾患,其中内侧半月板撕裂19例,外侧半月板撕裂6例,软骨退变18例。术后未出现血管、神经或手术切口并发症。28例术后均获随访,随访时间11~26个月,按Rauschning和Lingdgren分级法分级,0级25例,Ⅰ级2例,Ⅱ级1例。27例治愈,1例腘窝囊肿复发,总有效率96.4%。结论关节镜下前路关节清理+后路囊肿切除术治疗腘窝囊肿,具有创伤小、复发率低、手术安全,可同时处理关节内病变的优点,值得临床推广应用。     

关节镜下治疗胭窝囊肿32例分析

目的探讨关节镜下治疗胴窝囊肿的方法及临床疗效。方法对本组32例有膝关节症状、B超提示囊肿与后关节囊相通的胭窝囊肿患者,采用关节镜技术同期行膝关节清理与后内侧间室扩大胭窝囊肿与关节腔之间的通道口,其中6例巨大囊肿（直径〉5cm）同时行后路关节镜下囊壁切除术。根据Rauschning和Lindgren分级方法评定手术疗效。结果32例患者关节镜检查均可发现伴有关节内病变,28例患者术后获得随访,随访时间为6～29个月,平均11个月。其中有2例复发,为严重的骨关节炎患者,采用全膝关节置换术后痊愈。Rauschning和Lindgren分级结果：术前Ⅱ级24例,Ⅲ级8例;术后0级26例,Ⅰ级4例,Ⅱ级2例。结论关节镜下治疗窝囊肿具有创伤小、恢复快、复发率低的优点。     

关节镜下清理术结合囊肿-关节腔交通口扩大术治疗腘窝囊肿

目的探讨关节镜下清理术结合囊肿-关节腔交通口扩大术治疗腘窝囊肿的效果。方法对12例腘窝囊肿患者行关节镜下清理术结合囊肿-关节腔交通口扩大术。手术前后采用Lysholm膝关节功能评价、Rauschning和Lindgren分级方法和膝关节MRI进行评估。结果12例均获随访,时间12-23（16±4）个月,Lysholm评分术前为（55.8±3.7）分,术后6个月为（82.1±4.2）分,差异有统计学意义（P〈0.05）,Rauschning和Lindgren分级术前为1级1例,2级1例,3级10例,术后6个月为1级11例,2级1例。所有患膝运动能力均较术前有所改善。结论关节镜下清理术结合囊肿-关节腔交通口扩大术治疗腘窝囊肿具有创伤小、康复快、复发率低的优点。     

关节镜下治疗腘窝囊肿的疗效

目的 探讨关节镜下切除腘窝囊肿的手术方法与疗效.方法 自2013年1月至2014年2月我科采用关节镜下切除25例腘窝囊肿,腘窝囊肿均为单膝,左膝13例、右膝12例.其中,男10例,女15例,年龄为40~65岁.术前常规体检、患膝X线和MRI检查,观察膝关节骨与软组织的病变.膝关节镜手术常规采用前内、前外侧入路,术中常规探查并清理膝关节内病变.评价病人并发症、疼痛、复发情况,采用Lysholm膝关节评分、美国膝关节协会评分(knee society score,KSS)、美国特种外科医院(Hospi-tal for Special Surgery,HSS)评分比较病人术前术后的情况.结果 25例病人均获得随访,随访时间为6~12个月,平均为(9.0±1.9)个月.复查MRI发现1例类风湿性膝关节炎病人腘窝囊肿复发,但无明显临床症状.术前Lysholm膝关节评分为(48.76±12.07)分,术后术后末次随访为(81.72±7.57)分;术前KSS为(52.32±11.16)分,术后末次随访为(85.84±6.85)分;术前HSS评分为(55.62±10.76)分,术后末次随访为(88.64±6.24)分.3个指标术后与术前比较,差异均有统计学意义(均P<0.05).结论 关节镜下打开内侧关节囊与腘窝囊肿之间的"阀门"并切除囊壁,可以达到治疗腘窝囊肿的目的.本研究手术方法简单有效、安全性高,并可同时处理腘窝囊肿的诱发因素,有效地降低囊肿的复发率.     

