腘窩囊腫綜述中英文對(duì)照

1、Popliteal Cysts: A Current ReviewAlyssa M. Herman, BS; John M. Marzo, MD,Zhu xi The Orthopaedics of General Hospital of NMU,,The authors are from the Department of Exercise and Nutrition Sciences (AMH) and the Departme

2、nt of Orthopaedics (JMM), University at Buffalo, Buffalo, New York.,Orthopedics,Abstract,Of the possible cystic lesions around the knee joint, popliteal cysts are the most prevalent.Popliteal cysts most commonly form by

3、distention of the gastrocnemio-semimembranosus bursa, which is located in the medial aspect of the popliteal fossa.These cysts are also referred to as Baker’s cysts, a name given to the condition after Baker’s classic ca

4、se description of popliteal swelling腘窩囊腫是膝關(guān)節(jié)周圍最常見(jiàn)的囊性病變。腘窩囊腫通常由腘窩內(nèi)側(cè)的腓腸肌 - 半膜肌滑囊膨脹形成，最早由 Baker 報(bào)道，又稱 Baker’s 囊腫。,Abstract,The gastrocnemio-semimembranosus bursa is situated between the tendons of the gastrocnemius and sem

5、imembranosus muscles and is a normal anatomic finding.腓腸肌 - 半膜肌滑囊是位于腓腸肌、半膜肌肌腱之間的正常解剖組織。,Abstract,This bursa has been found to communicate with the knee joint capsule via a transverse opening in the posterior capsule at

6、 the level of the medial femoral condyle, where the gastrocnemius tendon merges with the joint capsule.該滑囊通過(guò)一橫孔與膝關(guān)節(jié)囊腔相通，橫孔位于股骨內(nèi)側(cè)髁水平處的關(guān)節(jié)囊后部。且腓腸肌肌腱與膝關(guān)節(jié)囊在股骨內(nèi)側(cè)髁處相連。,Abstract,Most often, this opening takes the shape of a ho

7、rizontal slit measuring 4 to 24 mm.The communication between the bursa and the joint capsule is almost nonexistent in children, and the presence of this opening increases in frequency with age.橫孔通常是 4 到 24 毫米大小的水平裂縫。滑膜

8、囊腔通常在兒童階段并不與關(guān)節(jié)腔相通，隨著年齡的增加，出現(xiàn)缺口的幾率也增加。,Abstract,The integrity of the joint capsule decreases with age, and it is theorized that this opening results from a tear in the degenerated joint capsule. Rauschning observed that,

9、when no opening was found, capsular thinning was seen in the same area and noted that the cyst is simply a herniation of synovium, as originally postulated by Baker.膝關(guān)節(jié)囊完整性隨著年齡增加而減低，有理論認(rèn)為缺口是由于退化的膝關(guān)節(jié)囊撕裂后所致。Rauschning 觀

10、察到，對(duì)無(wú)關(guān)節(jié)缺口的人群，在囊腫的同一區(qū)域仍可觀察到關(guān)節(jié)囊，提示腘窩囊腫可能是貝克最初假設(shè)的滑膜疝出所致。,Abstract,A true ganglion cyst can form, usually by fluid leakage through a horizontal or oblique medial meniscus tear, forming a wall of dense fibrous connective tiss

11、ue (not synovium) as a distinguishing feature (Figure 1).真正腱鞘囊腫通常是液體從斜行或水平內(nèi)側(cè)半月板裂隙滲出形成，其明顯的特征是形成厚厚的纖維連接組織壁（不是滑膜）（圖.1）。,Abstract,,Abstract,The communication between the gastrocnemio-semimembranosus bursa and the joint c

12、apsule, which allows for the movement of synovial fluid between the 2 spaces, has been shown by arthrography. A valvelike mechanism that allows only unidirectional flow from the joint into the bursa has been found in som

