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膝关节镜下关节囊单向活瓣切除术治疗腘窝囊肿的临床分析

Knee arthroscopic resection of articular capsule valvular treat popliteal cysts

摘要:

目的 研究膝关节镜下采用关节囊后内侧单向活瓣切除术治疗腘窝囊肿的临床疗效和术后并发症情况.方法 回顾性研究2007年7月至2010年7月对因腘窝囊肿导致膝关节疼痛、活动受限的45例(45膝)患者采用关节镜下内侧关节囊活瓣切除术进行治疗,术中建立后内侧探查通道和囊肿切除工作通道,使用刨刀、等离子刀切除腘窝囊肿与后内侧关节囊单向交通的活瓣结构和囊肿内纤维分隔组织,同期对关节内合并的其他病变进行处理.在术前和随访时采用Rauschning和Lindgren评分标准进行评分,采用Wilcoxon秩和检验对评分结果进行统计学分析.结果 45例患者中,40例患者合并关节内病变(88.9%),最为常见病变为内侧半月板撕裂27例(60.0%),其次为外侧半月板撕裂20例(44.4%);关节软骨Ⅲ°~Ⅳ°损伤28例(62.2%),其中髌股关节软骨损伤12例(26.7%),股骨内髁软骨损伤10例(22.2%),股骨外髁软骨损伤6例(13.3%).前交叉韧带损伤2例(4.4%).随访时间13 ~51个月,平均(34±7)个月.所有患者术后膝关节后方不适症状明显缓解,Rauschning和Lindgren评分结果平均提升1~2级;术后末次随访时的Rauschning和Lindgren评分明显低于术前水平(Z=-6.092 P=0.00).患者术后切口愈合良好,无切口感染及延迟愈合病例.1例患者术后2年复发,复发率为2.2%.随访期间无患者出现神经血管并发症,如隐神经、大隐静脉和腘血管损伤.结论 关节镜下后内侧关节囊活瓣切除术治疗腘窝囊肿,微创、安全、有效、复发率低.可同期处理关节内并发的病变,手术效率高,近期临床疗效优良.

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abstracts:

Objective To retrospective study the results of arthroscopic resection of articular capsule valvular treated popliteal cysts and examined the incidence of complication.Methods From July 2007 to July 2010,45 patients with symptomatic popliteal cysts such as knee pain and limitation of motion were treated with arthroscopic technique to resect the connecting valvular mechanism at posteromedial compartment of articular capsule.Through the posteromedial viewing portal and cyst resection working portal,resected the valvular mechanism by shaver and plasma cutter,associated intra-articular pathology was treated simultaneously.The functional outcome was evaluated by employed Rauschning and Lindgren score before the surgery and the last follow-up.By using of Wilcoxon rank sum test to statistics analyze the clinic outcome.Results In all cases,40 patients were found the associated intra-articular pathology,the incidence was 88.9%.The intra-articular pathology was medial meniscus tear (27 cases,60.0%),lateral meniscus tear (20 cases,44.4%),cartilage lesion (28 cases,62.2%),which composed with patellofemoral joint(12 cases,26.7%),medial condyles of femur (10 cases,22.2%),lateral condyles of femur(6 cases,13.3%).The anterior cruciate ligment injury was found in 2 cases,the incidence was 4.4%.All the patients achieved symptoms relief postoperative,such as posterior knee discomfort and swelling after activities.The Rauschning and Lindgren score was improved 1-2 grade in average (Z =-6.092,P =0.00).The recurrence rate was 2.2%.All the incision healed good.No major complications were encountered such as saphenous nerve,great saphenous vein,blood vessel in popliteal injury.Conclusions Arthroscopic resection of articular capsule valvular treatment of popliteal cyst and treatment of associated intra-articular pathology are effective and safe.This surgery technique has more minimally trauma and lower recurrence rate.The clinic results in short term are excellent.

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