医学--腘窝囊肿的关节镜治疗课件.ppt
Arthroscopic Treatment of Popliteal Cyst（腘窝囊肿的关节镜治疗）（腘窝囊肿的关节镜治疗）-浙江省运动医学中心一、概述一、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、二、发病机制病机制单向流通的“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、三、临床表床表现Rauschning和Lndgren对腘窝囊肿评价分级如表1：五、治五、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、关六、关节镜手手术的方法的方法方法一：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 posteromedialcompartment by compressing the posteromedial part skin of the ballooned cyst.(M,medial femoral condyle.)FIGURE 4.(A)Schematic cross-sectional image of the knee with theopening of the connection.The image shows the location of theposteromedial viewing portal(b).(P,popliteal cyst.)(B)Arthroscopicfinding from the posteromedial portal of the right knee showsseptation and loose fragments of the inside of the popliteal cyst.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.ArthroscopyTHANK YOU