13、e of these openings.關(guān)節(jié)造影術(shù)顯示，關(guān)節(jié)液在腓腸肌 - 半膜肌滑囊與膝關(guān)節(jié)囊互通的兩個(gè)腔隙之間運(yùn)動(dòng)。在有些互通缺口中發(fā)現(xiàn)類瓣膜機(jī)制，只允許關(guān)節(jié)液?jiǎn)畏较蛄飨蚧摇?Abstract,Intra-articular and intracystic pressure measurements have been made in the knees of patients with rheumatoid arthrit

14、is who have popliteal cysts，and in every case intracystic pressure was higher than intra-articular pressure.These findings of fluid accumulating in the popliteal cyst and not being able to leave, despite high pressure, i

15、ndicate the presence of a 1-way valve-type mechanism.測(cè)量類風(fēng)濕患者腘窩囊腫內(nèi)壓和關(guān)節(jié)內(nèi)壓發(fā)現(xiàn)，所有患者囊腫內(nèi)壓高于關(guān)節(jié)內(nèi)壓。這些發(fā)現(xiàn)提示，液體積聚在囊腫內(nèi)，盡管內(nèi)壓高，但并不流走，表明存在單向瓣膜機(jī)制。,Clinical Presentation,In children, a popliteal cyst is most often an incidental finding

16、on physical examination. Occasionally a child or parent sees or feels a cyst and becomes concerned about the presence of a mass.兒童中，腘窩囊腫常在體檢中偶然發(fā)現(xiàn)。有時(shí)父母因腫塊（囊腫）發(fā)現(xiàn)囊腫。,Clinical Presentation,Typical adult clinical presentat

17、ion is vague posterior knee pain, possible localized swelling or mass, and a feeling of tightness in the popliteal region. Physical examination may show a tender palpable mass in the medial popliteal fossa, although this

18、 finding is subjective and is somewhat dependent on the physician’s opinion and experience。成人臨床常表現(xiàn)為膝后部隱約痛，局部腫脹及腫塊，腘窩區(qū)域緊張感。物理查體可以發(fā)現(xiàn)在內(nèi)側(cè)腘窩可觸及柔軟腫塊。這還有賴于醫(yī)生主觀的經(jīng)驗(yàn)。,Clinical Presentation,Most cysts are found on the medial sid

19、e of the posterior knee and are reported more rarely on the lateral side.The cyst is usually rounded, smooth, and fluctuant, and may feel tense in extension, but this is a difficult finding to quantify.This hardness of t

20、he cyst in full extension followed by softening with knee flexion is known as Foucher’s sign囊腫在膝關(guān)節(jié)后內(nèi)側(cè)，很少在外側(cè)，呈圓形，光滑，波動(dòng)感，擴(kuò)張時(shí)可能緊張，但是這很難量化。膝關(guān)節(jié)伸直時(shí)，囊腫變硬，屈曲時(shí)軟化，稱為 Foucher 征。,Clinical Presentation,Calf pain and swelling are al

21、so present in DVT or superficial thrombophlebitis, and the clinical imperative is to rule out DVT with appropriate diagnostic imaging studies.Pseudothrombophlebitis has the same clinical presentation as DVT or superficia

22、l thrombophlebitis, but is caused by another condition，such as a ruptured popliteal cyst.DVT 和表淺性血栓靜脈炎也會(huì)出現(xiàn)上述癥狀，因此影像學(xué)檢查排除 DVT 很有必要。假性血栓性靜脈炎臨床表現(xiàn)同 DVT 和表淺性血栓靜脈炎相同，比如破裂的腘窩囊腫就可以引起。,Clinical Presentation,Discoloration or ecc

23、hymosis in the calf, at the medial malleolus, or on the dorsum of the foot is a distinguishing feature of a ruptured cyst because bloody synovial cyst fluid dissects inferiorly.Treatment of ruptured cysts typically invo

24、lves treating resultant complications, but ruptured cysts without complications have been reported to resolve spontaneously with supportive conservative care, such as compression and elevation of the limb.在小腿，內(nèi)踝或是足背出現(xiàn)

