1.徐州医科大学 第一临床学院，江苏 徐州 221000;2.徐州医科大学附属医院 骨科， 江苏 徐州 221000;3.盐城市第六人民医院 骨科，江苏 盐城 224000
1.The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu 221000, China;2.Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, China;3.Department of Orthopedics, the Sixth People’s Hospital, Yancheng, Jiangsu 224000, China
目的 探讨关节镜下前方入路联合后内入路囊壁切除内引流精准治疗腘窝囊肿的临床效果。方法 选取2018年10月－2021年11月该院收治的腘窝囊肿患者114例，采用随机数表法分为对照组和研究组，各57例。研究组给予关节镜下前方入路联合后内入路囊壁切除内引流精准治疗，对照组给予关节镜下前方入路联合后内入路腘窝囊肿内引流精准治疗。统计两组患者手术情况、疼痛视觉模拟评分（VAS）、膝关节功能、术后腘窝囊肿分级、并发症发生率和腘窝囊肿残留情况。结果 研究组手术时间和腘窝淤斑持续时间长于对照组，术中出血量多于对照组（P < 0.05）。研究组与对照组术前、术后1、3和7 d的疼痛VAS比较，结果显示：①不同时间点的VAS有差异（P < 0.05）；②研究组与对照组的VAS无差异（P > 0.05）；③研究组与对照组的VAS变化趋势有差异（P < 0.05）。研究组术前和术后6个月的Lysholm评分和美国膝关节协会（AKS）评分差值均高于对照组（P < 0.05）。研究组与对照组的术前、术后3和6个月患肢膝关节活动度比较，结果显示：①不同时间点的膝关节活动度有差异（P < 0.05）；②两组的膝关节活动度有差异（P < 0.05），研究组膝关节活动度大于对照组；③两组膝关节活动度变化趋势有差异（P < 0.05）。研究组术后6个月的腘窝囊肿分级明显优于对照组（P < 0.05）。两组患者术后并发症总发生率比较，差异无统计学意义（P > 0.05）。研究组腘窝囊肿残余发生率明显低于对照组（P < 0.05）。结论 与关节镜下单纯内引流相比，关节镜下前方入路联合后内入路囊壁切除内引流精准治疗腘窝囊肿，虽然延长了手术时间，但是，对于近期膝关节功能和腘窝囊肿分级的改善更佳，且腘窝囊肿残余率更低。
Objective To investigate the effect of arthroscopic anterior approach combined with posterior internal approach in the precise treatment of popliteal cyst with internal drainage.Methods 114 popliteal cyst patients from October 2018 to November 2021 were selected as the research objects, and they were divided into control group and study group by random number table method, with 57 cases in each group. The study group was treated with arthroscopic anterior approach combined with posterior internal approach for cystic wall resection and internal drainage, while control group was treated with arthroscopic anterior approach combined with posterior internal approach for internal drainage of popliteal cyst. The operation status, visual analogue score (VAS) , knee function, the grade of popliteal cyst, complications rate and residual popliteal cavity in the two groups were compared.Results The operative time and duration of popliteal fossa ecchymosis in the study group were longer than those of the control group, intraoperative blood loss in the study group was more than that of the control group (P < 0.05). VAS of pain in the study group and the control group were compared before, 1 d, 3 d and 7 d after surgery, and the results showed as follows: VAS was different at different time points (P < 0.05), VAS was not different between the two groups (P > 0.05), the trend of VAS changes were different in the two groups (P < 0.05). The differences of Lysholm score and American Knee Society score (AKS) before and 6 months after operation in the study group were higher than the control group (P < 0.05). The knee motion of affected limb was compared before operation, 3 and 6 months after operation, and the results showed that: The range of motion of knee joint was different at different time points (P < 0.05), the range of motion of knee joint was different between the two groups (P < 0.05), the range of motion of knee joint in study group was bigger than control group, the trend of motion changes of knee joint was different (P < 0.05). Grade of popliteal cyst 6 months after surgery in the study group was better than control group (P < 0.05). There was no significant difference in incidence of postoperative complications (P > 0.05). The incidence of residual cyst in the study group was lower than control group (P < 0.05).Conclusion Compared with arthroscopic internal drainage alone, arthroscopic anterior approach combined with posterior internal approach for capsular wall resection and internal drainage for precise treatment of popliteal cyst can prolong operative time, but has better improvement effect on short-term knee function, knee range of motion and popliteal cyst grading, and lower cyst residual rate.