Two-stage operation for treatment of a large dissecting popliteal cyst after failed total knee arthroplasty

A symptomatic popliteal cyst after total knee arthroplasty (TKA) is rare, occurring most frequently as a result of intra-articular knee pathology. We present a case of a large dissecting popliteal cyst 7 years after TKA with symptoms of severe calf pain and functional disability. The symptomatic cyst was excised completely in a first-stage operation, and the severely worn TKA was corrected by a second-stage surgical procedure. The patient in this report was pain free and had satisfactory range of knee motion 5 years after the index revision TKA, without recurrence of effusion or popliteal cyst formation.     

Arthroscopic internal drainage and cystectomy of popliteal cyst in knee osteoarthritis

Background

The purpose of this study was to evaluate the efficacy of arthroscopic knee cavity internal drainage and cyst cavity debridement operation of popliteal cyst in knee osteoarthritis patients.

Methods

From August 2007 to March 2013, 58 knee osteoarthritis patients with popliteal cyst were treated with arthroscopic knee cavity internal drainage through posteromedial portal and popliteal cyst cavity debridement through superior posteromedial portal. In all patients, preoperative magnetic resonance imaging (MRI) was performed to detect combined intra-articular pathology and the communication between popliteal cyst and knee cavity. Clinical efficacy was evaluated through VAS score and Lysholm score.

Results

All patients had neither recurrence of popliteal cyst nor complaints of pain, swelling, or functional impairment at average 24 months follow-up after surgery. Postoperatively, VAS score was decreased significantly and Lysholm score was raised significantly comparing preoperatively.

Conclusion

Arthroscopic knee cavity internal drainage operation through posteromedial portal and popliteal cyst cavity debridement through superior posteromedial portal is an effective minimally invasive surgery method for the treatment of popliteal cyst without recurrence in knee osteoarthritis patients.

     

Isolated tuberculosis of the popliteal cyst

We encountered a case of tuberculosis of a popliteal cyst in a 76-year-old man. He visited our department for treatment of the left knee pain which had not responded to treatment over the previous ten months. At first examination, local rubor, swelling and tenderness on a popliteal cyst were noted. Therefore, curettage of the lesion, including resection of the cyst, was performed. Six weeks later, an abscess had formed in the subcutaneous area over the lateral aspect of the knee, which was cleaned out. The abscess recurred in the same area four months later. At the third operation, curettage of the abscess together with a knee joint synovectomy was performed. Upon pathologic examination, a tuberculous lesion of the popliteal cyst and skin were recognised. However, no tuberculous lesion was detected in the synovia of the knee joint. It is generally agreed that it is possible for a popliteal cyst to be infected from synovial tuberculosis of the knee joint. However, in our case, based on the histopathological and clinical observations, the primary tuberculous lesion appeared to have been in the popliteal cyst, which is very rare indeed. Recent developments in preventative medicine and chemotherapy have markedly reduced the incidence of tuberculous arthritis. However tuberculous arthritis is still an important disease in the differential diagnostic of persistent monoarthritis of the knee. Approximately half of the popliteal cyst communicate with the knee joint. However, it is not frequent for tuberculosis to propagate from the knee joint into the popliteal cyst.(ABSTRACT TRUNCATED AT 250 WORDS)     

Calf Pain and Cystic Adventitial Disease of the Popliteal Artery

In a 61year-old women, suffering a left calf pain for more18 months, a diagnosis of cystic adventitial disease of the popliteal artery was confirmed by scanner. At the operation, we found an intramural cyst of the popliteal artery. A total resection of the cyst and of the artery (resection & end to end anastomosis) was performed. Adventitial cystic disease represents 0, 1% of the vascular diseases (3). The popliteal artery seems to be the most frequent site.     

Calf pain and cystic adventitial disease of the popliteal artery

In a 61 year-old women, suffering a left calf pain for more 18 months, a diagnosis of cystic adventitial disease of the popliteal artery was confirmed by scanner. At the operation, we found an intramural cyst of the popliteal artery. A total resection of the cyst and of the artery (resection and end to end anastomosis) was performed. Adventitial cystic disease represents 0, 1% of the vascular diseases). The popliteal artery seems to be the most frequent site.