25、變色或是瘀斑是囊腫破裂的特異性特征。囊腫破裂后治療通常是治療相應(yīng)的并發(fā)癥，然而無(wú)并發(fā)癥的破裂囊腫在保守支持治療下可自行緩解，如抬高或加壓患肢。,Diagnostic Imaging,Multiple imaging techniques may be used in the diagnosis and assessment of a popliteal cyst.Plain radiographs are simple and rea

26、dily available, but they provide limited information about the popliteal cyst. However, they may help in identifying associated articular disorders, such as loose bodies in the cyst or the general findings of osteoarthri

27、tis and inflammatory arthritis. 診斷和評(píng)估腘窩囊腫可采用多種影像學(xué)方法。平片簡(jiǎn)單易行，僅能提供有限的信息。但有助于鑒別相關(guān)關(guān)節(jié)疾病，如囊內(nèi)游離體，骨關(guān)節(jié)炎，關(guān)節(jié)炎。,Diagnostic Imaging,Other imaging techniques are often more suitable for diagnosing popliteal cysts. Previously, arthrog

28、raphy was commonly used in the imaging of popliteal cysts, but disadvantages such as the invasiveness of the procedure and the possibility of contrast extravasation have been made apparent.其他影像學(xué)方法更適于診斷腘窩囊腫。以前常采用關(guān)節(jié)造影術(shù)

29、，但有如操作創(chuàng)傷性及造影劑可能外滲等缺點(diǎn)。,Diagnostic Imaging,Ultrasound quickly became a popular replacement for arthrography in imaging for the presence of popliteal cysts. Ultrasound is readily available, relatively inexpensive, and nonin

30、vasive, and it involves no exposure to radiation. 由于超聲簡(jiǎn)單易行，相對(duì)便宜，非創(chuàng)傷性，無(wú)輻射，因此很快替代關(guān)節(jié)造影檢查。,Diagnostic Imaging,Ultrasound, however, is not sensitive to intra-articular lesions, and so further imaging is needed to confirm

31、the presence of an associated internal derangement.然而超聲對(duì)關(guān)節(jié)內(nèi)病變不敏感，因此需要進(jìn)一步辨別相關(guān)關(guān)節(jié)內(nèi)部疾病。,Diagnostic Imaging,Magnetic resonance imaging is considered the gold standard in the visualization and characterization of masses abo

32、ut the knee.A distinct advantage of MRI is the ability of axial images to visualize a fluid-filled neck of the cyst communicating with the joint (Figure 1).MRI 是鑒定膝關(guān)節(jié)周圍腫塊的金標(biāo)準(zhǔn)檢查。MRI 獨(dú)特的優(yōu)點(diǎn)是軸向顯現(xiàn)囊腫與關(guān)節(jié)交通處充滿液體的頸部（圖.1）。,Dia

33、gnostic Imaging,,Treatment and Outcomes,There are many treatment options for popliteal cysts, dictated by the underlying cause and associated condition. Sometimes no treatment or simple supportive measures result in spon

34、taneous resolution of the cyst or at least reduction in associated symptoms. If not, both minimally invasive and surgical techniques are alternatives.治療腘窩囊腫的方法取決于潛在病因及相關(guān)疾病。有時(shí)不治療或簡(jiǎn)單支持治療也可以緩解腘窩囊腫癥狀。若保守治療無(wú)效，微創(chuàng)或外科手術(shù)均可選擇。,T

35、reatment and Outcomes,Ultrasound-guided aspiration with corticosteroid injection is a relatively low-risk and successful procedure for the treatment of knee osteoarthritis complicated with a popliteal cyst.Another optio

36、n is a similar procedure in which corticosteroid is injected directly into the popliteal cyst. 超聲引導(dǎo)抽吸術(shù)并注射皮質(zhì)激素治療膝關(guān)節(jié)炎并發(fā)腘窩囊腫是一個(gè)低風(fēng)險(xiǎn)和較成功的方法。另一相似方法是直接向腘窩囊腫內(nèi)注射皮質(zhì)激素。,Treatment and Outcomes,More recently, intra-articular corti

