全关节镜下与传统手术方法治疗腘窝囊肿疗效比较
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摘要
目的:比较全关节镜下手术与传统手术方法治疗腘窝囊肿临床疗效。方法 :2014年8月至2017年7月采用全关节镜和传统手术方法治疗腘窝囊肿各30例,关节镜组男7例,女23例;年龄(55.81±8.53)岁,病程(3.52±1.12)年;Rauschning Lingdgren分级:Ⅰ级7例,Ⅱ级19例,Ⅲ级4例。传统手术组男5例,女25例;年龄(57.93±9.84)岁,病程(3.48±1.34)年;Rauschning Lingdgren分级:Ⅰ级5例,Ⅱ级21例,Ⅲ级4例。术前患者有膝关节后方酸胀、活动受限等不适症状。MRI证实为腘窝囊肿。观察比较两组切口长度、手术时间、住院时间、住院总费用、Lysholm评分。结果:关节镜组神经损伤1例,切口处均愈合良好。传统手术组切口感染1例,愈合不良2例,神经损伤1例,复发1例。60例患者均得了随访,时间6～30(13.3±6.5)个月。术后两组患者膝关节酸胀、活动不适等症状明显改善,术后两组切口长度、手术时间、住院时间、住院总费用、术后6个月Lysholm评分比较,差异均有统计学意义(P<0.05)。结论:全关节镜下行腘窝囊肿切除术,在前路行膝关节腔探查处理病变半月板、滑囊的同时,后内侧入路行囊肿切除术,手术微创,痛苦少,术后恢复快,复发率低,并发症少,疗效明显优于传统开放手术,患者易于接受,临床疗效良好。
Objective:To compare the clinical efficacy of total arthroscopic surgery and traditional surgery for popliteal cyst. Methods:From August 2014 to July 2017,60 cases of popliteal cyst were treated with total arthroscopy or traditional surgery respectively. In total arthroscopy group,there were 30 patients including 7 males and 23 females with an average age of(55.81±8.53) years old; the duration of the disease was(3.52±1.12) years;according to Rauschning-Lingdgren grading,7 cases were grade Ⅰ,19 cases were grade Ⅱ,4 cases were grade Ⅲ. In traditional surgical group,there were 30 patients including 5 males and 25 females with an average age of(57.93±9.84) years old;the duration of the disease was(3.48±1.34)years; according to Rauschning-Lingdgren grading,5 cases were grade Ⅰ,21 cases were grade Ⅱ,4 cases were grade Ⅲ.Preoperative symptoms involved such as arthralgia and swelling after knee joint and limited mobility. MRI confirmed a popliteal cyst. Arthroscopic surgery and traditional surgical was used respectively. Incision length,operation time,average stay,total hospital cost and Lysholm score of two groups were compared. Results:In the total arthroscopic group,1 case suffered from nerve injury,and all cases' incision healed well. In the traditional surgical group,there was 1 case of incision infection,2 cases of poor healing,1 case of nerve injury and 1 case of recurrence. All 60 cases were followed up for 6 to 30 months with an average of(13.3±6.5) months. After operation,the symptoms of knee joint arthralgia and swelling,discomfort were significantly improved in the two groups. There were statistically significant differences in incision length,operation time,average stay,total hospitalcost and Lysholm score 6 months after surgery(P<0.05). Conclusion:The total arthroscopic resection of popliteal cyst,via anterior approach to having a knee joint cavity exploration and treatment of meniscus and bursa,while combined with posteromedial approach for cyst excision would promise a minimal surgery and less pain for patients. Patients will have a rapider recovery,lower recurrence rate and less complication. The total arthroscopic resection easy to accepting for the patient and having a better clinical curative effect is obviously superior to the traditional surgery.
