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.

Clinical research of arthroscopic excision of popliteal cyst using posteromedial approach

Objective To investigate the methods and results of the arthroscopic excision of popliteal cyst using a posteromedial approach. Methods From January 2012 to March 2013, 41 patients with popliteal cyst （all the popliteal cysts were unilateral） had been treated by the arthroscopic excision using a posteromedial approach, including 17 males and 24 females. The age ranged from 40 to 55 years old. The popliteal cysts included 19 left knees and 22 right knees. Before the operation, MR examination was used to observe the lesions in the knee joint and the relationship between the popliteal cyst and the surrounding tissue. During the arthroscopic operation, the intra-articular disorders were dealt first, then the connecting path between GSB and the knee joint cavity was found; the channel was expanded or a dual- channel was created while the popliteal cyst was removed. Rauschning and Lindgren criteria were used to evaluate the postoperative clinical results. Results During the operations, the medial meniscus tears were found in ld cases, the lateral meniscus tears were found in 9 cases, the osteoarthritis was confirmed in 15 cases （the osteoarthritis was isolated in 8 cases, associated with the medial meniscus tears in 4 cases, associated with the lateral meniscus tears in 3 cases）, the intra-articular loosening bodies were found in 5 cases, and the patellofemoral cartilage injury was found in 5 cases. During the operation and after the operation, there was no infection nor important neurovascular injury. All the patients were followed up for 6 -8 months, and only one patient recrudesced. Conclusion Popliteal cyst does not exist independently, so attentions should be paid to the treatment of the intra-articular lesions. The arthroscopic excision of the popliteal cyst using a posteromedial portal is feasible, safe and reliable with satisfactory results.