37、costeroid injections were compared with intracystic corticosteroid injections in patients with knee osteoarthritis.Although both methods are suitable treatment options in patients with knee osteoarthritis, direct inject

38、ion into the popliteal cyst may provide greater reduction in cyst size.最近，對(duì)關(guān)節(jié)內(nèi)注射與囊內(nèi)注射皮質(zhì)激素治療效果進(jìn)行了比較。雖然這兩種方法是治療膝關(guān)節(jié)骨性關(guān)節(jié)炎患者合適的治療方案，但是囊內(nèi)直接注射會(huì)更大地減小囊腫尺寸。,Treatment and Outcomes,Although conservative and minimally invasive me

39、asures are available to treat some of the conditions associated with popliteal cysts, not all may improve without invasive intervention. Currently, arthroscopic procedures are most commonly used to treat the conditions a

40、ssociated with popliteal cysts and to address cysts directly. 盡管保守和微創(chuàng)治療適用于某些腘窩囊腫患者，但有些患者尚需手術(shù)干預(yù)。目前，關(guān)節(jié)鏡最常用于治療腘窩囊腫，直接處理囊腫。,Treatment and Outcomes,The primary goal of surgical intervention in symptomatic popliteal cysts is

41、 to resolve the underlying intra-articular pathology and reduce chronic effusion. Others believe that popliteal cysts are best treated by closing the communication to the cyst.手術(shù)治療的主要目標(biāo)是解決潛在關(guān)節(jié)內(nèi)病變及減少關(guān)節(jié)慢性滲出。也有一些學(xué)者認(rèn)為，腘窩

42、囊腫最好的治療方法是閉合囊腫與關(guān)節(jié)之間的交通。,Treatment and Outcomes,Patients were treated arthroscopically for meniscal tears, chondral lesions, or a combination. In addition to these procedures, an arthroscopic suturing technique via an acc

43、essory posteromedial working portal was performed to close the communication into the popliteal cyst (Figure 2).患者均采用關(guān)節(jié)鏡治療半月板撕裂，軟骨損傷，或兩者同時(shí)存在，經(jīng)后內(nèi)側(cè)入口關(guān)節(jié)鏡下縫合囊腫與關(guān)節(jié)交通處（圖.2）。,Treatment and Outcomes,圖.2 關(guān)節(jié)鏡下修復(fù)腘窩囊腫瓣膜開(kāi)口。穿過(guò)可吸收縫線

44、（A）, 使用探針鉤回縫線（B），打結(jié)關(guān)閉囊腫開(kāi)口（C）。,Figure 2：Technique of arthroscopic repair of the valvular opening into a popliteal cyst. Passing of an absorbable suture (A). Retrieval of sutures with a hook probe (B). Final repair with kn

45、ots closing the cyst opening (C).,Treatment and Outcomes,Other approaches go a step further and include cystectomy in addition to arthroscopic treatment of internal joint derangements. One study examined the outcome of

46、resection of the valvular opening with excision of the wall of the cystic cavity when a fibrous membrane, septae, or nodules were seen in the cyst. Follow-up MRI at an average of 8.6 months showed that the cyst had disap

47、peared in 55% of patients and had significantly reduced in size in the remaining 45%.還有一些手術(shù)方法 ，除了處理關(guān)節(jié)疾病，又切除囊腫。一項(xiàng)研究使用的方法切除范圍包括纖維膜，隔膜及囊腫內(nèi)結(jié)節(jié)。術(shù)后 8.6 個(gè)月 MRI 隨訪發(fā)現(xiàn)，顯示 55% 患者囊腫消失，其余 45% 囊腫變小。,Treatment and Outcomes,Arthroscopi

48、c intervention is favored over open excision because of the successful outcomes of arthroscopic treatment for conditions associated with popliteal cysts. Arthroscopy is minimally invasive, is associated with lower risk,