Objective:To compare the clinical efficacy of total arthroscopic surgery and traditional surgery for popliteal cyst. Methods:From August 2014 to July 2017,60 cases of popliteal cyst were treated with total arthroscopy or traditional surgery respectively. In total arthroscopy group,there were 30 patients including 7 males and 23 females with an average age of(55.81±8.53) years old; the duration of the disease was(3.52±1.12) years;according to Rauschning-Lingdgren grading,7 cases were grade Ⅰ,19 cases were grade Ⅱ,4 cases were grade Ⅲ. In traditional surgical group,there were 30 patients including 5 males and 25 females with an average age of(57.93±9.84) years old;the duration of the disease was(3.48±1.34)years; according to Rauschning-Lingdgren grading,5 cases were grade Ⅰ,21 cases were grade Ⅱ,4 cases were grade Ⅲ.Preoperative symptoms involved such as arthralgia and swelling after knee joint and limited mobility. MRI confirmed a popliteal cyst. Arthroscopic surgery and traditional surgical was used respectively. Incision length,operation time,average stay,total hospital cost and Lysholm score of two groups were compared. Results:In the total arthroscopic group,1 case suffered from nerve injury,and all cases' incision healed well. In the traditional surgical group,there was 1 case of incision infection,2 cases of poor healing,1 case of nerve injury and 1 case of recurrence. All 60 cases were followed up for 6 to 30 months with an average of(13.3±6.5) months. After operation,the symptoms of knee joint arthralgia and swelling,discomfort were significantly improved in the two groups. There were statistically significant differences in incision length,operation time,average stay,total hospitalcost and Lysholm score 6 months after surgery(P<0.05). Conclusion:The total arthroscopic resection of popliteal cyst,via anterior approach to having a knee joint cavity exploration and treatment of meniscus and bursa,while combined with posteromedial approach for cyst excision would promise a minimal surgery and less pain for patients. Patients will have a rapider recovery,lower recurrence rate and less complication. The total arthroscopic resection easy to accepting for the patient and having a better clinical curative effect is obviously superior to the traditional surgery.
引文
[1]董宇,陈世益.关节镜技术改进有助于膝关节损伤的精准治疗[J].中国骨伤,2017,30(4):293-294.DONG Y,CHEN SY.Improvement of arthroscopic thenique to be helpful for the accurate treatment of knee joint injury[J].Zhongguo Gu Shang/China J Orthop Trauma,2017,30(4):293-294.Chinese with abstract in English.
[2]吴李闯,周海波,张超,等.膝关节镜下GSB通道扩大内引流囊壁剥除术治疗腘窝囊肿41例临床疗效分析[J].中国骨伤,2017,30(4):986-990.WU LC,ZHOU HB,ZHANG C,et al.Therapeutic effect of arthroscopic gastrocnemius semimembranosus bursa expanding internal drainage of cyst wall resection treatment for 41 patients with popliteal cyst[J].Zhongguo Gu Shang/China J Orthop Trauma,2017,30(4):986-990.Chinese with abstract in English.
[3]Alserr AH,Antonopoulos CN,Papapetrou A,et al.Endovascular repair of popliteal artery pseudoaneurysm with arteriovenous fistula after kneearthroscopy:case report and literature review[J].Vasc Endovascular Surg,2014,48(2):166-170.
[4]Akagi R,Saisu T,Segawa Y,et al.Natural history of popliteal cysts in the pediatric population[J].J Pediatr Orthop,2013,33(3):262-268.
[5]De Maeseneer M,Debaere C,Desprechins B,et al.Popliteal cysts in children:prevalence,appearance and associated findings at MRimaging[J].Pediatr Radiol,1999,29(8):605-609.
[6]Ravli-Gulan J,Gulan G,Novak S,et al.Rapid recurrence of a giant popliteal cyst in a patient with rheumatoid arthritis[J].J Clin Rheumatol,2009,15(6):300-302.
[7]Park SE,Panchal K,Jeong JJ,et al.Extra-articular ganglion cysts around the knee joint[J].Knee Surg Relat Res,2015,27(4):255-262.
[8]Rauschning W,Lindgren PG.Popliteal cysts(Baker's cysts)in adults.I.Clinical and roentgenological results of operative excision[J].Acta Orthop Scand,1979,50(5):583-591.
[9]Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J].Am J Sports Med,1982,10(3):150-154.
[10]Frush TJ,Noyes FR.Baker's cyst:diagnostic and surgical considerations[J].Sports Health,2015,7(4):359-365.
[11]Rupp S,Seil R,Jochum P,et al.Popliteal cysts in adults.Prevalence,associated intra-articular lesions,and results after arthroscopic treatment[J].Am J Sports Med,2002,30(1):112-115.
[12]Sansone V,De Ponti A.Arthroscopic treatment of popliteal cyst and associated intra-articular knee disorders in adults[J].Arthroscopy,1999,15(4):368-372.
[13]Johnson LL,van Dyk GE,Johnson CA,et al.The popliteal bursa(Baker's cyst):an arthroscopic perspective and the epidemiology[J].Arthroscopy,1997,13(1):66-72.
[14]Papadopoulos A,Karachalios TS,Malizos CN,et al.Complicated septic arthritis after knee arthroscopy in a 75-year-old man with osteoarthritis and a popliteal cyst[J].BMJ Case Rep,2015,pii:bcr2014207394.
[15]Ahn JH,Lee SH,Yoo JC,et al.Arthroscopic treatment of popliteal cysts:clinical and magnetic resonance imaging results[J].Arthroscopy,2010,26(10):1340-1347.
[16]Herman AM,Marzo JM.Popliteal cysts:a current review[J].Orthopedics,2014,37(8):e678-684.
