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.

Arthroscopic treatment of popliteal cyst

Objective To evaluate the clinical effect of arthroscopic treatment of popliteal cyst. Methods Data of 42 patients, who had undergone arthroscopic treatment for popliteal cyst from November 2005 to January 2010, were retrospectively analyzed. There were 13 males and 29 females, including 6 children, aged from 11 to 68 years (average, 43.2 years). All popliteal cysts were unilateral, including 14 cases of right knee and 28 cases of left knee. Eleven patients had recurrent popliteal cyst, and all of them underwent initial open surgery, and the duration from the initial surgery to recurrence ranged from 6 to 35 months (average, 18 months). According to the Rauschning and Lindgren classification, there were 3 cases of grade I, 18 cases of grade II and 21 cases of grade III. Based on the MRI, the long diameter of the popliteal cysts ranged from 4.2 to 7.9 cm (average, 5.4 cm), the transverse diameter 2.1 to 2.5 cm (average, 2.3 cm) and anteroposterior diameter 1.6 to 2.2 cm (average, 2.0 cm). All popliteal cysts were at posteriomedial parts of the knees, and 11 cases of popliteal cyst communicated with the knee joint cavity. Before operation, 1 to 2 ml methylene blue was injected into the cyst, which was used to determine the channel intraoperatively according to the site where methylene blue flowed out. The intraarticular diseases were thoroughly treated when the inner wall of the popliteal cyst was cleaned. Results The intraarticular diseases were found in all patients intraoperatively, including medial meniscus tear in 28 cases, lateral meniscus tear in 9 cases and lateral discoid meniscus in 4 cases. There were no blood vessel complications, nerve complications and incision complications. All patients were discharged 2 or 3 days postoperatively. All patients were followed up for 10 to 30 months (average, 18 months). No recurrence of popliteal cyst occurred at final follow-up. According to the Rauschning and Lindgren classification, there were 38 cases of grade 0 and 4 cases of grade I. Conclusion The arthroscopic treatment of popliteal cyst has several advantages, such as mini-invasion, fast recovery and low recurrence rate.