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  

ARTHROSCOPIC TREATMENT COMBINED WITH REPAIR OF JOINT CAPSULE USING TENDON FLAP OF MEDIAL HEAD OF GASTROCNEMIUS MUSCLE AFTER RESECTION OF POPLITEAL CYST

作　　者：杨磊[1] 唐新[1] 李棋[1] 陈刚[1] 付维力[1] 蒋海[1] 胡燕青[1] 李箭[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2015年第12期1462-1465,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：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。Objective To investigate the methods and the effectiveness of arthroscopic treatment combined with repair of the cyst wall using the tendon flap of medial head of gastrocnemius muscle after resection of popliteal cyst. Methods A retrospective analysis was made on the clinical data of 140 patients with popliteal cyst between August 2009 and June 2014, including 44 males and 96 females with a mean age of 54.68 years （range, 14-80 years）. The median course of symptoms was 31 months （range, 20 days to 30 years）. According to Rauschning and Lindgren criteria for popliteal cyst grade, 4 cases were rated as grade I, 44 cases as grade Ⅱ and 92 cases as grade Ⅲ The preoperative Lysholm knee score was 68.99_＋8.23. Firstly, cyst was resected, then the hernia sac of joint capsule was repaired with the tendon flap of medial head of gastrocnemius muscle, and finally a knee arthroscopy was used for the diagnosis and treatment of intra-articular lesions. Results No complication of nerve or blood vessel injury, infection, or necrosis occurred. The mean follow-up was 26 months （range, 6-64 months）. During follow-up, 1 case （0.71%） had cyst recurrence. According to Rauschning and Lindgren criteria for popliteal cyst grade, 37 cases were rated as grade 0, 92 cases as grade I, 10 cases as grade Ⅱ, and Ⅰ case as grade Ⅲ at 6 months after operation, showing significant difference when compared with preoperative one （Z= -14.303, P=0.000）; the Lysholm knee score （85.51±9.23） was significantly higher than preoperative score （t= -15.798, P=0.000）. Conclusion Arthroscopic treatment combined with repair of the cyst wall with the tendon flap of medial head ofgastrocnemius muscle after resection ofpopliteal cyst is a better way to avoid recurrence.

关 键 词：膝关节 腘窝囊肿 关节内紊乱 关节镜 

分 类 号：R687.4[医药卫生—骨科学]