Arthroscopic Treatment of Popliteal Cyst 腘窝囊肿的关节镜治疗 浙江省运动医学中心 一 概述 早在1840年已经被Adams所认识 Baker在1877年以他的名 字命名为贝克囊肿 Baker囊肿 腘窝囊肿是腘窝滑液囊肿的总称 多发生于半膜肌与腓肠 肌 并常与关节腔相通 临床表现为关节疼痛及活动受限 分为原发性和继发性两种 二 发病机制 单向流通的 阀门机制 只进不出 存在半膜肌与腓肠肌内侧头滑液囊 GSB 关节积液增多引起关节囊内压增高 通过平股骨髁腓肠肌 内侧头处的横向裂隙样结构进入GSB 但不能从GSB流向 关节腔 导致囊肿的形成和持续存在 关节内疾病 半月板损伤 软骨退变 交叉韧带损伤 滑膜 炎等 在腘窝囊肿的发病过程中起重要作用 Sansone等认为半月板尤其是内侧半月板损伤是致病的关键 84 90 的患者可见有内侧半月板损伤 三 临床表现 Rauschning和Lndgren对腘窝囊肿评价分级如表1 四 诊断 症状及体征 MRI B超 B超将腘窝囊肿分为3型 1 单纯囊肿型 囊肿孤立存在于腘窝软组织间 与深部关节腔不相通 其形态呈圆形或椭圆形 囊壁较薄 边界光滑清楚 包膜完整 透声好 2 分叶囊肿型 此型基底部与关节腔相通 有宽窄不一的蒂部管状结 构 囊肿形态欠规则呈多样性 囊壁厚薄不均 可见粗细不一的光带及 散在点状回声 探头加压囊肿形态改变 3 囊液混浊型 囊肿呈单房或分叶状 囊壁毛糙增厚 内见密集光点回 声或粗斑点状回声 呈悬浮状 可飘动 下垂部位可见回声分层 此型可 见于囊内出血或感染 五 治疗 原则 有症状才处理 开放手术 关节镜手术 开放手术 疤痕大 影响关节功能 易损伤血管神经 易复发 在囊肿切除时要同时将关节囊缝合 关节镜手术 微创 恢复快 关节功能影响小 复发率 低 六 关节镜手术的方法 方法一 成功治疗的关键是膝关节内相关病损的处理和重建滑囊与关节 腔正常的双向流通 囊肿本身不应是外科治疗的主要目标 方法二 FIGURE 1 A Schematic cross section image of the knee with the opening of the connection The image shows the location of the posteromedial portal and the anterolateral viewing portal P popliteal cyst B Arthroscopic finding from the anterolateral portal of the right knee shows a connecting hole curved arrow at the posteromedial compartment that verifies the retraction of the capsular fold C by probing straight arrow M medial femoral condyle FIGURE 2 A Arthroscopic finding from the anterolateral portal of the right knee shows that the capsular fold C was resected by basket forceps arrow inserted from the posteromedial portal B Arthroscopic finding from the anterolateral portal of the right knee shows a yellowish cystic fluid that gushes out to the posteromedial compartment by compressing the posteromedial part skin of the ballooned cyst M medial femoral condyle FIGURE 3 Arthroscopic finding of the anterolateral portal of the right knee shows an opening curved arrow The opening is shown at the posteromedial side of the medial head of the gastrocnemius G after the capsular fold was completely resected with a shaver straight arrow and basket forceps M medial femoral condyle FIGURE 4 A Schematic cross sectional image of the knee with the opening of the connection The image shows the location of the posteromedial viewing portal b P popliteal cyst B Arthroscopic finding from the posteromedial portal of the right knee shows septation and loose fragments of the inside of the popliteal cyst FIGURE 5 A Schematic cross sectional image of the knee with the opening of the connection The image shows the location of the posteromedial viewing portal b and the posteromedial cystic portal c P popliteal cyst B Gross view of the right knee joint that was positioned for arthroscopic surgery for a popliteal cyst The arthroscope was inserted through the posteromedial portal and a motorized shaver was introduced from the posteromedial cystic portal C Arthroscopic finding from the posteromedial portal of the right knee shows that a motorized shaver S was inserted to the inside of the popliteal cyst through the posteromedial portal The cyst wall W was resected with the shaver FIGURE 6 A A preoperative MR image axial view shows a huge popliteal cyst with multiple septation B A follow up postoperative 9 months MR image axial view shows that the popliteal cyst has disappeared Patient popliteal cyst Pre op Arthrosco py THANK YOU 此课件下载可自行编辑修改 供参考 感谢您的支持 我们努力做得更好 21