[17]Malinowski K,Synder M,Sibiński M.Selected cases of arthroscopic treatment of popliteal cyst with associated intra-articular kneedisorders primary report[J].Orthop Traumatol Rehabil,2011,13(6):573-582.
[18]Takahashi M,Nagano A.Arthroscopic treatment of popliteal cyst and visualization of its cavity through the posterior portal of the knee[J].Arthroscopy,2005,21(5):638.
[19]van Rutte PW,Rouwet EV,Belgers EH,et al.In treatment of popliteal artery cystic adventitial disease,primary bypass graft not always first choice:two case reports and a review of the literature[J].Eur J Vasc Endovasc Surg,2011,42(3):347-354.
[2]吴李闯,周海波,张超,等.膝关节镜下GSB通道扩大内引流囊壁剥除术治疗腘窝囊肿41例临床疗效分析[J].中国骨伤,2017,30(4):986-990.WU LC,ZHOU HB,ZHANG C,et al.Therapeutic effect of arthroscopic gastrocnemius semimembranosus bursa expanding internal drainage of cyst wall resection treatment for 41 patients with popliteal cyst[J].Zhongguo Gu Shang/China J Orthop Trauma,2017,30(4):986-990.Chinese with abstract in English.
[3]Alserr AH,Antonopoulos CN,Papapetrou A,et al.Endovascular repair of popliteal artery pseudoaneurysm with arteriovenous fistula after kneearthroscopy:case report and literature review[J].Vasc Endovascular Surg,2014,48(2):166-170.
[4]Akagi R,Saisu T,Segawa Y,et al.Natural history of popliteal cysts in the pediatric population[J].J Pediatr Orthop,2013,33(3):262-268.
[5]De Maeseneer M,Debaere C,Desprechins B,et al.Popliteal cysts in children:prevalence,appearance and associated findings at MRimaging[J].Pediatr Radiol,1999,29(8):605-609.
[6]Ravli-Gulan J,Gulan G,Novak S,et al.Rapid recurrence of a giant popliteal cyst in a patient with rheumatoid arthritis[J].J Clin Rheumatol,2009,15(6):300-302.
[7]Park SE,Panchal K,Jeong JJ,et al.Extra-articular ganglion cysts around the knee joint[J].Knee Surg Relat Res,2015,27(4):255-262.
[8]Rauschning W,Lindgren PG.Popliteal cysts(Baker's cysts)in adults.I.Clinical and roentgenological results of operative excision[J].Acta Orthop Scand,1979,50(5):583-591.
[9]Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J].Am J Sports Med,1982,10(3):150-154.
[10]Frush TJ,Noyes FR.Baker's cyst:diagnostic and surgical considerations[J].Sports Health,2015,7(4):359-365.
[11]Rupp S,Seil R,Jochum P,et al.Popliteal cysts in adults.Prevalence,associated intra-articular lesions,and results after arthroscopic treatment[J].Am J Sports Med,2002,30(1):112-115.
[12]Sansone V,De Ponti A.Arthroscopic treatment of popliteal cyst and associated intra-articular knee disorders in adults[J].Arthroscopy,1999,15(4):368-372.
[13]Johnson LL,van Dyk GE,Johnson CA,et al.The popliteal bursa(Baker's cyst):an arthroscopic perspective and the epidemiology[J].Arthroscopy,1997,13(1):66-72.
[14]Papadopoulos A,Karachalios TS,Malizos CN,et al.Complicated septic arthritis after knee arthroscopy in a 75-year-old man with osteoarthritis and a popliteal cyst[J].BMJ Case Rep,2015,pii:bcr2014207394.
[15]Ahn JH,Lee SH,Yoo JC,et al.Arthroscopic treatment of popliteal cysts:clinical and magnetic resonance imaging results[J].Arthroscopy,2010,26(10):1340-1347.
[16]Herman AM,Marzo JM.Popliteal cysts:a current review[J].Orthopedics,2014,37(8):e678-684.
[17]Malinowski K,Synder M,Sibiński M.Selected cases of arthroscopic treatment of popliteal cyst with associated intra-articular kneedisorders primary report[J].Orthop Traumatol Rehabil,2011,13(6):573-582.
[18]Takahashi M,Nagano A.Arthroscopic treatment of popliteal cyst and visualization of its cavity through the posterior portal of the knee[J].Arthroscopy,2005,21(5):638.
[19]van Rutte PW,Rouwet EV,Belgers EH,et al.In treatment of popliteal artery cystic adventitial disease,primary bypass graft not always first choice:two case reports and a review of the literature[J].Eur J Vasc Endovasc Surg,2011,42(3):347-354.