韦积华+罗群强+陈戟霞+班华登��

【摘要】目的探讨关节镜下经后内侧双入路治疗儿童腘窝囊肿的方法及临床疗效。

方法2014年6月至2016年2月，采用关节镜下经后内侧双入路治疗儿童腘窝囊肿18例。男15例，女3例；年龄6～11岁，平均8.5岁。腘窝囊肿均为单侧且均不伴关节内损伤的单纯性腘窝囊肿，其中左膝14例，右膝4例，术前均行MRI检查，了解有无关节内损伤及腘窝囊肿是否与膝关节腔相通。术中多数患者仅行膝关节后内侧双入路，单纯切除关节后方关节通向腘窝囊肿的单向活瓣结构，并根据Rauschning和Lindgren评价方法评定手术效果。

结果术中未出现重要血管和神经损伤，术后无伤口感染及下肢深静脉血栓形成等并发症，术后随访未发现隐神经、大隐静脉或假性囊肿形成等并发症。随访时间8～24个月，平均12.5个月， Rauschning和Lindgren评分明显低于术前水平（P=0.015<0.05）。术后未出现复发病例。

结论单纯关节镜下经后内侧双入路关节囊活瓣切除术治疗儿童腘窝囊肿，具有微创、恢复快、复发率低、并发症发生率低等优点。

【关键词】关节镜检查；膝关节；腘窝囊肿

中图分类号：R684文献标识码：ADOI：10.3969/j.issn.10031383.2017.02.015

【Abstract】ObjectiveTo evaluate the methods and effects of arthroscopic posteromedial approach of double joint capsule oneway flap resection in the treatment of popliteal cyst in children.

Methods18 patients diagnosed with popliteal cyst were treated with arthroscopic posteromedial approach of double joint capsule oneway flap resection from June，2014 to February，2016.There were 15 males and 3 females，aged from 6 to 11 years，with an average age of 8.5 years.All popliteal cysts were unilateral and simple popliteal cysts without intraarticular injury，with 14 cases in left knees and 4 cases in right knees.MR examination was performed before surgery to understand whether there was intraarticular injury and whether popliteal cyst in the joint was connected with the knee joint cavity.Most of the patients only underwent intraoperative double knee posteromedial approach，and simple resection oneway valve structure to the joint posterior articular popliteal cyst was applied.In addition，the effects of operation were evaluated according to Rauschning and Lindgren evaluation methods.

ResultsThere were no significant vascular and nerve injury during operation，no complications such as wound infection and deep venous thrombosis.No complications such as saphenous nerve，saphenous vein or pseudocyst were found during postoperative followup.The followup time ranged from 8 to 24 months（mean，12.5 months），Rauschning and Lindgren scores were significantly lower than those before operation（P=0.015<0.05）.No recurrence occurred after operation.

ConclusionSimple arthroscopic posteromedial approach of double joint capsule oneway flap resection in the treatment of popliteal cyst in children has the advantages of minimal invasion，quick recovery，low recurrence rate and low complication rate.

【Key words】arthroscopy；knee joint；popliteal cyst

腘窩囊肿又叫Baker囊肿，是骨科常见疾病，分为原发性与继发性，成人腘窝囊肿多为继发性，往往伴有半月板损伤、关节退变、骨关节炎等关节内病变。由于成人腘窝囊肿往往需要对关节进行探查并处理关节内病变，所以往往采取前后入路进行腘窝囊肿的治疗。儿童腘窝囊肿的发病原因和成人有所不同，大多数是一种原发性疾病，较少合并有关节内损伤[1]，所以在采用关节镜技术治疗儿童腘窝囊肿时，其手术方式也有所区别。……