漂浮体位下关节镜处理腘窝囊肿合并膝关节内病变  

Arthroscopic treatment of popliteal cyst complicated by intra-articular knee lesions under floating position

作　　者：周才胜[1] 梁杰[1] 尚峥辉[1] 吴咏德[1] 伍伟飞[1] 王华[1] 刘新宗[1] Zhou Caisheng Liang Jie Shang Zhenghui Wu Yongde Wu Weifei Wang Hua Liu Xinzong.(Department of Orthopedics, the People＇ s Hospital of Three Gorges University, Hubei Yichang 443000, Chin)

机构地区：[1]三峡大学人民医院骨科,宜昌443000

出　　处：《中华关节外科杂志（电子版）》2017年第3期77-81,共5页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨漂浮体位下关节镜处理腘窝囊肿合并膝关节内病变的手术技术和临床效果。方法 2013年6月至2016年2月,来自三峡大学人民医院骨科的30例症状性腘窝囊肿合并MRI证实的膝关节内病变患者,采用漂浮体位分步手术。首先患者于侧卧体位,建立后方通道,采用"囊内切除法",囊肿定位,针头穿刺抽液确认后关节镜进入囊肿腔内,刨刀刨削,结合射频等离子刀由内而外行腘窝囊肿汽化切除术。再更换成平卧位,无须二次消毒铺单,建立前方入路行膝关节镜下关节内病变探查处理。腘窝囊肿均予以大部或彻底切除,合并膝关节内病变包括半月板损伤、软骨退变损伤等,视情况予以半月板切除成形、软骨修整、滑膜刨削等处理。采用两个相关样本的非参数检验比较手术前、后腘窝囊肿变化。结果术后无感染,无下肢深静脉血栓形成,切口均顺利愈合1周拆线,切口美观。术后随访6~30个月,平均(15±6)个月,全部膝关节疼痛消失或好转。按Rauschning和Lindgren评价分级,术前:0级0例,Ⅰ级4例,Ⅱ级13例,Ⅲ级13例。术后:0级17例,Ⅰ级11例,Ⅱ级2例,Ⅲ级0例,差异有统计学意义(Z=-4.858,P<0.01)。结论漂浮体位下关节镜处理腘窝囊肿合并膝关节内病变,手术简便可行,能够较好处理前后病变,减少前后路联合手术中二次铺单的污染,缩短手术操作时间。手术微创,疗效满意。Objective To investigate surgical techniques and clinical efficacy of popliteal cyst complicated with intra-articular knee lesions by arthroscopic treatment under floating position. Methods From June 2013 to February 2016, 30 patients presenting with symptomatic popliteal cyst and intra-articular knee lesions were treated by stepwise surgery under floating position. The patients were positioned at the lateral position and posterior approaches were established. By adopting the ＂intracapsular excision＂ method the cyst was located. , the arthroscope entered the cyst cavity after needle puncture and liquid pumping. Planer cutting combining with ion knife-like radio frequency were applied for vaporization excision of the popliteal cyst. The patients were changed to the supine position and the anterior approach was established for intra-articular lesion exploration by knee arthroscopy. Popliteal, cysts were mostly or completely removed. Complicated intra-articular knee lesions included meniscus injury, damage to cartilage degeneration; menisceetomy, cartilage trimming, and synovial planing were conducted based on circumstance. Changes of popliteal cysts before and after the surgery were compared by two-related-samples non-parameter test. Results Post-operative infections and deep vein thrombosis formation were absent. All the incisions healed smoothly and suture lines were removed after one week. Post-operatiVe follow-up time were six to 30 months, with a mean time of （ 15 ± 6） months. Knee pain disappeared or relieved. Pre- operation： no patient at level 0, four patients at level I , 13 patients at level II , 13 patients at level III ; post-operation： 17 patients at level 0, 11 patients at level I , two patients at level II, no patient at level II1. Significant difference was found between preoperative and postoperative evaluation （ Z = - 4. 858, P 〈0. 01 ）. Conclusion Arthroscopic treatment of popliteal cyst complicated by intra-articular knee lesions under floating position is straight-forward and

关 键 词：腘囊肿 关节镜检查 膝关节 创伤和损伤 骨关节炎 

分 类 号：R687.4[医药卫生—骨科学]